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. It is typically most severe in the evening and night, potentially disrupting a person’s sleep and affecting daily activities.
There are two types of restless legs syndrome: primary and secondary.
Primary, or idiopathic, RLS has no known cause, but it can run in families, meaning there’s a genetic component. People with familial RLS typically experience an earlier onset — before age 45 — and slower disease progression.
Secondary RLS occurs as a complication of another disease or disorder, such as iron deficiency, diabetes, or chronic kidney disease, or as a medication side effect.
People with RLS experience uncomfortable feelings in their legs when sitting or lying down.
People with RLS frequently describe these feelings as:
Creeping
Crawling
Pulling
Itching
Tingling
Burning
Aching
Painful
Hard to describe
Children may identify symptoms differently from adults. They may describe their leg discomfort as an uncontrollable urge to move, wiggle, or kick.
These sensations usually occur in the lower leg (calf), but can less commonly affect the arms, and, rarely, the chest or head. Although the sensations can occur on just one side of the body, they most often affect both sides. They can also alternate between sides. The sensations range in severity from being uncomfortable to irritating to painful.
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.
People with mild cases may experience symptoms a few times a month, while those with more severe cases may have symptoms every night.
While the direct cause of RLS is often unknown, changes in the brain’s signaling pathways likely contribute to the disease. It’s thought that impaired transmission of dopamine signals in the brain’s basal ganglia may play a role.
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.
There is a genetic component, and the disorder can be found in families where the onset of symptoms is before age 40. As many as 40 to 90 percent of people with RLS report having at least one affected first-degree relative, such as a parent or sibling, and many families have multiple affected family members.
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.
Certain conditions seem to be associated with the development or worsening of restless legs syndrome, including:
Alcohol, nicotine, and caffeine can also trigger symptoms.
There are no medical tests to diagnose RLS, but your doctor may perform blood tests and other exams to rule out other disorders.
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.
In some cases, sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements throughout the night) are used to identify the presence of other causes of sleep disruption (such as sleep apnea), which may impact management of RLS. But guidelines suggest this method should only be used to diagnose RLS in cases when clinical history is ambiguous, and it is deemed necessary to document periodic leg movements. In most cases, polysomnography does not provide any necessary additional information for an RLS diagnosis to take place.
Diagnosing RLS in children can be especially difficult, since it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last. Pediatric RLS can sometimes be misdiagnosed as “growing pains” or attention deficit hyperactivity disorder.
As a result, this condition often goes undiagnosed in children.
The goals of treatment for RLS are to relieve symptoms, increase the amount and quality of sleep, and treat any underlying condition that may be causing RLS.
Treatment options for RLS include:
Medications: Gabapentin enacarbil, Gabapentin, and Pregabalin are medications advised by the American Society of Sleep Medicine (AASM).
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.
Intravenous ferric carboxymaltose: The AASM advises this for people with a serum ferritin level lower than 100 micrograms per liter (mcg/L).
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 (Neurontin) for the treatment of moderate to severe RLS.
Opioid drugs: Methadone (Dolophine), codeine, hydrocodone, or oxycodone (Oxycontin) 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 (Klonopin) and lorazepam (Ativan) are sometimes prescribed to treat anxiety, muscle spasms, and insomnia.
Until very recently, dopaminergic agents were also a standard treatment method for RLS, approved by the FDA and a standard practice advised by the AASM. But research showed that while these medications helped in the short term, in the long term they actually made RLS symptoms worse.
Medications previously recommended, that are now strongly advised against by the AASM include:
Ropinirole
Pramipexole
Rotigotine
Levodopa
Cabergoline
The AASM also advises against the use of these medications:
Bupropion
Carbamazepine
Clonazepam
Valerian
Valproic acid
Alternative and Complementary Therapies
Several studies have shown that acupuncture can improve symptoms of RLS. One study found that patients treated with acupuncture in combination with a low dose of gabapentin reported greater improvement in symptoms than did those who were treated with gabapentin alone.
In addition, studies have shown that certain other nonpharmacological therapies, including exercise and pneumatic compression devices, which improve circulation, can be effective in alleviating symptoms of RLS.
Relaxation techniques such as meditation or yoga may alleviate symptoms as well, but more studies are needed to determine exactly how effective these practices are.
Hot baths and massages can be helpful in relieving symptoms as well.
There is no known way to prevent RLS, because doctors aren’t sure what causes it. Lifestyle changes may help to prevent symptoms as well as limit them. Please see below for more information on lifestyle changes.
Symptoms of RLS also can be alleviated by some lifestyle changes. You can try the following:
Implement a regular exercise program.
Maintain regular sleep patterns.
Limit use of tobacco, alcohol, and caffeine.
Staying active throughout the day helps alleviate symptoms for some. This gives your muscles the chance to exert the energy that they would otherwise release at night.
Regular exercisers are 3.3 times less likely to have RLS than nonexercisers.
Some people find that good sleep habits can also help with symptoms of RLS.
These habits can include:
Only use your bedroom for sleep (not for watching TV or using a computer or cell phone).
Go to bed at the same time every night and wake up at the same time every morning.
Make 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.
Once it starts, primary RLS usually becomes a lifelong condition. Over time, symptoms tend to get worse and occur more often, especially if they began in childhood or early in adult life (before age 45). Late-onset RLS, which begins after age 45, tends to worsen more rapidly.
That said, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep.
People with RLS can sometimes experience remissions — spontaneous improvement for a period of weeks or months before symptoms reappear. This usually occurs during the early stages of the disorder.
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.
When RLS accompanies pregnancy, it usually occurs during the last three months and often improves or disappears within a few weeks after delivery. But some women may continue to have symptoms after giving birth or may develop RLS again later in life.
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.
RLS can affect both the quality and amount of sleep you get. As a result, affected individuals may experience difficulty concentrating during the day. Others may develop mood swings or depression.
Restless legs syndrome affects between 5 and 10 percent of the adult population in the USA. It affects 2 to 4 percent of children.
Reports suggest that most people do not visit a healthcare practitioner about their symptoms until middle age, although up to 40 percent of people may experience symptoms even before the age of 20.
Research suggests that RLS affects an estimated 1.5 million children and adolescents in the United States.
RLS occurs in both men and women, although women are more likely to have it than men.
According to a review published in 2020, changes in hormone levels may play a role in explaining why women are more vulnerable to RLS. This theory is based on the fact that both pregnancy and menopause appear to increase rates of occurrence. Another theory is that the higher prevalence in women is because RLS is comorbid with several disorders to which women are particularly prone, such as migraine, depression, and anxiety.
RLS is common during pregnancy, particularly in the last trimester. A study published in 2020 found that 22.9 percent of women experience RLS in the third trimester.
Many people with RLS also experience uncontrollable, repetitive leg movements that occur while they are relaxed, drowsy, or sleeping. When these movements occur during sleep, they are called periodic limb movements of sleep (PLMS). When these occur while a person is awake, they are called periodic limb movements of wakefulness (PLMW). It is unclear whether PLMS and PLMW are features of restless legs syndrome itself or represent similar, but separate, conditions.
RLS can cause exhaustion and daytime sleepiness, which can have a negative effect on mood, contributing to depression and anxiety. It can also affect your ability to perform well at school or at work. Many people with RLS say they’re often unable to concentrate, have impaired memory, or fail to accomplish daily tasks. Untreated moderate to severe RLS can lead to a 20 percent decrease in work productivity.
Restless legs syndrome (RLS) causes an overwhelming urge to move the legs. It is often accompanied by unpleasant sensations like tingling, itching, or burning, and it typically worsens at night, disrupting sleep.
The exact cause is unknown, but RLS can be linked to problems with dopamine signaling in the brain, genetic factors, iron deficiency, kidney disease, and certain medications.
Treatment usually centers around alleviating symptoms and improving sleep quality with a combination of medications and lifestyle changes. Some alternative therapies, such as acupuncture, may provide relief.
