What Is Restless Legs Syndrome?
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.
Doctors consider it a sleep disorder because it usually happens or gets worse while you’re at rest. You might have trouble sleeping or sitting for a long time, such as in a theater or a 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, and 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.
Who Gets Restless Legs Syndrome?
Experts estimate that up to 7% to 10% of people in the U.S. may have restless legs syndrome, also called RLS. About 2% to 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.
Restless Legs Syndrome Symptoms
People with restless legs syndrome have unusual feelings in their legs (like itching, crawling, pulling, aching, throbbing, or pins and needles) and a powerful urge to move their legs to make the sensations go away. The condition can also happen in other areas like 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. They 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.
Restless Legs Syndrome Causes
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.
It might also be tied to:
- Chronic diseases. Certain long-term medical conditions include RLS symptoms, including iron deficiency, Parkinson’s disease, kidney failure or renal disease, diabetes, and peripheral neuropathy. Damage to the spinal cord may also make RLS more likely.
- Medications. Some drugs might make symptoms worse, including anti-nausea meds, antipsychotics, some antidepressants, and cold and allergy medications that have antihistamines.
- Pregnancy. Some women have RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.
- Lifestyle. A lack of sleep or another sleep disorder like apnea can trigger symptoms or make them worse. So can alcohol, tobacco, and caffeine use.
Restless Legs Syndrome Diagnosis
There’s no medical test for RLS. Your doctor might want to talk to your sleep partner about what they’ve noticed.
The five basic criteria for a diagnosis of RLS 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.
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.
Restless Legs Syndrome Treatment
Although there’s no cure for restless legs syndrome itself, treatments can help control it so you can get a good night’s sleep.
If another condition is causing your restless legs, such as an iron deficiency, your doctor will treat it.
Treatment for RLS itself will target your symptoms. If your RLS is mild or moderate, some small changes to your everyday life might help: getting regular exercise; following a sleep schedule; and avoiding caffeine, alcohol, and tobacco.
Other ways to treat RLS without drugs include:
- Leg massages
- Hot baths
- Heating pads or ice packs on your legs
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) occasionally is prescribed
- 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)
Restless Legs Syndrome Prognosis
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.
It can help to talk to other people who know what you’re going through, whether it’s a family member who has RLS or a support group.
Does Restless Legs Syndrome Ever Go Away by Itself?
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.
When Should I See a Doctor About Restless Legs Syndrome?
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, like 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.
Can Restless Legs Syndrome Turn Into Something More Serious?
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, like Parkinson's disease.
Restless legs syndrome can get worse in people with other medical conditions if they don't get those conditions treated.
How Can I Get a Good Night's Sleep Despite Restless Legs Syndrome?
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.
What Else Can I Do to Help With Restless Legs Syndrome?
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, like a psychologist or psychiatrist. Depression and anxiety sometimes come with restless legs syndrome, but the exact link isn't clear.
What Is the Connection Between Iron and Restless Legs Syndrome?
Low levels of iron may be a factor in 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 involved. 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.
What Is the Link Between Restless Legs Syndrome and Periodic Limb Movement Disorder?
Experts estimate that about 80% of people with restless legs syndrome also have periodic limb movement disorder, or PLMD. In PLMD, the arms or legs twitch or jerk during the night. 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.