Restless Leg Syndrome (RLS) is a chronic neurological condition that causes uncomfortable feelings in the legs until they are moved in some way. There is no cure. The uncomfortable feelings return after moving the legs stops. RLS is also known as Willis-Ekbom Disease.
RLS symptoms commonly occur in the late afternoon or evening hours and are often most intense at night when you are resting.
RLS can severely disrupt your sleep, making it difficult to fall asleep or return to sleep after waking up. Moving the legs or walking typically relieves the discomfort but the sensations often come back once the movement stops. [1] [2]
RLS is somewhat common, affecting 7-10% of the population in the U.S. Females are more likely to suffer from RLS, but it does affect males as well. In the early stages of RLS, there may be periods of remission where symptoms decrease or even go away for weeks or months. However, they come back and they also become more frequent with age, so the most severely affected are people in midlife and older. [1]
The sensations are felt inside rather than on the skin of the leg.
RLS sensations are described as:
- ▢ crawling
▢ creeping
▢ pulling
▢ throbbing
▢ aching
▢ itching
▢ electric
▢ tingling
The most common signs of RLS:
- ▢ sensations that typically begin when you are inactive and sitting or resting for extended periods
▢ immediate relief of uncomfortable sensations when the legs are moved, like walking or pacing
▢ symptoms are worse at night, impacting the ability to get or stay asleep
▢ typically a symptom-free period in the early morning
▢ presence of nighttime leg twitching, called periodic limb movement of sleep (PLMS), where the legs twitch and kick during sleep
Secondary impacts of RLS:
RLS has a negative impact on sleep, and on those sleeping beside you, so people with RLS may also experience:
-
▢ mood changes
▢ exhaustion
▢ daytime sleepiness
▢ concentration and memory problems
▢ decreased productivity
▢ depression and anxiety
Genetics
Genetics
Restless Leg Syndrome may be inherited in some cases, especially if there is an early onset (before age 40). Active research into the genes and chromosomes involved in RLS is underway. Other cases are linked with causes including nerve damage in the legs from diabetes, kidney problems, iron deficiency, some medications, hormone changes, sleep disorders, and alcoholism. Magnesium deficiency is also implicated in RLS. [7][8]
Pregnancy
Pregnancy
Some women start experiencing RLS for the first time when they are pregnant, especially in the final trimester. If this is the case, symptoms typically disappear after delivery. [2] [3]
Menopause & Estrogen
Menopause & Estrogen
Menopause has been found to increase both the likelihood of having RLS, and the severity of its symptoms. This implies that changes in estrogen levels may be tied to developing RLS symptoms.[4] However, studies looking at the use of menopausal hormone therapy (MHT) have found that there is no improvement in the incidence or intensity of RLS symptoms when using MHT in doses typically used for managing perimenopause symptoms. [5] Another study found that RLS isn’t improved in patients taking MHT and in fact, is made more severe. [6]
Diagnosing Restless Leg Syndrome
There is no specific test for RLS. It is diagnosed by a doctor’s evaluation of the symptoms.
The five criteria for diagnosing RLS are:
- 1. Strong and often overwhelming need to move the legs, associated with unpleasant, or uncomfortable sensations
2. Urge to move legs starts or gets worse during periods of rest or inactivity, such as at a desk or on an airplane
3. Urge to move legs is temporarily relieved by moving them
4. Urge to move legs increases in the late afternoon, evening and into the night
5. The above four features are not due to any other medical or behavioral condition
RLS may occur with other conditions, including:
- peripheral neuropathy (nerve damage)
- iron deficiency, which may occur in women who have heavy bleeding during periods
- kidney failure, which may lead to iron deficiency
- spinal cord conditions including damage to the spinal cord, (receiving anesthesia in or near the spinal cord, such as a spinal block, appears to increase the risk of developing RLS)
- Parkinson’s disease [2]
- anxiety
- depression
- migraines [4]
Avoid or decrease the use of alcohol, nicotine, and caffeine
Practice good sleep hygiene
Get regular exercise
Have a massage
Take a warm bath
Apply heat or cold packs
There are foot wraps and vibration pads for the back of the legs, both designed specifically to provide relief from RLS
Stretch the muscles in the legs regularly
Iron Supplements
Calcium Magnesium Supplements
Magnesium & B6 Supplements
shown to lessen the severity of the symptoms
Anti-Seizure Drugs
the first-line prescription drugs for those with RLS
Dopaminergic Agents
drugs that increase dopamine in the brain can reduce symptoms of RLS when taken at night and are often used to treat Parkinson’s disease
Opioids
drugs that are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications
Benzodiazepines
drugs that are generally prescribed to treat anxiety, muscle spasms, and insomnia, and can help individuals get more restful sleep
Iron Therapy
Given only if iron deficiency is present [1][3]
The Science
Restless legs syndrome appears to be connected to a part of the brain called the basal ganglia. Damage to this area of the brain is the basis for several movement disorders and the presence of muscle spasms and tics. [9]
Dopamine is the neurotransmitter that the basal ganglia uses to coordinate with the nervous system in order to manage and control muscle activity. Dopamine levels are connected to the circadian rhythm, so they start to lower at the end of the day. This might explain why RLS symptoms are worse at night.
Dopamine levels naturally fall towards the end of the day, which may explain why the symptoms of restless legs syndrome are often worse in the evening and during the night. [10]
False. In some cases, like RLS that starts in pregnancy, symptoms may subside once the pregnancy is over. However, for most cases, RLS is not temporary and can cause serious insomnia. If there is a period of remission, at some point the RLS returns.
References
[1] https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome
[2] https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/
[3] https://www.hopkinsmedicine.org/health/conditions-and-diseases/restless-legs-syndrome-rls
[4] Seeman MV. Why Are Women Prone to Restless Legs Syndrome? Int J Environ Res Public Health. 2020 Jan 6;17(1):368. doi: 10.3390/ijerph17010368. PMID: 31935805; PMCID: PMC6981604.
[5] Päivi Polo-Kantola, Esa Rauhala, Risto Erkkola, Kerttu Irjala, Olli Polo. Estrogen replacement therapy and nocturnal periodic limb movements:: A randomized controlled trial. Obstetrics & Gynecology, Volume 97, Issue 4, 2001, 548-554, ISSN 0029-7844,
https://doi.org/10.1016/S0029-7844(00)01191-1.
[6] Mariusz Sieminski, Magdalena Karwacka, and Walenty Nyka Restless Legs Syndrome and Hormonal Replacement Therapy in Women at Menopausal Age (P05.010). Neurology, April 23, 2012 issue 78 (1_supplement). doi/10.1212/WNL.78.1_supplement.P05.010
[7] https://www.healthline.com/health/restless-leg-syndrome/link-between-magnesium-and-rls
[8] Jadidi A, Rezaei Ashtiani A, Khanmohamadi Hezaveh A, Aghaepour SM. Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial. BMC Complement Med Ther. 2022 Dec 31;23(1):1. doi: 10.1186/s12906-022-03814-8. PMID: 36587225; PMCID: PMC9804944.
[9] Mitchell UH, Obray JD, Hunsaker E, Garcia BT, Clarke TJ, Hope S, Steffensen SC. Peripheral Dopamine in Restless Legs Syndrome. Front Neurol. 2018 Mar 15;9:155. doi: 10.3389/fneur.2018.00155. PMID: 29599746; PMCID: PMC5862810.
10] https://www.nhs.uk/conditions/restless-legs-syndrome/causes/
Original content, last updated January 30, 2025.
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