A diagnosis of restless legs syndrome often relies mainly on the patient's description of symptoms. In general, the recommended approach is first to take a sleep and personal history. The doctor may conduct an interview that includes the following questions:
- How would you describe your sleep problem?
- How long have you had this sleep problem?
- How long does it take you to fall asleep?
- How many times a week does the problem occur?
- How restful is your sleep?
- What do your leg problems feel like (cramps, twitching, crawling feelings)?
- What is your sleep environment like? Noisy? Not dark enough?
- What medications are you taking (including the use of antidepressants and self-medications -- such as herbs, alcohol, and over-the-counter or prescription drugs)?
- Are you taking or withdrawing from stimulants, such as coffee or tobacco?
- How much alcohol do you drink per day?
- What stresses or emotional factors may be present in your life?
- Have you experienced any significant life changes?
- Do you snore or gasp during sleep? (This may be an indication of sleep apnea. Sleep apnea is a condition in which breathing stops for short periods many times during the night. It may worsen symptoms of restless legs syndrome or insomnia.)
- If you have a bed partner, does he or she notice that you have jerking legs, interrupted breathing, or thrashing while you sleep?
- Are you a shift worker?
- Do you have a family history of RLS or periodic movement limb disorder, "growing pains" at night, or night walking?
Keeping a Record of Sleep. To help answer these questions, the patient may need to keep a sleep diary. Every day for 2 weeks, the patient should record all sleep-related information, including responses to questions listed above described on a daily basis. Recording sleep behavior using an extended-play audio or videotape can be very helpful in diagnosing sleep apnea.
A bed partner can help by adding their observations of the patient's sleep behavior.
Sleep Disorders Centers
Some high-risk patients may need to consult a sleep specialist or go to a sleep disorders center before their sleep problem can be diagnosed. At most centers, patients undergo an in-depth analysis, usually supervised by a team of consultants from various specialties, who can provide both physical and psychiatric evaluations. Centers should be accredited by the American Academy of Sleep Medicine.
Among the signs that may indicate a need for a sleep disorders center are:
- Insomnia due to psychological disorders
- Sleeping problems due to substance abuse
- Snoring and sudden awakening with gasping for breath (possible sleep apnea)
- Severe restless legs syndrome
- Persistent daytime sleepiness
- Sudden episodes of falling asleep during the day (possible narcolepsy)
Review Date: 10/15/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.