Restless Legs Syndrome and Sleep Apnea

July 29, 2022

Medically Reviewed By

Z

Fact Checked

Our dedicated team rigorously evaluates every article, guide, and product to ensure the information is accurate and factual.

Failure to get a good night’s sleep is no fun, especially if the reasons are out of a patient’s control. Many factors can inhibit quality sleep, but in this article, we will address two prevalent causes: restless leg syndrome and sleep apnea.

Is there a connection between restless leg syndrome (RLS) and sleep apnea? Research supports that, yes, those with sleep apnea are more likely to experience restless leg syndrome. Likewise, treating sleep apnea helps improve symptoms of restless leg syndrome. 

Keep reading to learn more about these conditions, what the research shows, and treatment options available for either condition.

What is restless leg syndrome?

As its name suggests, restless leg syndrome (RLS) is a neurological condition in which one has an uncontrollable urge to move their legs, especially at night when sitting or lying down. The person experiences an uncomfortable sensation that seems to be relieved, at least temporarily, only by moving their legs. The following words are often used to describe the sensation that occurs in the legs:

  • Crawling
  • Creeping
  • Pulling
  • Throbbing
  • Aching
  • Itching
  • Electric

The sensation usually begins after a period of sitting still and is worse at night. During sleep, RLS often causes the person to twitch or kick their legs throughout the night. This can seriously disrupt sleep and interfere with daytime activities.

What is sleep-disordered breathing?

Simply put, sleep-disordered breathing, also referred to as sleep apnea, is a condition in which one experiences abnormal breathing patterns during sleep. Obstructive sleep apnea (OSA) occurs when the throat tissue collapses and blocks the airway, causing breathing to stop and start repeatedly during the night. The following are common symptoms and signs of OSA:

  • Loud snoring
  • Noticeable stops in breathing during the night
  • Restless sleep
  • Waking up tired
  • Morning headache
  • Dry or sore throat
  • Daytime fatigue or sleepiness
  • Memory impairment
  • Sexual dysfunction4

In addition to these undesirable symptoms, OSA can have long-term health consequences if left untreated, including hypertension (high blood pressure), stroke, arrhythmias (irregular heartbeat), cardiomyopathy (enlargement of the muscle tissue of the heart), heart failure, diabetes, obesity, and heart attacks.4

What is the connection between RLS and OSA?

While there is no evidence that one condition causes the other, restless leg syndrome (RLS) and obstructive sleep apnea (OSA) are shown to coincide. Both conditions are more common in older adults and worsen with age. Furthermore, certain habits, such as drinking alcohol and smoking, affect both conditions. 

In one study, clinically significant RLS occurred in one of every 12 patients with sleep apnea without RLS being suspected beforehand. So, it is recommended that those with RLS get tested for OSA and vice versa.9

Additionally, research shows that symptoms of RLS improve when treated for sleep apnea. In a study of about 100 participants with clinically significant RLS, treatment of OSA significantly improved RLS symptoms, enabling the reduction of drug therapy in more than half of the patients. The researchers highlighted the importance of diagnosing OSA in RLS patients.9

  • very day can help establish sleeping patterns, and establishing a morning and nighttime routine can signal what time of day it is. Consider incorporating music, tea, reading, or a bath into a nighttime routine to tell your body it is time for bed.
  • Get light exercise during the day: Exposure to sunlight can help regulate the body’s internal clock and hormones, and exercise can help you rest better when you lie down to sleep.
  • Pay attention to your diet: Certain foods and drinks can disrupt sleep, including those with caffeine or alcohol. Avoid tea and coffee in the late afternoon and evening. Similarly, alcohol should be avoided for at least three hours before bedtime for better-quality sleep.

If a patient is experiencing restless leg syndrome, don’t ignore the possibility they have sleep-disordered breathing or sleep apnea. Research supports that, while these two conditions might not directly cause the other, they tend to coincide, and getting treated for sleep apnea may improve symptoms of RLS. To learn more about screening for obstructive sleep apnea, visit thevivosinstitute.com.

What is the connection between RLS and OSA?

While there is no evidence that one condition causes the other, restless leg syndrome (RLS) and obstructive sleep apnea (OSA) are shown to coincide. Both conditions are more common in older adults and worsen with age. Furthermore, certain habits, such as drinking alcohol and smoking, affect both conditions. 

In one study, clinically significant RLS occurred in one of every 12 patients with sleep apnea without RLS being suspected beforehand. So, it is recommended that those with RLS get tested for OSA and vice versa.9

Additionally, research shows that symptoms of RLS improve when treated for sleep apnea. In a study of about 100 participants with clinically significant RLS, treatment of OSA significantly improved RLS symptoms, enabling the reduction of drug therapy in more than half of the patients. The researchers highlighted the importance of diagnosing OSA in RLS patients.9

What causes restless legs syndrome?

The cause of RLS is different for each person, and for many, the reason may remain unknown. Comorbid conditions such as OSA can contribute to worsening RLS symptoms. Possible causes of RLS include the following:

  • Low iron levels 
  • Diabetes 
  • Kidney Failure 
  • Pregnancy2
  • Medications.

RLS is familial in about 50 percent of patients, and women are twice as likely to suffer from RLS.7,8 In particular, menopausal women have a greater risk of RLS, indicating hormone changes contribute to the pathophysiology of RLS.7 RLS diagnoses are based solely on clinical symptoms. However, physicians often recommend polysomnography and blood tests for anemia, iron deficiency, hepatic function, and renal function to determine if underlying conditions are contributing to RLS.8 

What are the treatment options?

There are a variety of treatment options to discuss with patients.4

Lifestyle Changes 

For mild cases of sleep apnea, certain lifestyle changes might help:

  • Reduce obesity
  • Exercise regularly
  • Avoid drinking alcohol, especially at night
  • Quit smoking
  • Reduce allergies with a nasal decongestant or medication
  • Change sleeping position4

CPAP Machines

Continuous positive airway pressure (CPAP) machines deliver continuous air through a mask while you sleep. The air delivered is at a slightly higher pressure than normal, which helps keep the airway open, preventing snoring and interrupted breathing. CPAP is the most common sleep apnea treatment. Studies have found patients with concurrent OSA and RLS experience a reduction or cessation of RLS symptoms when treated with a CPAP.5 

Oral Appliances

Oral devices—such as a mouthguard, mandibular advancement device (MAD), or orthodontic retainer—can help reposition the jaw, open the throat, and relieve symptoms of OSA. This is especially useful for those with mild-to-moderate sleep apnea or who cannot use a CPAP machine. Plus, it can be much more comfortable than having the CPAP mask strapped to the face.

Surgery

This is usually a last-resort option for severe cases of sleep apnea if other treatment options have failed. Surgical options can include tissue removal, tissue shrinkage, jaw repositioning, implants, nerve stimulation, and tracheostomy (creating a new air passageway).

What can patients do to relieve restless legs syndrome symptoms?

If a patient is suffering from restless leg syndrome, in addition to getting screened for OSA, here are some recommendations you can share with patients to encourage better sleep:

  • Create comfortable sleeping conditions: People generally sleep best when a room is cool, quiet, and dark. Make sure the bed is comfortable. Adjust the air conditioning to be cooler at night, consider getting blackout curtains, and make sure it stays quiet during the night.
  • Establish a routine: Waking up and going to bed at the same time every day can help establish sleeping patterns, and establishing a morning and nighttime routine can signal what time of day it is. Consider incorporating music, tea, reading, or a bath into a nighttime routine to tell your body it is time for bed.
  • Get light exercise during the day: Exposure to sunlight can help regulate the body’s internal clock and hormones, and exercise can help you rest better when you lie down to sleep.
  • Pay attention to your diet: Certain foods and drinks can disrupt sleep, including those with caffeine or alcohol. Avoid tea and coffee in the late afternoon and evening. Similarly, alcohol should be avoided for at least three hours before bedtime for better-quality sleep.

If a patient is experiencing restless leg syndrome, don’t ignore the possibility they have sleep-disordered breathing or sleep apnea. Research supports that, while these two conditions might not directly cause the other, they tend to coincide, and getting treated for sleep apnea may improve symptoms of RLS. To learn more about screening for obstructive sleep apnea, visit thevivosinstitute.com.

References 
1. Delgado Rodrigues RN, Alvim de Abreu E Silva Rodrigues AA, Pratesi R, Krieger J. “Outcome of restless legs severity after continuous positive air pressure (CPAP) treatment in patients affected by the association of RLS and obstructive sleep apneas.” Sleep Med. 2006;7(3):235-239. doi:10.1016/j.sleep.2005.06.009
2. Dunietz GL, Lisabeth LD, Shedden K, et al. “Restless Legs Syndrome and Sleep-Wake Disturbances in Pregnancy.” J Clin Sleep Med. 2017;13(7):863-870. doi:10.5664/jcsm.6654.
3. Lakshminarayanan S, Paramasivan KD, Walters AS, Wagner ML, Patel S, Passi V. “Clinically significant but unsuspected restless legs syndrome in patients with sleep apnea.” Mov Disord. 2005;20(4):501-503. doi:10.1002/mds.20366.
4. Memon J, Manganaro SN. “Obstructive Sleep-Disordered Breathing.” StatPearls Publishing; 2021. Accessed July 6, 2022. https://www.ncbi.nlm.nih.gov/books/NBK441909/
5. Myc LA, Churnin IT, Jameson MJ, Davis EM. “Treatment of Comorbid Obstructive Sleep Apnea y Upper Airway Stimulation Results in Resolution of Debilitating Symptoms of Restless Legs Syndrome.” J Clin Sleep Med. 2018;14(10):1797-1800. doi:10.5664/jcsm.7400.
6. Pistorius F, Geisler P, Wetter TC, Crönlein T. “Sleep apnea syndrome comorbid with and without restless legs syndrome: differences in insomnia specific symptoms.” Sleep Breath. 2020;24(3):1167-1172. doi:10.1007/s11325-020-02063-8.
7. Seeman MV. “Why Are Women Prone to Restless Legs Syndrome?” Int J Environ Res Public Health. 2020;17(1). doi:10.3390/ijerph17010368.
8. Silber MH, Buchfuhrer MJ, Earley CJ, et al. “The Management of Restless Legs Syndrome: An Updated Algorithm.” Mayo Clin Proc. 2021;96(7):1921-1937. doi:10.1016/j.mayocp.2020.12.026.
9. Silva C, Peralta AR, Bentes C. “The urge to move and breathe – the impact of obstructive sleep apnea syndrome treatment in patients with previously diagnosed, clinically significant restless legs syndrome.” Sleep Med. 2017;38:17-20. doi:10.1016/j.sleep.2017.06.023.