Restless Legs Syndrome (RLS): Symptoms and Treatment

Medically Reviewed by Jabeen Begum, MD on July 19, 2024
Written by Mary Anne Dunkin, Kendall K. Morgan
9 min read

Restless legs syndrome (RLS) is a nervous system disorder that causes an overpowering urge to move your legs. It’s also known as Willis-Ekbom disease, primary RLS, or idiopathic RLS. Idiopathic means that there's no known cause.

Doctors consider it a sleep disorder because it usually happens or gets worse while you’re at rest. But it's also a movement disorder. You might have trouble sleeping or sitting for a long time, such as in a theater or car. It may get worse if you don’t get treatment. Over time, a lack of sleep can cause problems at work or home.

Restless legs syndrome affects up to 10% of people in the U.S. Anyone can get it, but it’s more common in women. Also, middle-aged people are more likely to have severe symptoms.

Sometimes, doctors don’t recognize RLS, especially if symptoms are mild or don’t happen often. But once it’s diagnosed, treatment can often stop it.

What's the link between RLS and periodic limb movement disorder?

Experts estimate that about 80% of people with restless legs syndrome also have periodic limb movement disorder, or PLMD, which is also called periodic limb movement of sleep (PLMS). In PLMD, the arms or legs twitch or jerk during the night. These movements can happen as often as every 15 seconds. The movements disturb sleep and can cause chronic sleepiness.

Many people have periodic limb movement disorder by itself and will never get restless legs syndrome. If you think you may have PLMD, see your doctor.

Experts estimate that up to 7%-10% of people in the U.S. may have restless legs syndrome, also called RLS. About 2%-3% of them have moderate to severe symptoms that affect their quality of life. Also:

  • More women than men get it. Doctors don't know why that is.
  • Most people with severe RLS are middle-aged or older.
  • While children can get RLS, it's rarer than in adults. Roughly 2% of school-age children may have RLS, and it may be more likely if they have a parent with RLS.

People with restless legs syndrome have unusual feelings in their legs (such as itching, crawling, pulling, aching, throbbing, or pins and needles). They also have a powerful urge to move their legs to make the sensations go away. The condition can also happen in other areas such as the arms, chest, or head. The feelings usually happen on both sides of the body. They can also happen on only one side, or they might start on one side and then move to the other. RLS symptoms range from mild to unbearable.

When do restless legs syndrome symptoms usually occur?

Your symptoms might come and go, and the intensity can vary between episodes. They’re generally worse in the evening and at night.

Symptoms almost always go away in the early morning, so people who have RLS can often sleep well then.

For some people, symptoms may cause severe nightly sleep disruption that can impair their quality of life.

What causes restless legs syndrome to flare up?

RLS symptoms are often at their worst after periods of rest. You may notice them after you've been inactive and sitting for a long period. For example, your symptoms may get worse if you're on a long flight or watching a movie. 

For the most part, it's not clear what causes RLS to flare. It can change from day to day. You might have symptoms once or twice a week with breaks in between.

Restless legs syndrome leg pain

RLS is unpleasant and uncomfortable, but you may or may not have pain. Your doctor may ask you if you have any RLS-related pain. Doctors sometimes do use pain medicines to help with RLS and any related pain you may have. In kids, RLS is mistaken for "growing pains."

Other problems RLS may cause

Your RLS discomfort and trouble sleeping may lead to other problems including:

  • Mood changes
  • Tiredness during the day
  • Trouble concentrating or paying attention
  • Memory problems
  • Trouble getting things done or being productive
  • Depression
  • Anxiety

Doctors don’t know what causes most cases of restless legs syndrome, but your genes might play a role. Nearly half of the people with RLS also have a family member with the condition.

Chronic diseases

Certain long-term medical conditions include RLS symptoms. These include:

  • Parkinson’s disease
  • Kidney failure or renal disease
  • Diabetes
  • Peripheral nerve damage (neuropathy)
  • Spinal cord injury

Iron deficiency

Low levels of iron may be a factor in RLS for some people. Getting more iron from food may help those people. Food sources of iron include lean meat, seafood, nuts, beans, vegetables, and iron-fortified grain products such as breakfast cereals. Your doctor can check your blood iron level and see if it's too low.

Even in people who are not anemic and have normal iron levels, iron levels may be a reason for RLS. Some research shows that there can be lower iron levels in some brain regions in people with RLS, although their iron level is normal. So, doctors may prescribe iron supplements even if a person's iron levels are within a normal range. But too much iron can lead to liver damage and other health problems.

Medications

Some drugs might make symptoms worse. These include:

  • Anti-nausea meds
  • Antipsychotics
  • Some antidepressants
  • Antihistamines

Other RLS causes

A lack of sleep or another sleep disorder such as apnea can trigger symptoms or make them worse. So can alcohol, tobacco, and caffeine use.

There’s no medical test for RLS. Your doctor might want to talk to your sleep partner about what they’ve noticed.

Diagnosis criteria

The five basic criteria for an RLS diagnosis are:

  • An overwhelming urge to move your legs, especially along with uncomfortable or unusual feelings
  • An urge that starts or gets worse while you’re at rest
  • An urge that goes away, either partly or totally, when you move
  • An urge that starts or gets worse in the evening
  • Another condition, such as leg cramps, arthritis, or muscle pains, isn’t causing it

Restless legs syndrome tests

Your doctor may use lab tests to rule out other conditions. A neurological exam can check for nerve damage or blood vessel problems. A sleep study called polysomnography can tell them if you have other sleep disorders that might cause RLS.

Although there’s no cure for restless legs syndrome itself, treatments can help control your symptoms. If another condition is causing your restless legs, such as an iron deficiency, your doctor will treat it.

Lifestyle changes to help with restless legs syndrome

Treatment for RLS itself will target your symptoms. If your RLS is mild or moderate, some small changes to your everyday life might help. These include:

  • Getting regular exercise
  • Following a sleep schedule
  • Avoiding caffeine, alcohol, and tobacco

Physical treatments for RLS

  • Leg massages
  • Hot baths
  • Heating pads or ice packs on your legs

Medications for restless legs syndrome

Medications help some people. But a drug that eases symptoms in one person may make them worse in another, or a drug that works for a while may stop working.

Drugs to treat RLS include:

  • Dopaminergic drugs, which act on the neurotransmitter dopamine in your brain. The FDA has approved pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro) for moderate to severe RLS.
  • The Parkinson's disease drug carbidopa/levodopa (Sinemet) is prescribed sometimes.
  • Benzodiazepines, a type of sedative, may help with sleep, but they can cause daytime drowsiness.
  • Narcotic pain relievers
  • Anticonvulsant or anti-seizure drugs such as carbamazepine (Tegretol), gabapentin (Neurontin), gabapentin enacarbil (Horizant), and pregabalin (Lyrica)

Sleep and restless legs syndrome

If RLS is keeping you up at night, you may need to take sleep medicines. It's best not to take them for too long. Ask your doctor if you should consider sleep medicines if your RLS is disrupting your sleep.

Restless legs syndrome massage

Studies have shown that massage can help with RLS symptoms. It may improve your quality of life, but the evidence is limited. How well massage works may also depend on how it's done, and there are no clear guidelines for it. If you're struggling with RLS symptoms, it could be a good idea to try massage. Look for a massage therapist who has some experience with massage for restless legs.

It's possible you could have RLS during pregnancy, especially in the last trimester. Symptoms of RLS in pregnancy usually go away within a month after delivery.

Restless legs syndrome is a lifelong condition that might get worse with age. But some people go into remission and don’t have symptoms for days to years.

Keep your doctor updated on how you’re doing. If you start to feel worse, they might suggest lifestyle changes or medications.

Talking to other people who know what you’re going through, such as a family member who has RLS or a support group, can be of help.

In some cases, restless legs syndrome can disappear on its own. But this is rare. Instead, for most people, symptoms get worse over time.

For people with RLS symptoms caused by a medical condition, treatment of that condition can improve their RLS.
 

You should see a doctor to confirm the diagnosis of RLS and to exclude other conditions that may resemble RLS. The doctor can treat problems linked to RLS, such as iron deficiency.

If you have RLS, you should also see a doctor if you are:

  • Losing sleep often
  • Feeling depressed or anxious
  • Having trouble concentrating

You don't have to wait until one of these things happens. If you just want to feel better, see your doctor. 

Most people with restless legs syndrome have the "idiopathic" form, meaning there's no known cause. For them, there is no risk of RLS becoming something more serious, such as Parkinson's disease.

Restless legs syndrome can get worse in people with other medical conditions if they don't get them treated.

Experts agree that simply changing your behavior can often help you sleep if you have restless legs syndrome. For people with mild to moderate RLS, these steps can reduce or prevent symptoms:

  • Cut down on caffeine.
  • If you drink alcohol, cut back.
  • Stop smoking, or at least cut back.
  • Go to bed and get up at the same time each day, including weekends.
  • Exercise regularly, but moderately (heavy exercise can worsen symptoms).
  • Apply heat or ice, or soak in a hot bath. 

If you have moderate to severe RLS, it's important to find ways to handle any stress you feel from it. Here are a few ways to take control:

  • Work with your doctor to keep your symptoms under control.
  • Join a support group. The Restless Legs Syndrome Foundation can get you started. 
  • If you feel overwhelmed by RLS, talk with someone who treats mental health, such as a psychologist or psychiatrist. Depression and anxiety sometimes come with restless legs syndrome, but the exact link isn't clear.

Restless legs syndrome is both a sleep disorder and a movement disorder that can bring you plenty of discomfort, especially at night. It's usually a lifelong condition, although your symptoms may come and go. You can take steps to ease your symptoms and make sure you're getting enough rest. If you have RLS, see your doctor for help.

What helps restless legs go away?

There's no way to get rid of restless legs. But your symptoms can get better with medicines and other lifestyle changes, depending on the cause of your RLS.

What is the best medication for restless legs?

The best way to treat your RLS depends on what's causing it and your symptoms. See a doctor to find out if you may have another medical condition you could treat. You may also benefit from medicines that treat seizures, pain medicines, medicines that increase dopamine, or sleep medicines.

What drink helps restless legs?

You may find home remedies online for restless legs. Ask your doctor first if it's safe to try them and see if you think they help. Caffeine and alcohol can be triggers for RLS. You may want to avoid or limit coffee, caffeinated sodas, and alcoholic beverages.