Restless Legs Syndrome

What Is Restless Legs Syndrome? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Barbara Kean
By Medically Reviewed by 
Reviewed:
Medically Reviewed

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 and is typically most severe in the evening and night, potentially disrupting a person’s sleep and affecting daily activities.

Signs and Symptoms of Restless Legs Syndrome

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.

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.

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.

Causes and Risk Factors of Restless Legs Syndrome

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.

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.

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.


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:

Medications that may aggravate RLS symptoms include:

Alcohol, nicotine, and caffeine can also trigger symptoms.

How Is Restless Legs Syndrome Diagnosed?

There are no medical tests to diagnose RLS, but your doctor may perform blood tests and other exams to rule out other disorders.

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.

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.

As a result, this condition often goes undiagnosed in children.

Duration of Restless Legs Syndrome

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.

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.

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.

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.

Treatment and Medication Options for Restless Legs Syndrome

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.

Treatment options for RLS include:

  • 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.
  • 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.
  • Dopaminergic Agents These have been shown to reduce symptoms of RLS when taken at nighttime. The FDA has approved ropinirole (Requip), pramipexole (Mirapex), and rotigotine to treat 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.
Symptoms can also be alleviated by:

  • Hot baths
  • Massages
  • Lifestyle changes, including implementing a regular exercise program, maintaining regular sleep patterns, and limiting use of tobacco, alcohol, and caffeine

Being active throughout the day helps alleviate symptoms for some. This gives your muscles the chance to exert the energy that they would otherwise exert at night.

Regular exercisers are 3.3 times less likely to have RLS than nonexercisers.

Some people find that good sleep habits can also help with symptoms of RLS.

These habits can include:

  • Only using your bedroom for sleep (not for watching TV or using a computer or cell phone)
  • Going to bed at the same time every night and waking up at the same time every morning
  • Making 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.

Alternative and Complementary Therapies

Several studies have shown that acupuncture can improve symptoms of RLS. One recent 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.


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.

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.

Prevention of Restless Legs Syndrome

There is no known way to prevent RLS, because doctors aren’t sure what causes it.

Complications of Restless Legs Syndrome

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.

Research and Statistics: How Common Is Restless Legs Syndrome?

According to the National Institute of Neurological Disorders and Stroke (NINDS), up to 10 percent of the U.S. population may have RLS.

The number of cases of RLS rises with age and 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.

Research suggests that RLS affects an estimated 1.5 million children and adolescents in the United States.

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 migraines, depression, and anxiety.

Related Conditions of Restless Legs Syndrome

RLS is common during pregnancy, particularly in the last trimester. A study from 2020 found that 22.9 percent of women experience RLS in the third trimester.

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.

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.

Resources We Love

Restless Legs Syndrome Foundation 

On this organization’s site, you can find the latest information about RLS treatments and share your experience with others in the RLS community. Their Find a Healthcare Provider tool can help you find a doctor in your area who works with RLS patients.

The Sleep Doctor

This group was founded by physicians and scientists in 2002 with a mission to increase the awareness of the importance of sleep and the harmful effects of sleep disorders. On their site you can find lots of useful information on many sleep-related topics, including RLS. You can also find tips on how to choose a sleep doctor, sleep specialist, or clinic.

National Sleep Foundation

This foundation dedicates itself to improving health and well-being through sleep education and advocacy. On their site, you can find informative articles on many sleep-related subjects, such as tips for making more time for sleep and getting a better night’s sleep in addition to articles on RLS and other sleep disorders.

National Organization for Rare Disorders (NORD)

This is a great site to explore the latest research on RLS, including links to clinical trials.

Additional reporting by Joseph Bennington-Castro.

Editorial Sources and Fact-Checking

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