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.
Types of Restless Legs Syndrome Types 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296c7b0c66-009f-45bf-92d0-44185d60223c
Signs and Symptoms of Restless Legs Syndrome Symptoms 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629418b73fc-9466-4da9-8608-27dfffbc5dbd 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e43aa873-da12-4c40-b337-18ada4977074 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b25024e-0d47-4bc7-8a88-f3de3939fda0
Causes and Risk Factors of Restless Legs Syndrome Causes 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.e60dc2a1-f33c-4a05-9b50-8e3e8e59762925098017-a80c-4b16-b0dc-b6a9198b3bc7 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629121393a3-7ba5-4bfc-ab34-5fd37b372e29 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0d0d5f4-5129-48f0-8053-62051f16f2f8 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:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c6affc05-cc8d-43a5-bb82-96a22118bf14 Iron deficiency (with or without anemia ) Kidney failure Diabetes Parkinson’s disease Damage to the nerves in the hands or feet (peripheral neuropathy) Rheumatoid arthritis Pregnancy Medications that may aggravate RLS symptoms include: Antinausea drugs, such as prochlorperazine (Compazine) or metoclopramide Antipsychotic drugs, such as haloperidol (Haldol) or phenothiazine derivatives Some cold and allergy medications that contain older antihistamines like diphenhydramine In some cases , the use of antidepressants Alcohol, nicotine, and caffeine can also trigger symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296af6b6e9-e647-473e-b90e-e7f9b618137b
How Is Restless Legs Syndrome Diagnosed? Diagnosis There are no medical tests to diagnose RLS, but your doctor may perform blood tests and other exams to rule out other disorders.e60dc2a1-f33c-4a05-9b50-8e3e8e597629da6be556-e973-4f21-8390-bfdd366b3442 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab7e1898-17cf-486c-8e8e-ba0dbd8b5c59 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 .e60dc2a1-f33c-4a05-9b50-8e3e8e5976292d3732cd-bf5b-4ce8-9567-24b70311b310 As a result, this condition often goes undiagnosed in children.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba570711-1fad-4a14-bbfd-6677e0df0fe0
Treatment and Medication Options for Restless Legs Syndrome Treatment 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629243cc53a-d995-4598-b959-d0fc8d22f428 Treatment options for RLS include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762988556533-4562-4934-b56a-ac7a3aa6969c Medications: Gabapentin enacarbil, Gabapentin, and Pregabalin are medications advised by the American Society of Sleep Medicine (AASM).e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f744252-205b-4d6d-a50e-cc24d9d7e0ce 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).e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f744252-205b-4d6d-a50e-cc24d9d7e0ce 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f744252-205b-4d6d-a50e-cc24d9d7e0ce Medications previously recommended, that are now strongly advised against by the AASM include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f744252-205b-4d6d-a50e-cc24d9d7e0ce Ropinirole Pramipexole Rotigotine Levodopa Cabergolinee60dc2a1-f33c-4a05-9b50-8e3e8e5976293a1d6c3d-729e-4842-b2a6-05bac2c22347 The AASM also advises against the use of these medications:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f744252-205b-4d6d-a50e-cc24d9d7e0ce 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f4b3bc61-28b1-4284-be14-d80a72bb177d 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629687490be-a3ed-4b1c-b6db-8109d00d6eba 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292c834eef-6b1f-41bb-b42f-d363ea612ab5 Hot baths and massages can be helpful in relieving symptoms as well.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297a72a298-5c49-479d-8c1d-a3ec2133ea3a
Prevention of Restless Legs Syndrome Prevention 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629697da6d0-5c2f-4023-93c9-8d3a8163183f
Lifestyle Changes for Restless Legs Syndrome Lifestyle Changes Symptoms of RLS also can be alleviated by some lifestyle changes. You can try the following:e60dc2a1-f33c-4a05-9b50-8e3e8e59762921e7592a-a8e0-4697-b6f7-c16b1f451c69 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629514d3eaf-8475-4f0c-8dc2-8c2578ed7537 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.
Restless Legs Syndrome Prognosis and Outlook Prognosis and Outlook 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297e3dbf53-d007-49ce-87ce-d885fc9877cd 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b51459ba-6f4a-4513-a808-52729381ec63 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629564fe7f9-1d0a-4db3-812b-f8bd6c0dbe3b 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.
Complications of Restless Legs Syndrome Complications 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293f2d3b98-6b48-4ac7-81bb-0eb4071bedc9
Research and Statistics: How Common Is Restless Legs Syndrome? Research and Statistics Restless legs syndrome affects between 5 and 10 percent of the adult population in the USA. It affects 2 to 4 percent of children.e60dc2a1-f33c-4a05-9b50-8e3e8e59762918bdc28b-4397-4244-a7d1-fe31d59d4ad9 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296c7cd540-a82c-441f-86b5-1354a9e06de8 Research suggests that RLS affects an estimated 1.5 million children and adolescents in the United States.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f2cd7ede-e982-4d89-b5ef-2fbda9fd9c97 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.e60dc2a1-f33c-4a05-9b50-8e3e8e59762978de9395-6434-4b68-8572-bc6fee332c96
Related Conditions of Restless Legs Syndrome Related Conditions 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.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299ae481a6-2ea7-46e0-9882-a9188d899863 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.e60dc2a1-f33c-4a05-9b50-8e3e8e59762996bae783-1f3f-4bd9-bfe5-a13a8ed77ea9 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.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc1bc24a-e564-4ca6-b9ac-81ec6f9c6755
The Takeaway 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.
Resources We Trust Mayo Clinic: Mayo Clinic Q and A: Restless Legs Syndrome in Children Cleveland Clinic: Restless Legs Syndrome Restless Legs Syndrome Foundation: Diagnosis & Treatment National Sleep Foundation: Do I Have Restless Legs Syndrome? National Institute of Neurological Disorders and Stroke: Restless Legs Syndrome
