Restless Legs Syndrome: What can you do when your legs won’t stay still?
Published 31 Mar 2025 • By Somya Pokharna
Have you ever struggled with an overwhelming urge to move your legs, especially at night, making it nearly impossible to relax or fall asleep? If so, you’re not alone. Restless Legs Syndrome (RLS), is a neurological condition that affects millions of people worldwide. It often feels like a tingling, crawling, or burning sensation deep in the legs, forcing a person to constantly shift their position just to find relief.
For some, RLS is just an occasional annoyance. For others, it can severely disrupt sleep night after night, leading to chronic exhaustion, difficulty concentrating, and even emotional distress. Despite being a common disorder, many people go undiagnosed for years, often dismissing their symptoms as simple restlessness.
But what increases the risk of developing RLS? How can it be managed, and what treatment options are available?
Let’s leap into the answers in this article!
What is Restless Legs Syndrome (RLS)? What are its symptoms?
Restless Legs Syndrome, also known as Willis-Ekbom Disease, is a neurological movement disorder which is primarily characterized by an irresistible urge to move the legs, and often accompanied by discomfort such as tingling, crawling, pulling, or burning sensations. These symptoms occur when the body is inactive or at rest, worsen in the evening or nighttime, and are relieved by movement. In some cases, symptoms extend beyond the legs, affecting the arms or other parts of the body.
RLS is classified as either primary (idiopathic), meaning it has no known cause, or secondary, meaning it results from another medical condition such as iron deficiency or kidney disease.
People with RLS frequently experience sleep disorders, leading to difficulty falling asleep and staying asleep. As a result, excessive daytime sleepiness, mood changes, difficulty concentrating, and memory problems are common. The severity of symptoms varies, with some experiencing intermittent discomfort while others suffer from daily, debilitating episodes.
What causes Restless Legs Syndrome?
Age
RLS becomes more common with increasing age, with most cases appearing in middle-aged or older adults. Studies suggest that the prevalence of RLS is significantly higher in people over the age of 40.
Gender
Women are more likely to develop RLS than men. This gender difference may be due to hormonal factors, as studies show an increased prevalence in women with multiple pregnancies.
Genetic factors
A strong genetic component has been identified in RLS, particularly in those patients who experience symptoms before the age of 40. Several genetic variations, including MEIS1, BTBD9, and PTPRD, have been associated with a higher risk of developing the condition.
Pregnancy
RLS symptoms commonly appear or worsen during pregnancy, especially in the third trimester. While the exact cause is unknown, hormonal fluctuations, changes in blood volume, and iron deficiency during pregnancy may contribute. Symptoms often resolve after delivery.
Neurological dysfunction and disorders like Parkinson’s disease
RLS is believed to result from dysfunction in the dopaminergic system, particularly in the basal ganglia, a part of the brain responsible for movement control. Similar dopaminergic dysfunction is seen in conditions such as Parkinson’s disease, and a person afflicted with it is at an increased risk of developing RLS.
Iron deficiency anaemia (low serum ferritin)
Iron plays a critical role in dopamine production, and a deficiency in iron levels, particularly in the brain, has been strongly linked to RLS. Low ferritin levels (<50 ng/mL) are associated with more severe symptoms, making iron supplementation a key treatment for some patients.
Chronic kidney disease
RLS is prevalent in patients with end-stage renal disease and those undergoing hemodialysis. The exact mechanism is unclear, but it is believed that iron metabolism disturbances and toxin buildup contribute to symptom development.
Diabetes and peripheral neuropathy
Diabetes, particularly when associated with nerve damage (peripheral neuropathy), can increase the likelihood of RLS. Nerve dysfunction and metabolic disorders may worsen symptoms in diabetic patients.
Medications
Certain medications can trigger or worsen RLS symptoms. These include antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), antihistamines, antipsychotics, and some anti-nausea drugs.
Lifestyle
Lifestyle factors such as caffeine, alcohol, and nicotine consumption can aggravate RLS symptoms. Reducing intake of these substances and maintaining a healthy sleep routine can help manage the condition.
How is Restless Legs Syndrome diagnosed?
Diagnosing RLS is primarily based on clinical criteria, as no single test confirms its presence. The International Restless Legs Syndrome Study Group (IRLSSG) has established five key diagnostic criteria:
- A strong urge to move the legs, often with unpleasant sensations.
- Symptoms that begin or worsen during rest or inactivity.
- Relief with movement, at least temporarily.
- Symptoms that are more severe in the evening or night.
- Symptoms that are not solely explained by another medical or behavioural condition.
In addition to clinical evaluation, laboratory tests may be conducted to rule out underlying conditions such as iron deficiency. A sleep study (polysomnography) may also be recommended for patients with significant sleep disturbances or suspected periodic limb movement disorder.
How can Restless Legs Syndrome be treated and managed?
The treatment of RLS depends on the severity of symptoms and the presence of any underlying conditions.
Non-pharmacological approaches
For mild cases, lifestyle modifications, exercise, and sleep hygiene can be effective. Avoiding caffeine, nicotine, and alcohol, as well as maintaining a consistent sleep schedule, can help reduce symptom severity.
Iron supplementation
For people with low iron levels, iron supplementation may provide relief. Studies suggest that raising ferritin levels above 50 ng/mL can improve symptoms. Patients with more severe RLS may require pharmacological treatment.
Medications
Some treatments that can be helpful for RLS management include:
- Dopamine agonists such as pramipexole, ropinirole, and rotigotine are commonly prescribed for moderate to severe cases. These medications help regulate dopamine levels in the brain and are effective in reducing symptoms. However, long-term use of dopamine agonists can lead to augmentation, a worsening of symptoms over time that requires careful monitoring and management. If symptoms worsen earlier in the day or become more severe, a reduction in dopamine agonist dosage or a switch to an alternative treatment may be necessary.
- Alpha-2-delta ligands, such as gabapentin and pregabalin, are alternative treatments that work by affecting calcium channels in the nervous system. These medications have a lower risk of augmentation compared to dopamine agonists and are often used in patients with neuropathy or pain-related RLS.
- In cases where standard treatments fail, opioids such as tramadol, oxycodone, or methadone may be considered. These medications are typically reserved for severe, refractory RLS due to the risk of dependency and side effects.
Key takeaways
Restless Legs Syndrome is a prevalent yet often overlooked neurological disorder that significantly impacts sleep and quality of life. While the exact cause remains unclear, research has identified links to iron deficiency, dopamine dysfunction, genetic factors, and certain medical conditions.
Early diagnosis and tailored treatment strategies, including lifestyle changes, iron supplementation, and medication, can help manage symptoms effectively. Raising awareness and encouraging people to seek medical advice for persistent symptoms is crucial in improving patient outcomes.
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