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COVID-19 Pandemic Stress Could Be Triggering Restless Leg Syndrome

Tips for easing restless leg syndrome at home, and its possible connections to COVID-19.

Restless leg syndrome (RLS) may not immediately be associated with COVID-19. But during the current pandemic, RLS – characterized by an irresistible urge to move the legs because of an uncomfortable sensation in them – has been widely searched by consumers online.

Although no studies establishing a direct correlation between RLS and COVID-19 have been published as of yet, Dr. Karl Doghramji medical director for Jefferson Health’s Sleep Disorders Center, offers some plausible possibilities.

headshot of Dr. Karl Doghramji

Dr. Karl Doghramji is the medical director of the Jefferson Sleep Disorders Center.

“First and foremost, anxiety and depression are associated with the pandemic, and being distressed in general tends to be a restless leg stimulant,” says Dr. Doghramji. “The pandemic has been very tough emotionally on a lot of people, and I think that for that reason, it seems to be triggering RLS.”

Dr. Doghramji also believes that because many people have been staying at home and avoiding physical activity during the pandemic, this sedentary lifestyle may be triggering RLS.

“I also think people who get COVID-19 may be at a higher risk of getting RLS,” he says. “That’s never been reported, but I would not be surprised to find it to be true, because COVID-19 results in inflammatory changes throughout the body. RLS is very sensitive to general inflammation.”

Primary and Secondary Symptoms

RLS is definitely not a one-size-fits-all condition. The cause can vary from patient to patient, and is often unknown. According to Dr. Doghramji, however, the American Academy of Sleep Medicine and the international sleep community have pinpointed four primary symptoms common to everybody with RLS:

  • An urge to move the legs, usually associated with some discomfort or unpleasant sensation
  • Worsening symptoms in the evening or at night, while asleep or awake
  • Increased symptoms while resting, day or night
  • Partial relief of symptoms with physical activity

In addition, there are secondary symptoms that aren’t universal but, nevertheless, occur in many patients:

  • Family history of RLS
  • High response rate to therapy with dopamine nerve agents – that is, agents that increase the neurotransmission of dopamine within the body, especially the brain and the spinal cord
  • Periodic bursts of muscle activity in the feet and legs (common in 80% of restless leg patients)
  • Sleep disturbance – many patients complain about the degree to which restless legs simply bother their sleep

Some patients with primary RLS have specific triggers – like cold temperatures, caffeine or anxiety – that spark movement. They can find strategies to avoid these triggers and prevent a recurrence or modulate symptoms. That’s more challenging for patients with secondary RLS, which is more closely associated with medical conditions that can worsen their situation, such as kidney problems, uremia, neuropathies (nerve damage or dysfunction), anemia, pregnancy, fibromyalgia and rheumatoid arthritis.

There and Back Again

Another inconsistency of RLS: it is a constant presence for some patients, while others experience an undulating course, or recurrence of symptoms.

“What’s frustrating for a lot of patients with recurring symptoms is that they have no way of predicting when the symptoms are going to come back or of explaining why they disappeared – they simply come and go,” says Dr. Doghramji. “So, it is more challenging to mitigate their condition.”

Nevertheless, there are some strategies that patients with primary or secondary RLS can try at home to achieve some relief.

Practice Good Sleep Hygiene

Dr. Doghramji’s first and foremost recommendation is to engage in proper sleep behaviors, or “good sleep hygiene.” The alteration or disruption of sleep can also trigger and worsen restless legs. So, adopt and maintain the following good sleep hygiene habits:

  • Maintain a consistent bedtime and waking up time seven days a week
  • Avoid stimulants like alcohol and caffeine, especially close to bedtime
  • Stop eating at least three hours before bedtime
  • Avoid brightly lit environments at least three hours before bedtime
  • Avoid excessive napping during the day

“In my experience,” notes Dr. Doghramji, “restless leg patients experience significant reduction in symptoms 30 to 50% of the time from following these very basic sleep hygiene principles.”

More Suggested Home Remedies

Other recommendations from Dr. Doghramji for relieving RLS at home:

  • Hot or cold temperature changes – Some patients benefit from warm compresses or immersion in a warm bath for half an hour or so prior to bedtime, while others find that to be more aversive; for them, a cold compress would be helpful
  • Massagefrom a bed partner, a family member or from an inexpensive massage machine
  • Distract yourself – for example, needlework, reading or playing video games, or anything you enjoy that can take your mind away from focusing on the restless legs
  • Exercise or other physical activity close to bedtime – Generally, insomniacs should avoid this, but in the case of restless legs, it might actually be helpful to walk on a treadmill or around the house for half an hour or so prior to bedtime.

How a Physician Can Help

If none of the above home remedies provides adequate relief, consider seeing a physician with expertise in sleep medicine. Their first step will be to give you a thorough medical workup, including blood tests, a sleep study and whatever else the physician deems necessary.

“Before we prescribe medications, we need to try to identify disorders that may be causing a patient’s secondary RLS,” explains Dr. Doghramji. “We need to do that before we jump to direct treatment of RLS, because in many cases, we can cure that problem by treating the underlying medical condition that’s causing it.”

If the physician determines that your RLS is primary – that is, no other condition is causing it – then they can offer pharmacologic treatment or medication management. The first option they may try is iron sulfate or iron gluconate.

“Iron therapy can help restless legs patients who have low stores of iron,” notes Dr. Doghramji. “It’s a medication that doesn’t help right away – it may take a few weeks or even months. Nevertheless, it can help us treat restless legs without necessarily having to jump to applying prescription medications.

In terms of prescription medications, there are two general categories for restless legs. The first major category is that of the dopamine agonists.  The newest of these is rotigotine transdermal patch that fits on the skin and provides relief for an entire 24 hours, which is great for those who have RLS during the day as well as at night.

The second major category of medications for restless legs are alpha 2 delta ligands – either gabapentin or gabapentin enacarbil. The latter is a prodrug, meaning that it transforms into gabapentin after being swallowed. And the reason it’s a good drug is that it is better absorbed throughout the body than gabapentin.

“Those two categories contain all the drugs that are actually FDA-indicated as specifically meant for restless legs syndrome,” says Dr. Doghramji. “But if they don’t help, there are other categories we can try. They include benzodiazepines – for example, valium or clonazepam – or, as a last resort, opioids, such as methadone, oxycodone or anticonvulsants.”

The Sooner, The Better

If you need help for your RLS, don’t put it off, pandemic or not, Dr. Doghramji advises: “We can help people by telemedicine. So, don’t let it get to the point where RLS is so excruciating that you can’t sleep for nights and nights – reach out for help. The earlier RLS patients are seen, the better the chances we have of nipping their RLS in the bud!”

COVID-19, From the Experts