What Is Restless Legs Syndrome? Symptoms, Causes, Diagnosis, Treatment, and Prevention
Restless legs syndrome (often called restless leg syndrome or RLS) is a disorder that causes an overwhelming urge to move the legs, usually to alleviate unpleasant sensations.
Also known as Willis-Ekbom disease, RLS occurs when the legs are at rest and is typically most severe in the evening and night, potentially disrupting a person's sleep and affecting daily activities.
Signs and Symptoms of Restless Legs Syndrome
People with RLS experience uncomfortable feelings in their legs when sitting or lying down.
People with RLS frequently describe these feelings as:
- Hard to describe
Some individuals experience symptoms throughout the day, but the symptoms will always be worse at night.
In general, getting up and walking will immediately relieve the symptoms; but they usually return as soon as you settle back into a restful state.
Causes and Risk Factors of Restless Legs Syndrome
Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinson’s disease, another disorder of the basal ganglia’s dopamine pathways, have an increased chance of developing RLS.
When the cause is unknown, the disorder is called primary RLS. When restless legs syndrome is caused by another disease or condition, or is a side effect of certain medications, the disorder is known as secondary RLS.
- Iron deficiency (with or without anemia)
- Kidney failure
- Parkinson's disease
- Damage to the nerves in the hands or feet (peripheral neuropathy)
- Rheumatoid arthritis
Medications that may aggravate RLS symptoms include:
- Antinausea drugs (such as prochlorperazine or metoclopramide)
- Antipsychotic drugs (such as haloperidol or phenothiazine derivatives)
- Some cold and allergy medications that contain older antihistamines (for example, diphenhydramine)
How Is Restless Legs Syndrome Diagnosed?
Your doctor may also order blood tests to look for underlying conditions that can cause RLS, such as diabetes or kidney disease.
In addition, your doctor may use a neurological and a physical exam, information from your medical and family history, and a list of your current medications to make a diagnosis.
Duration of Restless Legs Syndrome
That said, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep.
In cases of secondary RLS, when your RLS is caused by another disease or condition, symptoms usually go away when the disease or condition improves.
In addition, if your restless legs syndrome is triggered by medications or the use of caffeine, nicotine, or alcohol, the condition usually improves or goes away once you stop using the medications or substances.
RLS as a disorder is not dangerous or life-threatening, but it can be uncomfortable, making it hard to sleep and affecting your quality of life.
Treatment and Medication Options for Restless Legs Syndrome
- Iron A trial of iron supplements is often recommended as a first treatment if your blood test indicates low or low-normal ferritin, a protein in the body that binds to iron.
- Anti-seizure drugs These can be effective in decreasing sensory disturbances such as creeping and crawling as well as nerve pain. The U.S. Food and Drug Administration (FDA) has approved gabapentin enacarbil for the treatment of moderate to severe RLS.
- Dopaminergic agents These have been shown to reduce symptoms of RLS when taken at nighttime. The FDA has approved ropinirole, pramipexole, and rotigotine to treat moderate to severe RLS.
- Opioid drugs Methadone, codeine, hydrocodone, or oxycodone are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications.
- Benzodiazepines Medications such as clonazepam and lorazepam are sometimes prescribed to treat anxiety, muscle spasms, and insomnia.
- Hot baths
- Lifestyle changes, including implementing a regular exercise program, maintaining regular sleep patterns, and limiting use of tobacco, alcohol, and caffeine
Being active throughout the day helps alleviate symptoms for some. This gives your muscles the chance to exert the energy that they would otherwise exert at night.
Some people find that good sleep habits can also help with symptoms of RLS.
These habits can include:
- Only using your bedroom for sleep (not for watching TV or using a computer or cell phone)
- Going to bed at the same time every night and waking up at the same time every morning
- Making sure you get enough sleep so that you feel rested when you wake up
If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individual’s ability to fall asleep, the condition does not have to be treated.
Alternative and Complementary Therapies
Prevention of Restless Legs Syndrome
Complications of Restless Legs Syndrome
Research and Statistics: How Common Is Restless Legs Syndrome?
RLS occurs in both men and women, although women are more likely to have it than men.
Related Conditions of Restless Legs Syndrome
Resources We Love
Restless Legs Syndrome Foundation
On this organization's site, you can find the latest information about RLS treatments and share your experience with others in the RLS community. Their “Find a Healthcare Provider” tool can help you find a doctor in your area who works with RLS patients.
American Sleep Association (ASA)
This group was founded by physicians and scientists in 2002 with a mission to increase the awareness of the importance of sleep and the harmful effects of sleep disorders. On their site you can find lots of useful information on many sleep-related topics, including RLS. You can also find tips on how to choose a sleep doctor, sleep specialist, or clinic.
This foundation dedicates itself to improving health and well-being through sleep education and advocacy. On their site, you can find informative articles on many sleep-related subjects, such as tips for making more time for sleep and getting a better night's sleep in addition to articles on RLS and other sleep disorders.
National Organization for Rare Disorders (NORD)
This is a great site to explore the latest research on RLS, including links to clinical trials.
Additional reporting by Joseph Bennington-Castro.
Editorial Sources and Fact-Checking
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- Restless Legs Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). March 17, 2020.
- Restless Legs Syndrome. MedlinePlus. September 18, 2020.
- Restless Legs Syndrome. American Sleep Association (ASA).
- Restless Leg Syndrome. Disease InfoSearch.
- Howard H, Kamat D. Restless Legs Syndrome in Children. Pediatric Annals. December 13, 2018.
- Lifestyle. Restless Legs Syndrome Foundation.
- Raissi GR, Forogh B, Ahadi T, et al. Evaluation of Acupuncture in the Treatment of Restless Legs Syndrome: A Randomized Trial. Journal of Acupuncture and Meridian Studies. October 2017.
- Guay A, Houle M, O’Shaughnessy J, Descarreaux M. Current Evidence on Diagnostic Criteria, Relevant Outcome Measures, and Efficacy of Nonpharmacologic Therapy in the Management of Restless Legs Syndrome (RLS): A Scoping Review. Journal of Manipulative and Physiological Therapeutics. November–December 2020.
- Restless Leg Syndrome. American Academy of Family Physicians. September 2020.
- Restless Legs Syndrome. National Organization for Rare Disorders (NORD). 2018.
- RLS & Kids. Restless Legs Syndrome Foundation.
- Seeman M. Why Are Women Prone to Restless Legs Syndrome? International Journal of Environmental Research and Public Health. January 2020.
- RLS & Kids. Restless Legs Syndrome Foundation.
- Darvishi N, Daneshkhah A, Khaledi-Paveh B, et al. The Prevalence of Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) in the Third Trimester of Pregnancy: A Systematic Review. BMC Neurology. April 13, 2020.