Restless Legs Syndrome

Medically Reviewed By William C. Lloyd III, MD, FACS

What is restless legs syndrome?

Restless legs syndrome (RLS) is a neurological condition also known as Willis-Ekbom disease. The condition creates unpleasant sensations in the legs that are temporarily relieved by movement. Because the condition often happens at night, it can be detrimental to a person’s ability to sleep.

Up to 10% of adults and 4% of children in the United States may have RLS. Females are more likely to be affected than males, and symptoms occur more often in older people. People who are pregnant or have iron deficiency anemia or certain other health conditions, such as Parkinson’s disease may be more likely to experience RLS. The condition often runs in families.

Some people describe their restless legs syndrome symptoms as a creepy-crawly feeling, throbbing, or aching in the legs. The person may feel an irresistible urge to move their legs to relieve the unpleasant feeling. The sensation can range anywhere from annoying to painful. Symptoms may worsen with increasing age.

There is no cure for RLS, but treating underlying conditions can help relieve symptoms. If there is no underlying condition, treatment focuses on symptom management using massage, heat or cold therapy, certain drugs, or medical devices. Sometimes more than one RLS treatment option is necessary for symptom relief, such medication and massage, or changing medications if one stops working.

Without treatment, RLS can affect a person’s quality of life, causing mood swings, difficulty concentrating, and problems with performance at work or school. A person may experience negative health effects related to sleep deficiency, such as depression, anxiety, heart problems, or obesity. If you have RLS or think you have it, it’s important to talk with your doctor about a diagnosis, especially if your symptoms are disruptive. Together, you can develop a treatment plan to reduce symptoms.

What are the symptoms of restless legs syndrome?

The main restless legs syndrome (RLS) symptom is an irresistible urge to move the legs due to discomfort in keeping them still. People often describe the sensation as crawling, throbbing or aching within the legs, not on the skin. Walking, stretching, shaking or jiggling the legs usually relieves the sensation, but only temporarily. In some cases, RLS affects the arms too.

RLS symptoms often come and go and may fluctuate in severity, ranging from uncomfortable to painful. Some people with mild symptoms may experience them only once or twice a month, while others have symptoms daily. Symptoms usually tend to get worse with time. This is more likely to happen in people with RLS due to an underlying health condition.

For most people, RLS symptoms happen at night, oftentimes after sitting or lying down for a while. Many people with RLS also experience a similar condition in which their legs twitch or kick while they sleep. This condition is periodic limb movement of sleep (PLMS), though most people who experience PLMS do not have RLS.

RLS often affects a person’s quality of sleep or indicates an underlying health condition, such as diabetes, iron deficiency, or kidney problems. For this reason, it’s important to seek professional medical help for symptoms of RLS.

What causes restless legs syndrome?

While many people seem to have restless legs syndrome (RLS) unrelated to any specific cause, other conditions can trigger or worsen the condition. Some RLS causes include:

  • Pregnancy or other hormonal changes 

  • An imbalance of dopamine in the brain

  • Multiple sclerosis

  • Parkinson’s disease

  • Iron deficiency 

  • Genetics, and family history of RLS

According to the National Institute of Neurological Disorders and Stroke, RLS is linked to an area of the brain involved in regulating movement. Disruption of pathways that use dopamine, a chemical messenger, can lead to involuntary muscle movements as seen with RLS.

What are the risk factors for restless legs syndrome?

While the cause of restless legs syndrome is often not known, some people do have a higher chance of developing RLS symptoms. RLS risk factors include:

  • Parkinson’s disease: Conditions stemming from a problem in the movement center of the brain increase the risk of RLS. 

  • Sex: Females are more likely than men to have RLS. 

  • Older age: People who are middle aged or older are more likely to have RLS, but it can happen to anyone of any age. 

  • Pregnancy: RLS in pregnancy, especially in the last trimester, is common.

  • Diabetes: People with diabetes often also have peripheral neuropathy, which is nerve damage in the hands and feet. This nerve damage can contribute to RLS.

  • Alcoholism: People with alcohol use disorder can also develop peripheral neuropathy (nerve damage) and RLS related to the damage).

  • Low iron levels: A low level of iron in the blood increases the chances of developing RLS. 

  • Bleeding or blood donation: Blood loss can contribute to low iron levels, which in turn can raise the risk of RLS.

  • Kidney failure: End-stage renal disease can lead to low iron levels, which is a risk factor for RLS. 

  • Certain medications: Some antidepressants, antipsychotics, cold and allergy drugs, and drugs to reduce nausea may contribute to RLS symptoms. 

  • Damage to the spinal cord: Conditions that cause lesions on the spinal cord can contribute to RLS. 

If you experience symptoms of RLS (or other uncontrollable movements), talk with your doctor about your potential risk factors for the condition. After an evaluation, your doctor can make recommendations about how to either reduce your risk or ways to manage your symptoms.

What are the diet and nutrition tips for restless legs syndrome?

While you can’t change your age or family history, there are ways to reduce your risk of experiencing restless legs syndrome with some simple changes to your diet.

If you have low blood-iron levels, you can add more iron-rich foods to your diet. Some options include:

  • Red meat, such as beef and pork

  • Chicken and turkey

  • Seafood

  • Eggs 

  • Dark green leafy vegetables, such as kale and spinach

  • Veggies, such as broccoli and potatoes

  • Dried fruit, such as raisins and prunes

  • Legumes, such as kidney beans, chickpeas, peas, and lentils

  • Seeds and nuts

In addition to adding iron, cutting back on caffeine and alcohol may also help reduce your symptoms.

Before making any big changes to your diet, talk with your doctor about which nutritional adjustments would be most beneficial for your exact situation.

How do doctors diagnose restless legs syndrome?

First, your doctor will perform a physical exam and ask you about your family and medical history. There is no specific test for diagnosing restless legs syndrome (RLS). Rather, your doctor will focus on your symptoms. If your symptoms match five specific criteria, your doctor may diagnose you with RLS.

RLS diagnostic criteria include:

  • A strong urge to move your legs, typically in response to uncomfortable sensations

  • Rest or inactivity increases this urge

  • Movement temporarily relieves the unpleasant sensations, at least partially

  • The urge occurs primarily later in the day and at night

  • No other medical or behavioral condition can explain these symptoms

To find out whether you meet these five criteria, your doctor may ask such questions as:

  • What do the sensations in your legs feel like?

  • What makes your symptoms worse? 

  • What helps relieve your symptoms?

  • Are your symptoms worse at night?

  • How often do your symptoms occur?

  • Does anyone else in your family have restless legs syndrome?

  • What medications are you taking?

  • What other health conditions do you have?

If you meet the criteria for RLS, your doctor may want to investigate further with additional testing to rule out underlying conditions. For example, a blood test can reveal low iron levels. Your doctor may also perform a neurological examination.

In some situations, your doctor may refer you for a sleep study to rule out sleep apnea or other sleep disorders.

What are the treatments for restless legs syndrome?

If you do have an underlying medical condition, treating that condition may relieve or reduce restless legs syndrome (RLS) symptoms. For example, if low iron levels are causing your RLS symptoms, taking an iron supplement can help.

Lifestyle changes for RLS

For people with mild RLS symptoms, a few lifestyle changes may be enough to alleviate the problems. These changes can include:

  • Reducing caffeine and alcohol use

  • Stopping smoking

  • Improving sleep habits 

  • Massaging and stretching the legs

  • Applying heat or cold to the legs

  • Soaking the legs in a warm bath

  • Aerobic exercise approved by your doctor

Medical devices

An approved medical device for your feet and legs may help relieve symptoms. There are a couple of different devices your doctor may recommend for you, including:

  • A special foot wrap that puts pressure on the bottom of the foot and increases blood flow to the legs

  • A vibrating pad for the back of the legs

Medications

RLS treatment can include medications that can help with symptom management. These medications can include:

  • Iron supplements 

  • Drugs to increase dopamine level in the brain

  • Antiseizure drugs

  • Drugs that affect a particular calcium-channel protein

  • Low-dose opioids

  • Muscle relaxants

  • Sleep medication

Some of these medications can have side effects, such as nausea, daytime drowsiness, or fatigue. Drugs that affect the brain neurotransmitter, dopamine can sometimes cause impulse control disorders, and opioids can be highly addicting. Discuss the pros and cons of any medication for RLS with your doctor.

Sometimes, the RLS medication may stop working after taking it for a long time, so you may need to change medications at some point. It may take some trial and error to find effective relief for RLS.

How does restless legs syndrome affect quality of life?

In addition to the unpleasant sensations of restless legs syndrome (RLS), the condition can affect your quality of life.

RLS symptoms may affect your ability to get restful sleep leading to excessive daytime drowsiness. People with severe restless legs syndrome may also experience depression, anxiety, mood swings, memory problems or difficulty concentrating. Someone with RLS may find that the condition affects their performance at work or school. All of these effects can have a negative impact on their personal relationships as well.

Although RLS is considered a chronic condition, some people experience periods of remission, according to the National Institute of Neurological Disorders and Stroke. For RLS, remission means symptoms are mild or may be absent for weeks, months or years.

Coping with RLS 

While RLS can negatively affect your daily life, there are steps you can take to manage your symptoms and reduce their effect. Some of the ideas you can try include:

  • Exercise and massage your legs to ease uncomfortable sensations.

  • Don’t resist the urge to move, which can make your symptoms worse.

  • If you feel self-conscious about your need for movement, tell others around you about your condition.

  • Find others who understand what you’re going through, such as an RLS or movement disorder support group.

  • Learn about RLS and RLS research, including clinical trials testing investigational new therapies.

What are the potential complications of restless legs syndrome?

While restless legs syndrome (RLS) isn’t dangerous on its own, the effects it can have on someone’s life, particularly sleep disturbances, may be detrimental to a person’s health.

Because RLS symptoms can prevent someone from falling or staying asleep, the person is less likely to get a good night’s rest on a regular basis. People who don’t get enough sleep are more likely to develop mental health problems, such as depression and anxiety, as well as other health issues, such as heart disease and obesity. Insomnia related to RLS symptoms also increases the risk for these complications.

Medication and other therapies can decrease symptoms and increase the amount of restful sleep reducing the risk of complications.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Dec 13
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