Restless Legs Syndrome -

Restless legs syndrome (RLS) is a condition that causes a very strong urge to move the legs. The urge to move usually is caused by an uncomfortable feeling in the legs. It typically happens in the evening or at night when sitting or lying down. Moving eases the discomfort for a short time.

Restless legs syndrome can begin at any age and tends to get worse with age. It can disrupt sleep, which interferes with daily activities. RLS also is known as Willis-Ekbom disease.

Simple self-care steps and lifestyle changes may help relieve symptoms. Medicines also help many people with RLS.

The chief symptom of restless legs syndrome is an urge to move the legs. It’s common to experience:

Uncomfortable sensations that begin while resting. A feeling in the legs typically begins after you’ve been lying down or sitting for an extended time. It might happen while sitting in a car, airplane or movie theater.
Relief with movement. The sensation of RLS lessens with movement. Stretching, jiggling the legs, pacing or walking may improve symptoms.
Worsening of symptoms in the evening. Symptoms occur mainly at night.
Nighttime leg twitching. RLS may be associated with another, more common condition called periodic limb movement of sleep. This condition causes the legs to twitch and kick during sleep, possibly throughout the night.

People typically describe RLS symptoms as compelling, unpleasant feelings in the legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.

The sensations are felt within the leg rather than on the skin. They’re described as:

Crawling.
Creeping.
Pulling.
Throbbing.
Aching.
Itching.
Electric.

Sometimes the feelings of RLS are hard to explain. People with RLS usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move the legs.

It’s common for symptoms to get better and worse. Sometimes symptoms disappear for periods of time, then come back.

When to see a doctor

Talk with your healthcare professional if you have symptoms of restless legs syndrome. RLS can interfere with your sleep, cause daytime drowsiness and affect your quality of life.

Often, there’s no known cause for restless legs syndrome. Researchers suspect the condition may be caused by an imbalance of the brain chemical dopamine. Dopamine sends messages to control muscle movement.

Heredity

Sometimes RLS runs in families, especially if the condition starts before age 40. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy

Pregnancy or hormonal changes may worsen RLS symptoms. Some people get RLS for the first time during pregnancy, especially during the last trimester. However, symptoms usually disappear after delivery.

Restless legs syndrome can develop at any age, even during childhood. The condition is more common with increasing age. It’s also more common in women than in men.

RLS usually isn’t related to a serious underlying medical condition. However, it sometimes occurs with other conditions, such as:

Peripheral neuropathy. This damage to the nerves in the hands and feet is sometimes due to chronic diseases such as diabetes and alcohol use disorder.
Iron deficiency. Too little iron in the body, known as iron deficiency, can cause or worsen RLS. People who have a history of bleeding from the stomach or bowels may have iron deficiency. Deficiency also may affect people who have heavy menstrual periods or who often donate blood.
Kidney failure. If you have kidney failure, you also may have iron deficiency, often with anemia. When kidneys don’t function properly, iron stores in the blood can decrease. This and other changes in body chemistry may cause or worsen RLS.
Spinal cord conditions. Damage to or injury of the spinal cord has been linked to RLS.
Parkinson’s disease. People who have Parkinson’s disease may have an increased risk of developing RLS.

Restless legs syndrome symptoms can range from being mild to having a serious impact on people’s lives. Many people with RLS find it hard to fall or stay asleep.

Serious symptoms of RLS can affect quality of life and result in depression. Not being able to sleep may lead to excessive daytime drowsiness, but RLS may interfere with napping.

To diagnose restless legs syndrome, your healthcare professional takes your medical history and asks about your symptoms. A diagnosis of RLS is based on the following criteria, established by the International Restless Legs Syndrome Study Group:

You have a strong, often irresistible urge to move the legs. This usually occurs with uncomfortable feelings in the legs.
Your symptoms start or get worse when you’re resting, such as sitting or lying down.
Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
Your symptoms are worse at night.
Symptoms can’t be explained solely by another medical or behavioral condition.

Your healthcare professional may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes of your symptoms.

You may be referred to a sleep specialist. This may involve an overnight stay and a study at a sleep clinic if another sleep condition such as sleep apnea is suspected. However, a diagnosis of RLS usually doesn’t require a sleep study.

Symptoms of restless legs syndrome sometimes go away after treating an underlying condition, such as iron deficiency. Correcting an iron deficiency may involve taking an iron supplement by mouth. Or you may be given an iron supplement through a vein in your arm. Take iron supplements only with medical supervision and after having your blood-iron level checked.

Electrical stimulation of a nerve on the side of your knee may help RLS symptoms. Devices for electrical stimulation require a prescription from a healthcare professional.

If you have RLS without an associated condition, treatment focuses on lifestyle changes. If those aren’t effective, your healthcare professional may prescribe medicines.

Medications

Several prescription medicines are available to reduce the restlessness in the legs. Many of the medicines were developed to treat other diseases, but they may help with RLS. They include:

Medicines affecting calcium channels. Medicines such as gabapentin, gabapentin enacarbil and pregabalin are the first line of treatment for most people with RLS. These medicines can cause side effects such as dizziness, unsteadiness, mental fog and weight gain.
Medicines that increase dopamine in the brain. These medicines affect levels of the chemical messenger dopamine in the brain. Rotigotine, pramipexole and ropinirole work at first. But in many people taking these medicines, RLS gets worse over time. The medicines may cause symptoms to return earlier in the day. Some people taking these medicines find that symptoms spread to the arms. This is called augmentation. The medicines also can make it hard to manage impulses, such as compulsive gambling. Because of these risks, dopamine drugs are only used if medicines affecting calcium channels don’t work or cause side effects.
People who have occasional RLS symptoms may be prescribed carbidopa-levodopa (Duopa, Rytary, others) to take as needed. But healthcare professionals don’t recommend taking this medicine daily or near daily. Daily use of this medicine can cause augmentation.
Opioids. These medicines are used in low doses to treat RLS when other medicines haven’t worked or have caused side effects. Most people taking opioids don’t have major side effects, and these medicines are effective in managing RLS symptoms. In low doses, addiction is very rare. Some examples of opioids include oxycodone, hydrocodone and buprenorphine.

It may take several trials to find the right medicine or combination of medicines that work best for you.

And some medicines for other conditions may worsen symptoms of RLS. These include some antidepressants, some antipsychotic medicines, some antinausea medicines, and some cold and allergy medicines. Your healthcare professional may recommend that you don’t take these medicines, if possible. However, if you need to take them, talk about treatments to help manage RLS.

Most medicines prescribed to treat RLS aren’t recommended during pregnancy. Instead, self-care techniques and iron supplements may be recommended to relieve symptoms. But if symptoms are bothersome during your last trimester, your healthcare professional may recommend the use of certain medicines.

References

Restless legs syndrome fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet. Accessed Nov. 16, 2021.
Ondo WG. Clinical features and diagnosis of restless legs syndrome and periodic limb movement disorder in adults. https://www.uptodate.com/contents/search. Accessed Nov. 16, 2021.
Silber MH. Management of restless legs syndrome and periodic limb movement disorder in adults. https://www.uptodate.com/contents/search. Accessed Nov. 16, 2021.
Garcia-Borreguero D, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: A combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Medicine. 2016; doi:10.1016/j.sleep.2016.01.017.
Winkelman JW, et al. Practice guideline summary: Treatment of restless legs syndrome in adults — Report of the guideline development, dissemination and implementation subcommittee of the American Academy of Neurology. Neurology. 2016; doi:10.1212/WNL.0000000000003388.
Silber MH, et al. The appropriate use of opioids in the treatment of refractory restless legs syndrome. Mayo Clinic Proceedings. 2018; doi:10.1016/j.mayocp.2017.11.007.
Trenkwalder, et al. Comorbidities, treatment and pathophysiology in restless legs syndrome. The Lancet Neurology. 2018; doi:10.1016/S1474-4422(18)30311-9.
Ferri FF. Restless legs syndrome. In: Ferri’s Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Nov. 27, 2023.
Ami TR. Allscripts EPSi. Mayo Clinic. Nov. 14, 2023.
AskMayoExpert. Restless legs syndrome (RLS). Mayo Clinic; 2020.
Xu XM, et al. Complementary and alternative therapies for restless legs syndrome: An evidence-based systematic review. Sleep Medicine Reviews. 2018; doi:10.1016/j.smrv.2017.06.003.
Find a sleep facility near you. American Academy of Sleep Medicine. https://sleepeducation.org/sleep-center/. Accessed Nov. 27, 2023.
Gonzalez-Latapi P, et al. Update on restless legs syndrome: From mechanisms to treatment. Current Neurology and Neuroscience Reports. 2019; doi:10.1007/s11910-019-0965-4.
Silber MH, et al. The management of restless legs syndrome: An updated algorithm. Mayo Clinic Proceedings. 2021; doi:10.1016/j.mayocp.2020.12.026.
Medical review (expert opinion). Mayo Clinic. Nov. 28, 2023.
Medical review (expert opinion). Mayo Clinic. Jan. 4, 2025.
Treatment of restless legs syndrome and periodic limb movement disorder: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2024; doi.org/10.5664/jcsm.11390.

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Restless Legs Syndrome

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