What Is Restless Legs Syndrome?
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Medically reviewed by Nicholas R. Metrus, MD
Restless legs syndrome (RLS), also known as Willis-Ekbom disease (WED), is a sleep and neurological sensory condition, meaning it's related to your nervous system (which includes your brain and spinal cord). It causes urges to move your body due to unusual sensations you feel in your legs. About 7% to 10% of people in the United States experience RLS.
Symptoms of RLS often improve with movement and worsen during periods of inactivity, like when you're lying in bed. You might experience symptoms several nights a week or most nights, which can disrupt your sleep. Treatment options focus on reducing your symptoms and addressing potential underlying causes, such as iron deficiency.
Types
Healthcare providers may classify restless legs syndrome as primary or secondary.
Primary RLS is also known as idiopathic RLS. Idiopathic means there's no known cause. However, many people with idiopathic RLS have a family history of the condition.
Secondary RLS is a condition that occurs from a known cause, such as iron deficiency, kidney disease, or pregnancy.
About 11% to 29% of pregnant people experience symptoms of restless legs syndrome. RLS during pregnancy usually resolves within a few weeks after delivery, but it might increase the risk of developing chronic RLS.
Symptoms
Restless legs syndrome symptoms can vary in severity, though most people's symptoms get worse or occur later in the day.
Primary symptoms include:
Unusual sensations in your legs that may feel like aching, crawling, itching, pulling, or creeping. These sensations may less commonly affect the arms, chest, and head.
The urge to move your legs in response to the unpleasant sensations.
Sensations that begin after you have not moved for a while, such as when watching television or riding in the car for an extended time period.
Sensations that improve when you move, like when you pace, walk, or move your legs while sitting or lying down.
Symptoms that worsen at night and may keep you from falling asleep or staying asleep.
If you have moderate symptoms, you may only notice them once or twice a week. If you have severe symptoms, you may have symptoms three or more times a week.
Poorer sleep quality due to restless legs syndrome can also affect your cognition and emotions. For example, you might experience:
Difficulty concentrating
Extreme fatigue and daytime sleepiness
Memory problems
Mood changes
Your symptoms might go into remission, meaning they decrease or disappear for a period of time, then reappear at a later time. About 70% of people with restless legs syndrome experience progressively worse symptoms over time. Symptoms might also move to your arms.
What Causes Restless Legs Syndrome?
Researchers do not know exactly what causes restless legs syndrome, but the condition may result from other conditions.
Potential contributors include:
Dopamine deficiency: Low dopamine levels may affect how your nerves sense the environment. Healthcare providers often prescribe medications to increase dopamine levels when treating RLS symptoms.
Neurotransmitter abnormalities: Neurotransmitters are substances that help nerves communicate with your brain. Imbalances in neurotransmitters such as glutamate, histamine, and gamma-aminobutyric acid (GABA) may result in RLS symptoms.
Abnormal function of the peripheral nerves: Restless legs syndrome can cause more exaggerated responses to light physical touch. This response suggests that peripheral nerves in the legs that sense stimulation may not function effectively in people who have RLS.
Medical conditions: People with certain medical conditions experience RLS at higher rates. These conditions include spinal cord disease, multiple sclerosis, celiac disease, and Parkinson's disease.
Iron deficiency: Low blood iron levels may affect nervous system transmission and lead to RLS symptoms. People with iron deficiency anemia are five to six times more likely to have RLS.
Some medications might cause or worsen RLS symptoms. These include:
Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs): Classes of medications typically used to treat depression
Antidopaminergic medications, like neuroleptics: A class of medications used to treat psychiatric disorders like schizophrenia
Beta-blockers: A class of medications used to reduce hypertension (high blood pressure), control heart rhythm, and treat angina (chest pain)
Alcohol, nicotine, and caffeine use can also contribute to RLS.
People assigned female at birth are more likely than people assigned male at birth to experience RLS. There also seems to be a genetic component as well. Up to 65% of people with RLS have a family history of the condition, and there's about an 80% correlation with identical twins. In other words, when one identical twin has RLS, there's an 80% probability that the other twin also has symptoms.
Related:15 Iron Deficiency Signs and Symptoms
Diagnosis
There are not any specific tests to diagnose restless legs syndrome. A healthcare provider will ask you about your symptoms and your family history, review your medications, and consider possible causes.
There are five basic criteria for diagnosing restless legs syndrome:
A strong, sometimes overwhelming, need or urge to move your legs, often with unpleasant or uncomfortable sensations
Increased urge during periods of rest
Increased urge in the evening or at night
Symptom relief during movement
Symptoms with no other medical or behavioral causes
Your healthcare provider may also conduct the following tests:
Blood testing: Blood tests might indicate a potential underlying cause for RLS. For example, your healthcare provider will likely test your iron levels to rule out iron deficiency as a potential cause of your symptoms.
Electromyography (EMG) and nerve conduction studies: Tests for nerve function can help a healthcare provider rule out other potential causes, like neuropathy (nerve damage). These tests record your muscles' responses to nerve stimulation.
Sleep studies: Sleep studies, also known as polysomnography, involve monitoring you overnight while you sleep and recording any unusual movements.
Diagnosing Children
Diagnosing children with restless legs syndrome can be challenging because they might not be able to accurately describe their symptoms.
In addition, many childhood conditions can mimic RLS, including growing pains and nocturnal leg cramps (which both occur in the evening and during the night), as well as motor tics. RLS is also often seen in children who have attention deficit hyperactivity disorder (ADHD), and the two conditions share symptoms like irritability and motor restlessness (the urge to move).
Restless Legs Syndrome Treatment
Sporadic or milder symptoms of restless legs syndrome might not require treatment. However, for many people, restless legs syndrome is a life-long condition that can worsen over time. Around the age of 50, you might experience daily sleep disruptions that significantly affect your quality of life.
While there's no cure for RLS, treatments can help reduce symptoms. Treatments include over-the-counter and prescription medications as well as practicing certain lifestyle habits.
Medications
Medication is typically the primary treatment approach for restless legs syndrome, especially in more severe cases.
Medications to treat RLS include over-the-counter iron supplements as well as prescription medications, such as:
Anti-seizure medications: These medications are usually the first medications a healthcare provider prescribes. Examples of medication treatments include Horizant (gabapentin enacarbil) or Lyrica (pregabil).
Benzodiazepines: These anti-depressant medications may help to reduce muscle spasms and promote sleep. Examples include Klonopin (clonazepam) and Ativan (lorazepam).
Dopaminergic agents: Dopaminergic agents, like the combination medication Sinemet (carbidopa-levodopa), increase the amount of dopamine in the brain. Healthcare providers prescribe them to treat moderate to severe RLS.
Opioids: Opioid medications like codeine, methadone, or oxycodone may be prescribed if no other medications are effective. These medications can be habit-forming and require frequent monitoring by your healthcare provider.
Lifestyle
If you have mild to moderate restless legs syndrome, you may be able to reduce your symptoms through lifestyle choices. Recommendations from your healthcare provider may include:
Refrain from consuming alcohol or caffeine
Avoid nicotine
Maintain a regular sleep schedule
Take a warm bath at night
Massage your legs in the evening
Engage in regular leg-stretching exercises, such as calf and hamstring stretches
Using vibrating leg massaging devices may also reduce your symptoms.
Prevention
While you can't always prevent restless legs syndrome, you may be able to prevent mild RLS or minimize flares.
Prevention strategies are similar to treatment strategies. They include the following:
Avoid caffeine, alcohol, and nicotine
Get plenty of sleep at night (usually at least seven hours)
Engage in regular, moderate-intensity exercise in the morning or early afternoon, as evening exercise may worsen symptoms
Engage in relaxing activities to reduce your anxiety levels, such as taking baths, reading, meditating, and stretching
Take iron supplements if your healthcare provider prescribes them for low iron levels
Related Conditions
Restless legs syndrome may be related to some of the following disorders, which commonly affect your neurologic (nervous system) health:
End-stage renal (kidney) disease
Neuropathy (nerve damage)
Pregnancy, usually in the last trimester (beginning in week 28), possibly due to hormonal shifts
Sleep deprivation
Sleep disorders, such as sleep apnea
Possible complications of RLS stem from disrupted sleep and resulting fatigue.
Living With Restless Legs Syndrome
Restless legs syndrome varies from person to person. You may experience infrequent and milder symptoms, or you may find that more frequent and severe symptoms significantly affect your sleep and overall quality of life.
Researchers are learning more about the causes and treatments for RLS. While there is not currently a cure, medications and lifestyle choices can help you manage your symptoms. Talk to your healthcare provider if you think you might benefit from treatment.
Frequently Asked Questions
Is RLS a form of Parkinson's disease?
Parkinson's disease is a condition that causes uncontrolled movements. While this symptom may sound similar to RLS, they aren't the same. However, both conditions may be due to imbalances in the neurotransmitter dopamine.
At what age is restless legs syndrome most common?
RLS can affect people of all ages, including children. However, the symptoms tend to worsen more rapidly around the age of 45.
Is RLS linked to dementia?
One retrospective cohort study observed participants from 2002-2013 and identified a connection between dementia causes (such as Alzheimer's disease) and RLS. However, the research regarding this connection is newer and requires further investigation.
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