Restless Legs Syndrome

What Is Restless Legs Syndrome?

Restless Legs Syndrome (RLS) is a sensory disorder causing an almost irresistible urge to move the legs. The urge to move is usually due to unpleasant feelings in the legs that occur when at rest. People with RLS use words such as creeping, crawling, tingling, or burning to describe these feelings. Moving the legs eases the feelings, but only for a while. The unpleasant feelings may also occur in the arms.

Effects of Restless Legs Syndrome

RLS can make it hard to fall asleep and stay asleep. People with RLS often don’t get enough sleep and may feel tired and sleepy during the day. This can make it difficult to:

Concentrate, making it harder to learn and remember things
Carry out other usual daily activities
Take part in family and social activities

Risk Factors and Treatment of Restless Legs Syndrome in Adults

RLS can range from mild to severe, based on:

How much discomfort you have in your legs and arms
Whether you feel the need to move around
How much relief you get from moving around
How much sleep disturbance you have
How tired or sleepy you are during the day
How often you have symptoms
How severe your symptoms are on most days
How well you carry out daily activities
How angry, depressed, sad, anxious, or irritable you feel

Types of RLS

There are two types of Restless Leg Syndrome:

Primary RLS is the most common type of RLS. It is also called idiopathic RLS. “Primary” means the cause is not known. Primary RLS, once it starts, 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. In milder cases, there may be long periods of time with no symptoms, or symptoms may last only for a limited time.
Secondary RLS is RLS that is caused by another disease or condition or, sometimes, from taking certain medicines. Symptoms usually go away when the disease or condition improves, or if the medicine is stopped.

restless leg syndrome
restless leg syndrome

Periodic Limb Movement Disorder or Periodic Leg Movements during Sleep

Many people with RLS also have a condition called periodic limb movement disorder (PLMD). PLMD is a condition in which a person’s legs twitch or jerk uncontrollably about every 10 to 60 seconds. This usually happens during sleep. These movements cause repeated awakenings that disturb or reduce sleep. PLMD usually affects the legs but can also affect the arms.


RLS can be unpleasant and uncomfortable. However, there are some simple self-care approaches and lifestyle changes that can help in mild cases. Restless Leg Syndromesymptoms often improve with medical treatment. Research is ongoing to better understand the causes of RLS and to develop better treatments.

What Causes Restless Legs Syndrome?

Primary RLS

In most cases of restless leg syndrome (RLS), no cause can be found. When no cause can be found, the condition is called primary RLS. It is known, however, that primary RLS tends to run in families. People whose parents have RLS are more likely to develop the disorder. This suggests that there may be a genetic link that increases the chance of getting RLS.

Secondary RLS

Secondary RLS is RLS that is caused by another disease or condition, or as a side effect of certain medications. Some of the diseases and conditions that can cause RLS are:

Iron deficiency (with or without anemia)
Kidney failure
Parkinson’s disease
Damage to the nerves in the hands or feet (peripheral neuropathy) (pe-RIF-e-ral noo-ROP-a-the)
Rheumatoid arthritis (ROO-ma-toyd ar-THRI-tis)

RLS is common in pregnant women. It usually occurs during the last 3 months of pregnancy and usually improves or disappears within a few weeks after delivery. However, some women may continue to have symptoms after giving birth or may develop RLS again later in life.

People with PMLS or PMLD have uncontrollable leg movement during sleep.

Some of the types of medicines that can cause RLS are:

Antiseizure medicines
Antinausea medicines
Some cold and allergy medicines

RLS symptoms usually go away when the medicine is stopped.

Certain substances can trigger RLS symptoms or make them worse. These substances include:

  • Caffeine
  • Alcohol
  • Tobacco

Who Is At Risk for Restless Leg Syndrome?

Restless Leg Syndrome (RLS) may affect as many as 12 million people in the United States.


RLS affects both men and women. The disorder occurs more often in women than in men.


The number of cases of RLS rises with age. Many people with RLS are diagnosed in middle age. But in up to two out of every five cases, the symptoms of RLS begin before age 20. People who develop RLS early in life usually have a family history of the disorder.

Race/Ethnic Group

RLS can affect people of any race or ethnic group. The disorder is more common in persons of northern European descent.


RLS is common in pregnant women. It usually occurs during the last 3 months of pregnancy and usually improves or disappears within a few weeks after delivery.

What Are the Signs and Symptoms of Restless Legs Syndrome?

Restless legs syndrome (RLS) has several major signs and symptoms:

An almost irresistible urge to move the legs or arms when sitting or lying down
An unpleasant feeling in the legs
Difficulty falling asleep or staying asleep because of the unpleasant feelings in the legs or arms
Daytime sleepiness, which results from a lack of restful sleep due to the repeated limb movements

Urge To Move

RLS gets its name from the urge to move the legs when sitting or lying down. This urge is due to unpleasant feelings in the legs that are relieved by movement. Typical movements are:

  • Pacing and walking
  • Jiggling the legs
  • Stretching and flexing
  • Tossing and turning
  • Rubbing the legs

Unpleasant Feelings

The urge to move the legs usually is due to unpleasant feelings in the legs. People with RLS describe these feelings as:

  • Creeping
  • Crawling
  • Pulling
  • Itching
  • Tingling
  • Burning
  • Aching
  • Painful
  • Hard to describe

Children may describe RLS symptoms differently than adults.

The unpleasant feelings in RLS usually occur in the lower leg (calf). But the feelings can occur at any place between the thigh and the ankle and also in the arm. The feelings are worse:

When lying down or sitting for a long period of time
During the evening or night, more so than during the day

The unpleasant feelings also:

Make it hard to fall asleep or stay asleep
Are not as bad or go away when you move

Duration and Severity

RLS symptoms tend to get worse over time. They may begin in childhood and develop slowly over several years. People with early symptoms are more likely to have other family members with RLS than people who develop RLS later in life.

Symptoms tend to worsen faster when RLS occurs later in life. RLS that occurs later in life is also more likely to result from an underlying condition or illness than RLS that occurs early in life.

People with mild symptoms may only notice them when they are still or awake for a long time, such as on a long airplane trip.

How Is Restless Legs Syndrome Diagnosed?

The way that you describe your symptoms is very important in diagnosing restless legs syndrome (RLS). Your doctor will:

Take a complete medical history
Do a complete physical examination
Order other tests

The diagnosis of RLS usually requires the following four conditions be present:

An urge to move the legs due to an unpleasant feeling in the legs.
The urge to move the legs, or the unpleasant feelings in the legs, begins or gets worse when you are at rest or not moving around frequently.
The urge to move the legs, or the unpleasant feelings in the legs, is partly or completely relieved by movement (such as walking or stretching) for as long as the movement continues.
The urge to move the legs, or the unpleasant feelings in the legs, is worse in the evening and at night, or only occurs in the evening or at night.

Medical History

Your doctor will take a medical history and ask questions such as:

Can you describe your symptoms?
When did your symptoms first begin?
When during the day or night do the symptoms usually occur?
When are your symptoms worse?
Do symptoms interfere with your sleep?

Your doctor will also ask about your sleep habits, such as:

The time you go to bed and get up
Your routine before going to bed
Noise, light, and interruptions in the room where you sleep
Whether you snore

Your doctor will ask about how you feel during the day, including whether:

You are tired and sleepy when you wake up and during the day.
You have trouble concentrating.
You doze off or have difficulty staying awake doing routine tasks, especially driving.

Your doctor will ask questions to find out if your symptoms are a result of a possible underlying condition. Questions might include:

Do members of your family have similar symptoms?
What medicines (over-the-counter and prescription) do you take?
Do you snore loudly and frequently?
Do you gasp for air during sleep?
Do you use caffeine, tobacco, or alcohol?

Physical Exam

A physical exam is done to:

Identify any underlying condition that may cause RLS
Rule out other disorders

Your doctor also will pay special attention to:

The nerves in your spinal cord (especially) and legs and arms
The blood flow in your legs and arms

Other Tests

There is no test currently available to diagnose RLS.

However, blood tests can be used to look for underlying conditions that can cause RLS. These tests check for:

Low iron stores or iron deficiency
Kidney disease
Other vitamin and mineral deficiencies

How Is Restless Legs Syndrome Treated?

The goals of treatment for restless legs syndrome (RLS) are to:

Relieve symptoms
Increase the amount and quality of sleep
Treat or correct any underlying condition that may cause RLS

Types of treatment include:

Lifestyle changes and other nondrug treatments

Lifestyle changes can improve and relieve symptoms of RLS. Lifestyle changes may be the only treatment needed for mild RLS. Some lifestyle changes that may help include:

Avoid things that can make symptoms of RLS worse:
Caffeine—Chocolate, coffee, tea, and some soft drinks contain caffeine. Although it may seem to help overcome daytime sleepiness, caffeine usually only delays or masks RLS symptoms, and often makes them worse.
Some medicines—Some types of over-the-counter and prescription medicines can also make RLS symptoms worse. These include:
Antidepressants (most of them)
Antinausea medicines
Antipsychotic medicines
Adopt good sleep habits:
Keep your bedroom or sleep area cool, quiet, comfortable, and free of unnecessary light.
Use your bedroom for sleeping, not for watching TV or using computers or cell phones.
Go to bed every night at the same time and wake up at the same time every morning. Some people with RLS find it helpful to go to bed later in the evening and get up later in the morning. The important thing is to get enough sleep so that you feel rested when you wake up.
Follow a program of moderate exercise

Other activities that also may help relieve symptoms include:

Walking or stretching
Taking a hot or cold bath
Massaging the leg or arm
Using heat or ice packs


Medicines can help relieve some symptoms of RLS. Doctors prescribe medicines to treat RLS in people:

With clearly defined symptoms
Whose symptoms cannot be controlled by lifestyle and nondrug treatments

No single medicine is helpful in all persons with RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.

Some medicines may not be safe for pregnant women.

Always talk with your doctor before taking any medicines, even over-the-counter medicines.

Specific medicines

Medicines used to treat Parkinson’s disease also are used to treat RLS. Even though these medicines help reduce RLS symptoms, RLS is not a form of Parkinson’s disease. The medicines help reduce the amount of motion in the legs. They include:

Levodopa (le-vo-DO-pa)
Is best used to treat mild cases of RLS
Is short-acting
Works for a while but does not work long term in most people
Dopamine agonists (pergolide (PER-go-lid), pramipexole (prah-mih-PEX-ohl), and ropinirole (roh-PIN-ih-roll))
Are used to treat moderate and severe cases of RLS
Are used to treat mild cases of RLS if levodopa stops working
Are long-acting

The U.S. Food and Drug Administration recently approved ropinirole to treat moderate to severe RLS.

Other medicines may be used to treat RLS, including:

Strong pain-relieving medicines (narcotics).
Used most often when symptoms are severe
May be used in people who don’t respond to dopamine agonists
Sedatives (benzodiazepines (BEN-so-di-AZ-e-pens)).
Help with falling asleep
May cause daytime sleepiness
Are not recommended for people with sleep apnea and for older persons
Medicines used to treat epilepsy (anticonvulsants: gabapentin (gab-ah-PEN-tin), carbamazepine (kar-bam-AZ-e-pen), and valproate (val-PROH-ate)). These types of medicines are:
Considered when dopamine agonists fail
Most effective in persons with daytime and evening symptoms, as well as sleep-onset symptoms, and in those who describe the unpleasant feelings in the legs as painful.
Iron supplements, if iron deficiency appears to be contributing to RLS. Iron supplements should only be used if recommended by a doctor.

Above courtesy of NHLBI

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18 thoughts on “Restless Legs Syndrome

  1. Jim Reply

    I suffer from Sleep Apnea and use the ASV machine. I also suffer from Restless Leg Syndrome. I am curious if there are coorelation between sleep apnea and RLS? If so is there any literature or website that supports the coorelation?

  2. Pauline Mott Reply

    RLS can and does hapen at any time day or night. I have had RLS since childhood and I am on Pramipexole which works effectively to control my symptoms. Without the drug I would not be able to take a long car or bus ride, read a book or newspaper while holding it, go to a concert or movie, sit quietly in a chair, drive a car without the possibility that my leg will spontaneously jerk my foot off the gas or brake pedal. On the other hand until recently I have had no problem with RLS at night due to taking the drug but since starting to use a CPAP unit I have been getting RLS, mostly in my arms.

  3. Paul Reply

    I suffer from insomnia RLS and anxiety periodically. Disclaimer: I have no medical background and no expertise in the area. Treat everything said here as being the rantings of an uninformed idiot. The content of this message is pure conjecture. Talk to a doctor before starting any exercise regime. If you are taking medication then talk to a doctor before changing or stopping your medication. My opinion is worthless in these matters.
    End of disclaimer.
    The sensation though difficult to describe and I know that this description is not really exactly what I feel but this is my best effort and and attempt to hypothesize the cause and a potential solution. (It seems to work for me.)
    It is as though my muscles are feeling the sensation of contraction (or being under stress) even though they are at rest. When you deliberately move this sensation of contraction is not unpleasant because you have are all of the other neural messages that get sent telling your brain that your limb is actually moving. To have the message of contatraction without the other accompanying messages is unpleasant it is like music without being able to hear the melody or rhythm. This causes your brain to want to satisfy the demand for the other neural messages so you have the urge to move to generate the other messages. So you move for the duration of the motion that that fraction of a second every thing is fine but the motion comes to an end and the sensation of contraction is still there. you resist for a while until the sensation comes unbearable and the urge to move again becomes overwhelming.

    Anxiety, stress and insomnia can cause muscles to stay in a contracted state for uncommonly long periods of time this I think can lead to the muscle fibre shortening. My father deals with his RLS with medication. His symptoms are far worse than mine, he has always managed this with drugs which from my point of view have seemed to exacerbate the problem in the long term creating dependancy on the drugs. It seems to me (having no medical education or knowledge) that drugs actually feed the habit because rather than lengthening the muscle they prevent the messages that tell the muscle it needs to be lengthened. Allowing the muscle to shorten further.

    I have been doing yoga for the last year now. This lengthens the muscle fibres. The fibres are no longer under tension when the muscle is at rest so it does not generate the sensation of being under tension when at rest. I find that a regular routine of and hour of Yin yoga before bedtime helps enormously. Check out Kassandra’s youtube videos on Yin Yoga.

  4. Suzy Reply

    Im so sorry that all of you are going through this. RLS has become not just pain but a form of torture. I have had RLS for 24 years! I slao have Fibromyalgia,
    DDD ( degeneratve disc disease) Chronic migraines, O. Arthriris. I’m going on 60 yrs old. I was a military dependent wife 20 yrs. I saw American, British, and German doctors. I was told it was all in my head, MS, muscle issues, nerve issues, and chemical imbalance in my brain. I have taken every med. for it. Clonazepam and hydrocodone or any opiod worked like a miracle for 2 yrs. Now it is worse and has moved to my arms and body. I cry, even scream in pain every night. I even tried doubling the Clonazepam but did not help. Every day I get depressed knowing its going to happen again. I sleep less then than 16 hours a week. RLS has robbed me of my life. Due to no sleep, my immune system is compromised. I am always tired, I had to quit work, stop going to church, lost friends. I’m praying for a miracle for all of us, a cure, a reason why would be nice. They are still just guessing what csuses it. But im glad im not going through this alone . Not that i want anyone in the world to suffer like this but that I’m not alone or crazy. If i get anything that works i will let uou lnow and please do the same for me.

    • deb nowak Reply

      Oh my gosh you sound just like me ! This weekend I told my friend I can understand and how someone with Fibromyalgia, osteoporosis and restless leg syndrome and degenerate disc disease would consider suicide however I couldn’t do it but I can understand why they would if they do. I take mirages but doesn’t seam like it helps like it did at first but there again I have it when I just sit down let alone lie down that’s why I hate for night to come cuz I just stay on my feet all day ! Appreciate any help in Illinois carlyle Lake

      • Deborah Luich Reply

        I have all your conditions too.Born with my 5 top vertebrae straight,and out of proper alignment most of the time. They are supposed to be curved in a c-shape and the bottom 5 are also out of alignment and very thin as well as hips;dr. Says don’t fall..Tingly from head to foot all the time now, and now have spondylosis the last few yrs ..had a sleep study and was told my RLS is wearing out the joints in my neck ,low back and knees too.I hate to go to bed.Im 68 yrs.old.Waiting to see my sleep sp.again in a few weeks,to discuss blood work and meds.Side affects of alot of meds cause itching..more than what I usually deal with..being out in the sun really intensifies the itching..or even in the house when I do chores and get fibro screws up my arm can be cold the other hot.Worse part,when you look and friends have no clue of our personal on-going torment!!!Faith, prayer and alot of bible reading keeps me from killing myself.God sees and helps me to endure these invisible illnesses.That belief helps me keep going.’Im able to walk to the mailbox still at end of my parking lot in my aptI try to go 4 or 5 times a week..Im glad for that.I know others have worse things going on..but,I wouldn’t wish my daily pain and symptoms on my worst enemy.

  5. Maria Reply

    It’s after midnight and I am lying here in bed writing a response to this thread because I too am one that suffers immensely from severe RLS. I have had it since I was a kid, at least 7 years old, and now 33 it has gotten progressively worse. I have bad anxiety and my doctor used to prescribe me Klonopin, which also helped relieve my RLS symptoms very well. When I switched to a neurologist, he put me on Mirapex which did not work. Then to Ropinorole, which works great. But I’ve had to request an increase in my prescription twice in the last few years because I have symptoms even taking doses in both AM and PM because daytime RLS has started to take effect. I f*ed up and forgot to refill, so here I am in pure misery. 10-15 second intervals of the feeling like my leg is going to implode. I’m so miserable. I have asked to go back on Klonopin before and the neurologist won’t approve it because it is a tier 2 drug, but I feel it did so much better for me because it also helped my anxiety too. Is anyone else having the same issue?

  6. Mike Powers Reply

    I have had RLS ever since I was a kid. Now that I am old, it’s getting worse. I usually get up, go to the sink and do up/downs until I can’t any more. Either I am just so tired I fall asleep or the excercise actually works. But, a couple of weeks ago I invented something that works. I am in the process of getting an Utility patent and then I will share it here and with the world. All I know is it works for me and doesn’t have anything to do with pills or supplements or lifestyle changes. I need a name for it, any ideas?

    • Maria Reply

      Hi Mike I am terrible at coming up with names but if you get it patented and it works, I will become a customer for sure! I’m so miserable. I missed one night of meds tonight due to my mess up on picking up my refill and I’m in RLS hell. I look forward to the future on your idea!!

  7. Helen Garson Reply

    Amazingly I think I have just made a discovery….my restless legs have been getting worse by CUTTING BACK on coffee! One is normally told that it exacerbates RLS and maybe cutting it out completely would be the answer but that is an issue in itself. I have found that instead of cutting my coffee consumption back and rarely drinking it after lunchtime, if I keep drinking it throughout the day, maybe 4/5 hour intervals it seems to keep the caffeine levels up and somehow my legs are ok. Incredible so far. I think I have been suffering from caffeine withdrawal. Not ideal I know….I still take my 0.35mg of mirapexin every evening, maybe I can wean myself off that too. Which is better, caffeine or the drug! Sounds bonkers but it’s working for me right now.

  8. Rebecca Reply

    I have restless legs that is almost constant now. I have this along with back pain. Mirapex was working but as of the last 4 months I have been having more and more days where I get no relief at all. My doctor is trying me on gabapentin and valum. Taking it the last 2 days, restless legs have lasted on and off for the last few nights I have a call into my doctor, cant take this anymore. Has anyone else had this day and night almost constantly and any suggestions on something to give relief? Having other issues now due to lack of sleep.

    • Mark Churchman Reply

      I have sciatica and diabetes , my left leg jerks constantly whilst trying to sleep , am on medication for my ailments , but the leg spasms persist at night , they do make one tired and moody due to lack of sleep , i just go for walks in the evening and do mild stretching to help combat the spasms, i sympathize with those fellow sufferers .

    • Bob Reply

      My rls is to the point where it happens all day. I have to stand up to watch TV. I tripled my requip to 1.5 and last night was the first time in three weeks that I slept for more than two hours or not at all. I don’t know if that will do it. The only people who have any idea how crippling it can b r people who have it. Mine has gotten so bad I’m wondering how long I can take this. I’m losing my mind. Going to get checked for iron deficiency. I hope he tells me I have low iron. I wish I could give u more other than you’re not alone. All these home remedies and advice work as well as taking a baby aspirin for a migrane.

  9. mike offord Reply

    i agree with bill. some nights can feel like your being tortured. its agonizing to lay there watching the clock while kicking my spouse over and over again. so get up and walk it off. sometimes i will drag my feet on the carpet and do a few puzzles. after that i can usually lay back down. the parkinson’s medication works great.

  10. Bill Blaauboer Reply

    Keep trying to find anything for help. When RLS hits, get up and move, walk, exercise for @ 10 minutes. If a doctor tells you that he can cure the symptoms or if he tells you he knows the cause of the disease, very politely get up, tell your Dr., that you and run like hell from his office and never return.

    The only help I’ve had is a drug used for Parkinson’s disease, which does help me sleep, however there is no cure.

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