Restless legs syndrome

Overview

Restless legs syndrome (RLS) is a condition that causes an overwhelming urge to move your legs. It often comes with uncomfortable feelings like crawling, creeping, pulling, or throbbing inside the legs. These symptoms usually happen when you are resting or sitting still, and they tend to get worse in the evening or at night. Moving your legs provides temporary relief.

Yes, restless legs syndrome is common. It affects about 5 to 10 out of every 100 people. Many people have mild symptoms that do not require treatment.

RLS can affect people of any age, including children, but it is more common in middle-aged and older adults. Women are more likely than men to have RLS. It also tends to run in families.

Symptoms

Common symptoms

• An irresistible urge to move your legs, especially when sitting or lying down.
• Uncomfortable sensations in the legs, such as crawling, creeping, pulling, throbbing, or aching.
• Symptoms that get worse in the evening or at night.
• Temporary relief from moving your legs, stretching, or walking.
• Difficulty falling asleep or staying asleep due to leg discomfort.

Symptoms in children

• Children may describe the feeling as 'growing pains' or 'bugs crawling' on their legs.
• They might have trouble sitting still in class or during car rides.
• Sleep problems, including restlessness at night, can lead to daytime sleepiness or behavior issues.

Symptoms in older adults

• Symptoms may become more frequent and severe with age.
• Older adults often have more trouble sleeping, which can affect memory and mood.
• RLS can be mistaken for nighttime leg cramps or arthritis pain.

Causes

Main causes

• Primary RLS: This form has no clear cause. It often runs in families, which suggests a genetic link.
• Secondary RLS: This form is caused by another condition, such as iron deficiency (low iron levels), pregnancy (especially in the last trimester), chronic kidney failure, or nerve damage (peripheral neuropathy).
• Some medications, including certain antidepressants and antihistamines, can trigger or worsen RLS.

Risk factors

• Having a family history of RLS.
• Being middle-aged or older.
• Being female.
• Having low iron levels (iron deficiency) or anemia.
• Having chronic conditions like kidney disease, diabetes, or Parkinson's disease.
• Pregnancy, especially in the third trimester.

When to see a doctor

See a doctor urgently if:

• If your leg symptoms are severe and affecting your ability to sleep or function every day.
• If you have sudden, severe leg pain, swelling, or warmth (call emergency immediately).

Book a routine appointment if:

• If you have an ongoing urge to move your legs at rest, especially in the evening, that bothers you or affects your sleep.
• If you think you might have iron deficiency or another health condition linked to RLS.
• Before trying any over-the-counter remedies or supplements for RLS.

Diagnosis

There is no single test for restless legs syndrome. A doctor will diagnose it based on your symptoms, medical history, and a physical exam. They will ask you about when your symptoms happen, what makes them better or worse, and whether you have any family members with similar symptoms.

Tests that may be done

• Blood tests: To check for iron deficiency (low ferritin levels) or other conditions like kidney problems or diabetes.
• Sleep studies (polysomnography): Not usually needed, but may be done if sleep disorders like periodic limb movement disorder are suspected.
• Neurological exam: To rule out other nerve problems.

What to expect at your appointment

During your visit, the doctor will listen to your description of the leg sensations and urge to move. They may ask you to keep a symptom diary for a couple of weeks. They will also review any medicines you take. The diagnosis is based mainly on the pattern of your symptoms. If tests show low iron, treating that can sometimes resolve RLS.

Treatment

Treatment for restless legs syndrome depends on how severe your symptoms are and whether there is an underlying cause. For mild to moderate RLS, lifestyle changes often work well. For more bothersome symptoms, a doctor may recommend medications. Treatment does not cure RLS but can greatly reduce symptoms and improve sleep.

Self-care at home

• Cut back on caffeine, nicotine, and alcohol, especially in the evening.
• Get regular physical activity, such as walking or stretching, but avoid intense exercise close to bedtime.
• Practice good sleep habits: go to bed and wake up at the same time each day, keep the bedroom cool and dark.
• Massage or stretch your legs before sleep.
• Apply warm or cool packs to your legs for relief.
• Avoid sitting still for long periods – take breaks to move around.

Medical treatments

If self-care is not enough, a doctor may suggest treatments that help reduce the urge to move your legs. These can include iron supplements if you are low in iron, or other medications that affect dopamine (a brain chemical) or certain nerve signals. Your doctor will choose a treatment based on your health, age, and other conditions. Never stop or change a medication for RLS without talking to your doctor first.

When is surgery considered?

Surgery is not a treatment for restless legs syndrome.

Living with this condition

Living with restless legs syndrome can be challenging, especially if symptoms disrupt sleep. It helps to plan your day so you are not stuck in one position for too long. If you work at a desk, take short walks every hour. In the evening, do gentle leg stretches or yoga to wind down. Many people find that staying active during the day reduces symptoms at night.

Lifestyle tips

• Establish a regular sleep schedule.
• Reduce or avoid caffeine, alcohol, and tobacco.
• Stay physically active with moderate exercise like walking, swimming, or cycling.
• Practice relaxation techniques such as deep breathing or meditation before bed.
• If symptoms wake you at night, get up and walk around for a few minutes.

Diet and exercise

A balanced diet rich in iron (e.g., lean meats, beans, spinach) may help if you are low in iron. Avoid heavy meals close to bedtime. Regular moderate exercise can improve symptoms, but avoid vigorous exercise late at night. Some people find that leg massages or warm baths before sleep are helpful.

Mental health and emotional wellbeing

RLS can lead to chronic sleep deprivation, which may cause daytime fatigue, irritability, anxiety, or depression. The constant discomfort and lack of rest can affect your mood and ability to concentrate. It is important to talk to your doctor if RLS is affecting your emotional well-being. Treatment can improve both your sleep and your mood.

Prevention

There is no sure way to prevent restless legs syndrome, especially if you have a family history. However, you may be able to reduce your risk or prevent symptoms from getting worse by managing any underlying conditions (like iron deficiency), avoiding triggers such as caffeine and alcohol, and staying physically active.

Complications

If left untreated

• Severe sleep disruption, leading to daytime sleepiness and trouble concentrating.
• Increased risk of depression and anxiety.
• Poor quality of life due to constant discomfort and fatigue.
• In some cases, untreated RLS can lead to periodic limb movements during sleep, which further disrupts rest.

Long-term outlook

The outlook for restless legs syndrome is generally good. While it is a chronic condition, most people can manage their symptoms effectively with lifestyle changes and, if needed, medical treatment. Symptoms may come and go, but with the right support, you can still enjoy restful sleep and a full, active life.

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