Ask The Doctor Diagnosing Restless Legs Syndrome

Overview

Restless legs syndrome (RLS) is a condition that makes you feel an overwhelming urge to move your legs. You may also feel uncomfortable tingling, crawling, or aching inside your legs. These feelings usually happen in the evening or at night, especially when you are sitting or lying down. Moving your legs often brings temporary relief.

Yes, restless legs syndrome is common. Some research suggests it affects about 1 in 10 adults at some point in their lives. Many people have mild symptoms, but some have symptoms that are severe enough to disturb sleep and daily activities.

RLS can affect people of any age, including children, but it is more common as you get older. Women are about twice as likely as men to have it. It can also run in families, and pregnancy can trigger or make symptoms worse.

Symptoms

Common symptoms

• A strong urge to move your legs, especially when sitting or lying down
• Unpleasant feelings in your legs like crawling, pulling, itching, or aching
• Symptoms that start or get worse in the evening or at night
• Temporary relief from movement, such as walking, stretching, or rubbing your legs
• Sleep problems, including trouble falling asleep or waking up often

Symptoms in children

• Children may describe the feeling as 'growing pains' or say they 'need to wiggle' their legs
• Trouble falling asleep or restless sleep
• Difficulty sitting still in class or during car rides
• Mood swings or daytime tiredness

Symptoms in older adults

• Symptoms may happen more often and be more intense
• Sleep disruption can be more severe, leading to daytime drowsiness
• RLS may overlap with other health conditions or medicines that older adults take
• Older adults may be at higher risk for falls when they get up to walk during the night

Causes

Main causes

• The exact cause isn't fully known, but it involves a problem with how the brain uses dopamine, which helps control movement
• Low iron levels in certain parts of the brain can be a factor, even if you don't have anaemia
• Family history: RLS often runs in families
• Pregnancy, especially in the later months
• Some chronic conditions like kidney failure, diabetes, and Parkinson's disease
• Some medicines, including certain antidepressants and allergy medicines (antihistamines)

Risk factors

• Being female
• Middle age or older
• Having a close family member with RLS
• Having low iron or anaemia
• Being pregnant
• Having sleep problems or mental health conditions like anxiety and depression

When to see a doctor

See a doctor urgently if:

• If your symptoms are making it impossible to sleep night after night, talk to a doctor soon
• If you also have severe leg pain, swelling, or a fever, seek medical help the same day

Book a routine appointment if:

• If you have uncomfortable urges to move your legs that affect your sleep or daily activities, make a regular appointment with your GP
• If symptoms started after you began a new medicine, your doctor may be able to adjust it
• If you notice your symptoms are getting worse over time, discuss this with your doctor

Diagnosis

There is no single test for RLS. Your doctor will listen to your symptoms and ask you about when they happen, how they feel, and what makes them better. They may also check your legs and ask about your sleep habits and any medicines you take.

Tests that may be done

• Blood tests to check iron stores (ferritin) and blood count
• Blood tests to check kidney function, blood sugar, and thyroid function
• Sometimes a sleep study (polysomnography) if your doctor suspects a sleep disorder like periodic limb movement disorder

What to expect at your appointment

Your doctor will ask questions such as: 'Do you get an urge to move your legs?', 'Is it worse at night?', and 'Does moving help?'. You may have a physical exam. The doctor may also review your medicines and health conditions. You might want to bring a note with your symptoms and how often they happen.

Treatment

The goal of treatment is to reduce your symptoms and help you sleep better. For many people, lifestyle changes are enough. If symptoms are more severe, your doctor may recommend medicines. It's important to treat any underlying causes, such as low iron.

Self-care at home

• Move your legs regularly — walking or stretching can ease symptoms
• Massage your legs or use a warm bath or heating pad
• Avoid caffeine, alcohol, and nicotine, especially in the evening
• Set a regular sleep schedule and keep your bedroom cool and comfortable
• Try relaxation techniques like gentle yoga, deep breathing, or meditation
• Spend time doing activities that distract your mind, like puzzles or reading

Medical treatments

If self-care isn't enough, doctors can consider several types of medicines. These include certain anti-seizure medicines that calm nerve signals, dopamine-like medicines that affect brain pathways, and in some cases other agents that relax muscles or improve sleep. All of these can have side effects, and some are more suitable for long-term use than others. Your doctor will discuss the risks and benefits with you. Never start or stop a medicine without your doctor's advice.

When is surgery considered?

Surgery is not used to treat restless legs syndrome.

Living with this condition

Living with RLS can feel frustrating, but small daily habits can help. Plan physical activity earlier in the day. Before bed, do a few gentle leg stretches. Keep your mind busy when you feel restless — reading or doing a puzzle can help distract you from the sensations. If symptoms bother you at night, sometimes getting up and walking around for a minute can reset your legs.

Lifestyle tips

• Take regular exercise, but avoid very hard workouts late in the evening
• Stretch your legs before bed and when you wake up
• Limit caffeine, alcohol, and nicotine
• Maintain a consistent sleep routine
• Try a warm bath or leg massage in the evening
• Reduce stress with calming activities like journaling, music, or talking with friends

Diet and exercise

Eat a varied diet with plenty of fruits, vegetables, whole grains, and lean proteins. Some people find that foods rich in iron (like beans, spinach, and red meat) help, but don't take iron supplements unless your doctor tells you to. Gentle exercises like walking, swimming, or yoga may reduce symptoms. Avoid sitting still for long periods — take short breaks to move.

Mental health and emotional wellbeing

RLS can be stressful and exhausting, especially when it keeps you up at night. It's normal to feel anxious, frustrated, or low. Your sleep loss can affect your mood and concentration. Talk to your doctor if you feel like RLS is hurting your mental health. Reaching out for support is a sign of strength.

Prevention

RLS cannot always be prevented, especially if you have a family history. However, for some people, avoiding triggers like alcohol, caffeine, and poor sleep habits can help reduce symptoms. Treating low iron and getting regular exercise may also prevent symptoms from getting worse.

Vaccines

There is no vaccine for restless legs syndrome.

Screening programmes

There is no routine screening test for RLS. If you are concerned about symptoms, talk to your doctor about a thorough check-up.

Complications

If left untreated

• Severe sleep loss, which can cause daytime tiredness and poor focus
• Mood problems, including irritability, anxiety, or depression
• Difficulty sitting still during meetings, long journeys, or social events
• Lower quality of life and reduced enjoyment of daily activities

Long-term outlook

The outlook for restless legs syndrome is good. Although RLS is often a chronic condition, most people can find meaningful relief with the right combination of lifestyle changes and, if needed, medical care. Many people manage it very well and go on to sleep well and live full, active lives.

Find support

International organisations

• Restless Legs Syndrome Foundation ↗
• Restless Legs Syndrome UK ↗

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