What Is Restless Legs Syndrome?

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Restless legs syndrome (RLS) is a neurological disorder that causes an uncontrollable urge to move your legs. Also known as Willis-Ekbom disease, RLS symptoms typically arise in the evenings or during the night, when you’re seated or lying down, and it often affects sleep. Moving the legs or walking provide temporary relief.

RLS affects 7% to 10% of people and is more common and severe among people over age 45 and those assigned female at birth.

This article provides an overview of restless legs syndrome, including its symptoms, diagnosis, treatment, and prognosis.     

Person wearing pajama pants and slippers exiting a dark room

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Types of Restless Legs Syndrome

RLS is categorized based on cause and age of onset.

By cause:

  • Primary (idiopathic) RLS arises without any known cause.
  • Secondary RLS occurs alongside other diseases or conditions, such as pregnancy, iron deficiency, neurological disorders, Parkinson’s disease, peripheral neuropathy, kidney failure, and others.

By age of onset:

  • Early-onset RLS arises in people under age 45. In these cases, the symptoms gradually worsen over time.
  • Late-onset RLS occurs in people who first experience symptoms at 45 years old or older. With this later onset, the disease tends to progress more rapidly.

Restless Legs Syndrome Symptoms

RLS causes an uncomfortable sensation in the legs, leading to an overwhelming urge to move them. People with RLS describe this feeling as:

  • Aching
  • Throbbing
  • Itching
  • Pulling
  • Crawling
  • Creeping

Two or more episodes of RLS a week is considered severe and includes other characteristics, such as:

  • Arising at rest: Symptoms arise when you’re at rest or lying down for more extended periods.
  • Helped by movement: The discomfort diminishes when you move your legs, as in walking, tapping, or shaking while seated.
  • Nocturnal pattern: Symptoms are worse in the evenings or at night, while early mornings are generally symptom-free.
  • Sleeping problems: The symptoms of RLS can make falling asleep and getting enough sleep difficult, and it is associated with sleep disorders.

Complications

Living with RLS can cause several other complications due to its impact on sleep, which includes:

  • Exhaustion and an inability to stay awake during the day
  • Shifts in mood
  • Difficulty concentrating
  • Memory problems
  • Decreased productivity and performance at work or school
  • Depression and anxiety

Increased Severity Over Time

People may experience periods of no symptoms in the early stages of RLS, but RLS tends to recur. This disorder is also progressive, which means symptoms become more severe over time.

Periodic Limb Movement Disorder

Periodic limb movement disorder is a different but often co-occurring condition with RLS, characterized by involuntary movements of the limbs and torso during sleep or while awake. Unlike RLS, there’s no uncomfortable sensation, and people with the condition are typically unaware that they’re moving.

This condition occurs in 80% of people with restless legs syndrome. However, most people with periodic limb movement disorder don’t experience RLS.

What Causes Restless Legs Syndrome?

Restless legs syndrome is believed to arise due to a combination of genetic and environmental factors affecting how the brain communicates with the muscles that control movement. However, many of the factors involved are still unknown.

The causes also vary for primary RLS, which often runs in families and has some identified genetic risk factors, and secondary RLS that can be linked to other disease processes.

While the exact cause varies, the following play a role in the development of RLS:

  • Low iron levels in the brain
  • Problems producing dopamine, a chemical messenger (neurotransmitter) produced in brain cells that's involved in signaling and controlling physical movement
  • Genetics

Genetics

A family history of RLS dramatically increases your chances of developing primary and secondary forms, indicating a strong genetic component. Mutations in several genes have been linked to higher risk. These reduce iron metabolism and dopamine production, which can lead to symptoms.

Primary RLS is sometimes called genetic RLS. Up to 63% of people with RLS have a first-degree relative with RLS, meaning a parent, sibling, or child. This association is especially common in people with early-onset RLS.

Research is still identifying the genes associated with primary RLS. These genes generally are involved in iron storage and regulating iron in the brain. But genes involved in developing the limbs have also been associated with RLS.

The inheritance pattern of RLS is usually autosomal dominant. This means only one copy of the faulty gene (from one parent) is needed to produce the condition in a child. Also, since the genes are not on the X or Y chromosome, children of any sex have an equal risk of getting the gene from one parent.

Low Iron in the Brain

Though the exact relationship is unknown, RLS is associated with insufficient iron levels in the brain. This can affect many processes, including oxygen transportation, cellular communication, and the metabolism of neurotransmitters (the brain’s chemical messengers).

As a result, there’s less dopamine production and fewer receptors, which can affect motor (movement) function.

Having iron deficiency or a condition that alters your iron status (such as pregnancy or kidney failure) increases your risk of developing RLS. However, you don't have to have a low level of iron stored in your tissues to have low iron in the brain. There are various processes at work resulting in low iron in the brain in RLS.

Low Dopamine Production

Low dopamine levels may be at the root of RLS symptoms. Dysfunction among dopamine-producing cells in the midbrain and thalamus region (a part of the limbic system that regulates emotions and survival responses) may contribute to RLS. This affects the body’s pain system, leading to the discomfort associated with RLS.

Risk Factors

The risk of developing RLS is higher among certain groups and those living with certain diseases. These risk factors include:

  • Family history of RLS
  • End-stage kidney disease
  • Hemodialysis, a medical treatment for kidney disease that cleans water and waste from the blood
  • Sleep deprivation or sleep disorders (especially sleep apnea, or nighttime snoring)
  • Pregnancy, especially in the third-trimester, or changes in hormone levels
  • Iron deficiency anemia
  • Parkinson's disease (a neurological disease related to the brain being unable to produce enough dopamine)
  • Diabetes
  • Multiple sclerosis (an autoimmune condition in which the immune system attacks the sheath covering nerve cells)
  • Rheumatoid arthritis (an autoimmune disease in which the immune system attacks the synovial lining of the joints)
  • Alcohol, nicotine, or caffeine use
  • Medications that can aggravate or cause RLS symptoms include antipsychotic, antidepressant, and antinausea drugs

How Is RLS Diagnosed?

There is no specific test for restless legs syndrome, so diagnosis is based on medical and family histories, current health status, and symptoms.

Questionnaires and neurological tests may be performed to look for signs of the condition, such as the following:

  • A growing urge to move the legs at rest
  • A reduction in discomfort with leg movements
  • Increased frequency of symptoms at night
  • An absence of other causes

In addition, you may be given blood tests to catch causes of secondary RLS or rule out other conditions. These can identify health factors that lead to the condition, including kidney failure, low iron levels, and pregnancy.     

Treatment

While RLS doesn't have a cure, some treatments can help. A provider will tailor therapies specific to individual needs, including a combination of lifestyle changes and medications. Lifestyle modifications include:

  • Going to bed and getting up at the same times every day
  • Aiming for seven to eight hours of rest a night
  • Regular moderate—but not excessive—exercise
  • Stopping the use of certain antidepressants and antinausea drugs, under a medical providers approval and direction
  • Avoiding caffeine, alcohol, and nicotine

For symptom relief, you may try:

  • Massaging the legs
  • Taking a warm bath
  • Applying a heating pad
  • Applying an ice pack
  • Foot wraps designed for RLS
  • Vibration pads on the back of the legs
  • Leg stretching exercises

If you have secondary RLS, therapies focus on managing the underlying cause. In primary cases, or if symptoms persist in secondary cases, several classes of drugs may help ease symptoms, such as:

  • Dopamine precursors: Levodopa or L-dopa, Cinemet (combination of levodopa and carbidopa)
  • Dopamine agonists: Requip (ropinirole), Mirapex (pramipexole), Neupro (rotigotine)
  • Calcium-channel ligands: Neurontin (gabapentin), Lyrica (pregabalin), Horizant (gabapentin enacarbil)
  • Opioids: Xtampza ZR (oxycodone)
  • Benzodiazepines: Klonopin (clonazepam), Restoril (temazepam)

If you have low levels of iron alongside RLS, you may also need to take iron supplements.

A small study found supplementing with vitamin B6 and magnesium helped people with RLS improve their sleep quality and reduce the severity of their symptoms.

Prognosis

RLS doesn’t have a cure and is a lifelong condition. It typically worsens over time and can significantly impact mental health. As many as 39% of people with RLS experience psychiatric comorbidities, especially depression and anxiety.

Medications and therapeutic approaches can help ease the impact of the symptoms, increase periods of remission, and improve sleep. Seeking out timely therapy and diagnosis is critical for managing this condition.

Living With Restless Legs Syndrome

Since RLS can significantly affect the quality of life, people with RLS may need extra support. Strategies to help cope with the impact of this disorder include:

  • Social support: If you’ve been diagnosed, talk to family, friends, and loved ones about your condition. Don’t be afraid to ask for help when needed; seek out those you trust and can confide in.
  • Counseling: Individual or group counseling can also help, especially if RLS makes you feel depressed, stigmatized, or anxious. Your healthcare provider may be able to recommend a therapist or counselor who can help.
  • Help online: Online forums and social media groups devoted to RLS can also be helpful. They connect you with others in your position and can help share information and experiences.
  • Advocacy organizations: Nonprofit organizations, such as the Restless Legs Syndrome Foundation, among others, can be excellent sources of information and support. These groups also promote awareness and research on therapies.

Summary

Restless legs syndrome (RLS) is a neurological disorder characterized by an uncontrollable urge to move your legs when at rest. Often affecting sleep, RLS symptoms tend to arise at night and are most often seen in adults 45 or older, though people of all ages can be affected.

Therapies for this incurable and chronic disorder include lifestyle changes and taking certain medications.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institute of Neurological Disorders and Stroke. Restless legs syndrome.

  2. Guo S, Huang J, Jiang H, et al. Restless legs syndrome: from pathophysiology to clinical diagnosis and managementFront Aging Neurosci. 2017;9:171. doi:10.3389/fnagi.2017.00171

  3. MedlinePlus. Restless legs syndrome.

  4. Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, and Lanteri P. Restless legs syndrome across the lifespan: Symptoms, pathophysiology, management and daily life impact of the different patterns of disease presentationInternational Journal of Environmental Research and Public Health. 2020;17(10)3658. doi:10.3390/ijerph17103658

  5. National Organization of Rare Diseases. Restless legs syndrome: standard therapies.

  6. 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;23(1):1. doi:10.1186/s12906-022-03814-8

  7. Kallweit U, Werth E, Seiz A, et al. Psychiatric comorbidities in restless legs syndromeJNP. 2016;28(3):239-242. doi:10.1176/appi.neuropsych.15030055

By Mark Gurarie
Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University.