Restless Legs Syndrome: The Unseen Sleep Disruptor Plaguing Millions
It often starts subtly. You lie down to sleep, utterly exhausted, but just as you begin to drift off, an uncomfortable sensation invades your legs: a tingling, pulling, or crawling feeling deep within. The only relief comes from movement—stretching, shaking, or walking around. For many, this nightly disturbance is brushed off as stress or a temporary sleep issue. However, medical professionals warn it could be something more specific and far more prevalent: restless legs syndrome (RLS).
Prevalence and Impact in India
A clinical review published in the Journal of the American Medical Association (JAMA) estimates that approximately 8% of adults globally experience these symptoms annually, with nearly 3% suffering moderate to severe episodes multiple times a week. In India, the prevalence stands at around 6%, highlighting a significant yet often overlooked health concern.
Prof Manjari Tripathi, head of neurology at the All India Institute of Medical Sciences (AIIMS), noted that RLS is more frequently observed in individuals with anaemia, renal failure, and those residing at high altitudes. "Typically, symptoms commence in the evening when a person goes to bed but cannot sleep due to an uncomfortable crawling or tingling sensation in the legs," she explained. "It can manifest daily and become chronic, or it may appear intermittently, particularly during prolonged sitting, such as on long flights." She added that some patients describe the sensation as deep-seated and difficult to localize, complicating explanation and often delaying medical consultation.
Diagnostic Challenges and Key Indicators
What sets RLS apart from ordinary restlessness is its distinct cycle. "Patients report a strong urge to move their legs that intensifies during rest and alleviates with movement," said Dr Neha Kapoor, associate director and head of neurology at Asian Hospital. Because these sensations are subjective, many people mistakenly attribute them to anxiety, ageing, muscle cramps, or poor circulation. "Unless someone asks the right questions, it can go unrecognized," she emphasized, pointing out that the evening-worsening pattern serves as a crucial diagnostic clue.
The Role of Iron Deficiency and Comprehensive Evaluation
Iron deficiency plays a pivotal role in RLS. Even when haemoglobin levels appear normal, low iron stores can trigger or exacerbate symptoms. Prof Tripathi stressed that evaluation should encompass serum ferritin, along with assessments of vitamin B12, vitamin D, calcium, kidney function, and blood sugar levels. "It is often misunderstood or mistaken for neuropathy or labeled psychological, leading to underdiagnosis. Yet, it is relatively straightforward to diagnose and treat."
Dr PN Renjen, senior consultant of neurology at Indraprastha Apollo Hospitals, highlighted that untreated RLS can fragment sleep night after night, resulting in fatigue, poor concentration, irritability, and even depression. Early intervention, he noted, can prevent years of avoidable sleep disruption.
Evolution of Treatment Approaches
Treatment strategies for RLS have advanced in recent years. Dopamine-based medications, once widely prescribed, are now used cautiously due to potential long-term use exacerbating symptoms. Current clinical guidelines favor gabapentinoids. Additionally, lifestyle modifications such as reducing caffeine intake, especially after the afternoon, avoiding alcohol, and maintaining regular sleep habits can provide significant relief.
A Call for Awareness and Action
RLS often remains concealed behind the label of "just poor sleep." Doctors assert that persistent nighttime restlessness that repeatedly disrupts sleep is not normal and should not be ignored. Increased awareness and timely medical consultation are essential for improving quality of life for those affected.
