COVID-19 Symptom: Restless Legs Syndrome

• COVID-19 can increase your risk of restless legs syndrome or intensify the symptoms for those with it.
• Sleep disturbances are a prevalent concern during the COVID-19 pandemic, and restless leg syndrome has emerged as a notable consequence. 
• COVID-19 may contribute to developing or exacerbating restless legs syndrome through various mechanisms. 
• Treatment options for restless legs syndrome with or without COVID-19 include lifestyle modifications and medication. 

The COVID-19 virus and the subsequent global pandemic have brought about a multitude of physical and psychological disturbances. While the primary focus has been on the respiratory and systemic effects of COVID-19, there’s growing evidence suggesting a broader impact on various aspects of human health. Among the consequences associated with COVID-19, sleep disturbances have emerged as a prevalent concern. The disruption of sleep patterns has been linked to various conditions, including depression, mood disorders, and, notably, restless legs syndrome. 

In this article, we explore the relationship between COVID-19 and restless legs syndrome, shedding light on the potential implications of the virus on this neurological disorder and the implications it may have on an individual’s well-being during and beyond the pandemic.

Restless legs syndrome (RLS) is a sleep-related movement disorder characterized by an irresistible urge to move the legs. 

Individuals with RLS often use the following terms to describe the sensations commonly experienced in the shin or between the knee and ankle: 1

• Tingling
• Creeping
• Burning
• Tugging
• Leg pains and aches
• Itching
• Throbbing
• Pulling
• A sensation akin to insects crawling inside the legs

It’s estimated that 7-10% of the population suffers from restless legs syndrome. 1

RLS is characterized by the following: 1

• Symptoms often begin after periods of rest.
• Discomfort is relieved through movement.
• Symptoms worsen at night but improve in the early morning.

Due to its tendency to occur at night, RLS can significantly disrupt sleep, leading to heightened levels of sleep disturbance, daytime drowsiness, and emotional distress for those affected. Individuals with RLS often experience elevated levels of depressive and anxiety symptoms, with notable rates of comorbid conditions such as major depressive disorder, generalized anxiety disorder, and panic disorder. 1 2 3

While doctors cannot pinpoint the exact cause of RLS, research has found various risk factors associated with the condition: 4 5 6 7 8 9 10 11

• Low iron levels. Insufficient iron levels in the body have been linked to the development of restless legs syndrome.
• Chronic kidney disease. Restless legs syndrome is prevalent in 25% to 50% of individuals with end-stage renal disease, a progressive loss of kidney function. Dialysis, a common treatment for CKD, can result in restless legs syndrome, with up to 73% of patients experiencing severe symptoms.
• Neuropathy. Restless legs syndrome may be associated with neuropathy or nerve damage. People with restless legs syndrome are more likely to have neuropathy caused by conditions like diabetes and alcohol use compared to the general population.
• Spinal cord conditions. Restless legs syndrome can arise from spinal cord injuries, tumors, and other spinal cord-related conditions. Restless legs syndrome may even occur following the administration of a spinal block, a method used for localized anesthesia.
• Multiple sclerosis. Multiple sclerosis, a condition that damages the protective tissue around nerve cells, can interfere with communication between the brain and the body. 
• Obesity. Research suggests a correlation between higher body weight and an increased risk of restless legs syndrome. This association may be attributed to the impact of obesity on the nervous system, iron levels, and the dopamine system.
• Sedentary behavior. Insufficient physical activity raises the risk of developing restless legs syndrome. Conversely, engaging in regular physical activity can help reduce the likelihood of restless legs syndrome by enhancing leg blood flow, triggering the release of endorphins and dopamine.
• Smoking. Although the relationship between smoking tobacco and restless legs syndrome is not fully understood, studies indicate a potential increased risk, particularly among females. 

The causes of restless legs syndrome have proven elusive in the general population, and the complexities of identifying the exact triggers become even more challenging in the context of a global health crisis such as COVID-19. 

Current studies explore direct and indirect factors contributing to the initial occurrence of restless legs syndrome and the potential worsening of symptoms. These include:

Inflammation of the central nervous system. COVID-19 is known to induce a systemic inflammatory response with elevated levels of cytokines and other inflammatory markers. These storms can lead to inflammation and injury of the central nervous system tissue. This raises the possibility of a direct link. Inflammation or viral invasion in the CNS might disrupt normal neurotransmission, contributing to the manifestation of restless legs symptoms. Chronic inflammation has been proposed as a potential trigger for restless legs syndrome. 12 13

Medications and drugs. The management of COVID-19 often involves the use of medications that may indirectly affect restless legs symptoms. These include specific drugs prescribed for the treatment of underlying health conditions like nausea, depression, mental health conditions, colds, allergies, heart ailments, and high blood pressure. Additionally, the consumption of caffeine, nicotine, or alcohol has the potential to act as a trigger for restless legs syndrome or exacerbate its signs and symptoms.

Psychological factors. The psychological impact of COVID-19 cannot be overlooked when considering its potential association with restless legs syndrome. The pandemic has caused significant stress, anxiety, and disrupted sleep patterns in many individuals. Psychological distress and sleep disturbances are known triggers for restless legs symptoms. Consequently, the emotional toll of the pandemic may indirectly contribute to the manifestation or worsening of restless legs syndrome. 15

When treating restless leg syndrome with COVID-19, your doctor will likely recommend home management options to try while you recover from the virus. These treatment options may include: 1

• Reduce or avoid alcohol, nicotine, and caffeine. Minimize the consumption of alcohol, nicotine, and caffeine as these substances can worsen restless legs syndrome symptoms. Consider healthier alternatives and gradually decrease your intake.
• Establish a consistent sleep schedule. Maintain a regular sleep pattern by going to bed and waking up at the same time each day. A consistent sleep routine can help regulate your body's internal clock and improve symptoms.
• Engage in moderate, regular exercise. Incorporate moderate exercise into your routine to promote overall well-being and alleviate symptoms. Activities such as brisk walking, swimming, or cycling can improve blood circulation and reduce restlessness.
• Massage the legs or take a warm bath. Gently massage your legs using long, sweeping strokes to alleviate discomfort. Additionally, a warm bath before bedtime can help relax the muscles and provide relief.
• Apply a heating pad or ice pack. Experiment with using a heating pad or ice pack on the affected legs. Apply heat or cold therapy to the areas experiencing symptoms to find which option provides the most relief for you.
• Utilize foot wraps or vibration pads. Consider using foot wraps specifically designed for individuals with restless legs syndrome, as they apply gentle pressure to the legs, reducing restlessness. Alternatively, vibration pads applied to the back of the legs can provide relief and stimulate the muscles.
• Engage in moderate-intensity aerobic and leg-stretching exercises. Incorporate aerobic exercises, such as walking, jogging, or cycling, into your routine. Aim for a moderate level of intensity and engage in these activities regularly. Additionally, perform leg-stretching exercises, such as calf stretches or ankle rotations, to alleviate muscle tension and symptoms.

In cases where self-care strategies prove ineffective, medications can be prescribed to alleviate restless legs syndrome symptoms. These medications include:

• Dopaminergic medicines. These medications increase dopamine levels and are primarily used to treat Parkinson's disease. They can also be effective in reducing symptoms.
• Benzodiazepines. Benzodiazepines like clonazepam and diazepam are prescribed to manage restless legs syndrome symptoms. They help in promoting relaxation and reducing muscle spasms associated with restless legs syndrome.
• Opioids. Opioid medications are typically reserved for severe restless legs syndrome cases. Codeine, propoxyphene, and oxycodone are examples of opioids that may be prescribed to alleviate symptoms when other treatments have not provided sufficient relief.
• Anticonvulsants. Medications such as gabapentin and pregabalin, originally developed to treat seizures, can also effectively reduce symptoms. These anticonvulsants help in controlling nerve activity and relieving discomfort.
• Iron therapy. Iron therapy is considered when iron deficiency is present and is known to be a contributing factor in some cases of restless legs syndrome. This treatment involves iron supplementation to restore iron levels and alleviate symptoms in individuals who respond positively to iron therapy.

It’s crucial to consult with your doctor to determine the most appropriate course of treatment. Regular communication with your doctor is essential to monitor the effectiveness and potential side effects of any of these therapies related to your restless legs syndrome and/or your COVID-19 diagnosis. 

The COVID-19 pandemic has highlighted the impact of the virus on sleep disturbances, including restless legs syndrome. The relationship between COVID-19 and restless legs syndrome involves factors such as inflammation, medications used in COVID-19 treatment, and the psychological effects of the pandemic. By understanding these connections, individuals can adopt self-care strategies, including lifestyle modifications, exercise, and symptom relief techniques to manage restless legs syndrome symptoms during and beyond the pandemic. 

Q: Can COVID-19 cause restless leg syndrome?
A: The impact of COVID-19 on restless leg syndrome is still being studied, and the exact relationship between the two is not fully understood. However, there is evidence to suggest that COVID-19 can potentially contribute to the development or exacerbation of symptoms. 

Q: Does COVID-19 make restless leg syndrome worse?
A: Growing evidence suggests that COVID-19 can potentially worsen restless leg syndrome symptoms in some individuals. Factors such as systemic inflammation, medications used in COVID-19 treatment, and psychological distress associated with the pandemic may exacerbate restless legs syndrome symptoms. 

Q: How long does restless leg syndrome last after COVID-19?
A: The duration of restless leg syndrome after a COVID-19 infection can vary from person to person. Based on their mental health, activity levels, and medications, some individuals may experience symptoms during the infection, while others may develop symptoms after recovering from COVID-19.

Q: What helps to ease restless leg syndrome with COVID-19?
A: Several strategies can be beneficial to treat restless leg syndrome with COVID-19. First, practicing good sleep hygiene and maintaining a regular sleep schedule can promote better sleep and alleviate restless legs syndrome symptoms. Engaging in moderate exercise, such as walking or swimming, can improve blood circulation and reduce restlessness. Additionally, relaxation techniques like massage, warm baths, or applying heating pads to the legs may relieve restless legs syndrome discomfort.