Restless Legs

What is it?

Restless legs syndrome (RLS) is a sensorimotor disorder characterized by an uncomfortable urge to move the legs, typically described as crawling, creeping, burning, or aching sensations, that are worse at rest, worse in the evening and at night, and partially or completely relieved by movement. It affects 5–10% of the US population and is the most common cause of difficulty initiating sleep. Primary RLS has a strong genetic component with autosomal dominant inheritance and involves dopaminergic dysfunction in the basal ganglia. Secondary RLS is caused by iron deficiency (the most important reversible cause), renal failure, pregnancy, and peripheral neuropathy. Ferritin should be measured in all RLS patients — iron supplementation is first-line if ferritin is below 75 μg/L.

Common causes

When to see a doctor

• 1RLS symptoms causing significant sleep disruption or daytime impairment
• 2RLS with no identified secondary cause — serum ferritin and iron studies needed
• 3RLS in pregnancy — safe treatment options differ
• 4RLS symptoms worsening on a new medication — medication review needed
• 5Symptoms suggesting augmentation (earlier onset, spreading to arms, worse at lower dopamine agonist doses) — requires treatment adjustment

What you can do

• ✓Avoid antihistamines, alcohol, and caffeine — all worsen RLS symptoms
• ✓Establish a consistent sleep schedule — sleep deprivation worsens RLS severity
• ✓Perform moderate exercise (walking, stretching) earlier in the day — not close to bedtime
• ✓Warm or cool compresses and leg massage temporarily relieve symptoms
• ✓Mental engagement (crossword, video games) can suppress RLS symptoms at rest

Conditions that cause this symptom

Medications that may help

Treatment depends on the underlying cause. Always consult your provider before starting any medication.

Frequently asked questions