Restless Legs Syndrome

Willis-Ekbom disease, restless leg syndrome

Restless legs syndrome is a condition that creates an overwhelming urge to move your legs, especially when trying to rest or sleep. Between 7% and 10% of people in the United States experience this condition, which can disrupt sleep and affect daily life.

Table of contents

• What is restless legs syndrome?
• Symptoms and what it feels like
• Types of restless legs syndrome
• Causes and risk factors
• How doctors diagnose restless legs syndrome
• Treatment options
• Self-care and lifestyle strategies

What is restless legs syndrome?

Restless legs syndrome (RLS) is a neurological disorder—a condition affecting the brain and nervous system—that causes a strong, nearly irresistible urge to move your legs. This urge typically comes with uncomfortable sensations and occurs mainly when your body is at rest, especially in the evening or at night.^[1][2]

RLS is also known as Willis-Ekbom disease. It is classified as both a sleep disorder and a movement condition because it is triggered by resting and attempting to sleep, yet people with RLS must move their legs to find relief from symptoms.^[4]

The condition can begin at any age and tends to get worse over time. It can severely disrupt sleep, making it difficult to fall asleep or stay asleep throughout the night.^[1][5]

Symptoms and what it feels like

The main symptom of restless legs syndrome is a strong urge to move the legs, usually accompanied by uncomfortable feelings. These sensations typically begin while resting, such as when lying down or sitting for extended periods.^[1]

People with RLS describe the sensations in many different ways. They may feel like aching, throbbing, pulling, itching, crawling, creeping, tingling, burning, or buzzing. Some describe it as having insects crawling under the skin or a constant itch that cannot be scratched.^[2][4][7]

These uncomfortable feelings usually occur in both legs, though they less commonly affect the arms or other parts of the body. The sensations are felt deep within the legs rather than on the skin surface.^[1][2]

Key features of RLS symptoms include:

• Symptoms occur or worsen during periods of rest and inactivity, such as when sitting in a car, airplane, or movie theater^[4]
• Movement provides temporary relief—walking, stretching, or jiggling the legs improves the discomfort, but sensations often return when movement stops^[1][4]
• Symptoms worsen in the evening or nighttime hours, with a distinct symptom-free period in the early morning^[1][4]
• Nighttime leg twitching or jerking during sleep is common^[1]

Because RLS interferes with sleep, people with the condition often experience additional problems including:

• Difficulty falling asleep or staying asleep
• Exhaustion and daytime sleepiness
• Fatigue or low energy
• Trouble concentrating or remembering things
• Mood changes, irritability, depression, or anxiety^[2][4]

With moderately severe RLS, symptoms might occur once or twice a week but often make it very difficult to fall asleep. In severe cases, symptoms occur more than twice a week and significantly affect quality of life.^[4]

Some people with RLS also experience a related condition called periodic limb movement of sleep, which causes the legs to twitch and kick during sleep, possibly throughout the night.^[1][4]

Symptoms may vary from day to day and from person to person. Some individuals experience periods when symptoms decrease or disappear for weeks or months, called remissions, usually during the early stages of the condition. However, symptoms often reappear and become more severe over time.^[4]

Types of restless legs syndrome

There are two types of RLS based on when symptoms begin:^[2]

Early onset RLS occurs when a diagnosis happens before age 45. This type usually runs in families and the condition progresses slowly over time. In some cases, symptoms can begin as early as the preschool years.^[2][4]

Late onset RLS is diagnosed after age 45. This type tends to progress more quickly than early onset RLS.^[2]

Causes and risk factors

The exact cause of restless legs syndrome is not well understood. Research suggests it may be related to how a part of the brain called the basal ganglia functions. This brain region controls movement and uses a chemical called dopamine to regulate how the body moves. If this part of the brain does not get enough dopamine, it cannot regulate movement as efficiently as it should, which may lead to RLS symptoms.^[2][5]

Research also suggests that restless legs syndrome is linked to levels of iron and dopamine in the body. Iron can be low in the brain despite normal blood levels.^[2][3]

Several factors may contribute to or increase the risk of developing RLS:

Genetics: RLS often runs in families. If someone in your family has the condition, you are more likely to develop it. One of your biological parents can pass a genetic trait that leads to an RLS diagnosis. About 40% to 50% of people with RLS have a family history of the condition.^[2][3][5]

Iron deficiency: Low levels of iron in the body or brain can trigger RLS symptoms.^[2][3][5]

Pregnancy: Some women develop RLS during pregnancy. Symptoms usually go away after the baby is born.^[2][3][5]

Certain medical conditions: Some chronic diseases can be associated with RLS or cause secondary RLS, which means RLS occurs alongside another medical condition. These include:

• Iron deficiency anemia
• Diabetes
• Kidney disease
• Parkinson’s disease
• Peripheral neuropathy (nerve damage)
• Rheumatoid arthritis^[2][3][5]

Medications: Certain medications can cause RLS or make symptoms worse. These include antihistamines (used for allergies and colds), some antidepressants, antipsychotic medications, and antinausea medications.^[2][5]

RLS is more common among women than men. Your risk of developing it increases as you get older. It affects between 7% and 10% of the United States population, with prevalence varying by age, gender, and ethnicity.^[2][7]

How doctors diagnose restless legs syndrome

To diagnose restless legs syndrome, your doctor will take your medical history and ask about your symptoms. A diagnosis of RLS is based on specific criteria established by the International Restless Legs Syndrome Study Group:^[8][10]

• You have a strong, often irresistible urge to move the legs, usually with uncomfortable feelings in the legs
• Your symptoms start or get worse when you are resting, such as sitting or lying down
• Your symptoms are partially or temporarily relieved by activity, such as walking or stretching
• Your symptoms are worse at night
• Symptoms cannot be explained solely by another medical or behavioral condition

RLS cannot be diagnosed or measured using blood tests or imaging alone, but an experienced neurologist or sleep expert can diagnose the condition based on a physical exam, medical history, and reported symptoms.^[5]

Your healthcare professional may conduct a physical and a neurological exam—a medical examination to check how the nervous system is working. Blood tests, particularly for iron deficiency, may be ordered to rule out other possible causes of your symptoms. Your doctor should check your iron levels, including ferritin (a protein that stores iron) and transferrin saturation.^[8][10][13]

Your doctor will also review all medications you take, both prescription and over-the-counter, as some can worsen RLS symptoms.^[5][10]

You may be referred to a sleep specialist. This may involve an overnight stay at a sleep clinic if another sleep condition such as sleep apnea is suspected. However, a diagnosis of RLS usually does not require a sleep study.^[8]

To prepare for your doctor visit, it can be helpful to track your symptoms, triggers, and bedtime habits. Make a list of all medications, vitamins, and supplements you take, and write down questions for your doctor in advance.^[10]

Treatment options

There is currently no cure for RLS, but many treatment options are available to help manage symptoms. Treatment may not be necessary for people with mild or sporadic symptoms. However, if symptoms are stopping you from sleeping or affecting your mental health, treatment should be considered.^[3][11]

Recent guidelines from the American Academy of Sleep Medicine, published in 2025, recommend significant changes in how RLS is treated. The first step in management should consist of identifying and managing factors that make symptoms worse.^[13][14]

Treating underlying conditions: If another condition is causing restless legs syndrome, treating that condition may help. For example, if you have low levels of iron in your blood, you may need iron supplements. Correcting an iron deficiency may involve taking an iron supplement by mouth or receiving an iron supplement through a vein in your arm. Iron supplements should only be taken with medical supervision and after having your blood iron level checked.^[3][8][11]

The updated guidelines provide strong recommendations for intravenous ferric carboxymaltose (iron given through a vein) for people with appropriate iron levels. They also include conditional recommendations for other forms of iron supplementation.^[13]

Medications for RLS: Several types of medications can help manage RLS symptoms:^[3][11]

Alpha-2-delta ligand calcium channel blockers are medications that affect how calcium moves in nerve cells. These include gabapentin enacarbil, gabapentin, and pregabalin. Recent guidelines strongly recommend these medications as first-line treatment for RLS because they are effective and do not cause augmentation (a worsening of symptoms over time).^[13][14]

Dopamine agonists are drugs that mimic dopamine, such as pramipexole (brand name Mirapex) and ropinirole (brand name Requip). While these were standard treatment for more than 20 years, new guidelines now recommend against their use as first-line treatment. Long-term use of these medications can lead to augmentation, where symptoms gradually worsen in intensity and duration. If these medications are prescribed, there should be close monitoring for worsening symptoms. Anyone currently taking a dopamine agonist should talk to their doctor about whether the medicine should be stopped.^[13][14]

Low-dose opioids, such as extended-release oxycodone and other low-dose opioid medications, have demonstrated effectiveness for RLS. However, opioids carry risks that require cautious use and clinical oversight. These medications have received conditional recommendations of support.^[13]

Painkillers such as codeine or tramadol may also be prescribed. Medicines to help with sleep problems may be recommended in some cases.^[3][11]

Electrical stimulation: Bilateral high-frequency peroneal nerve stimulation is an innovative treatment that involves using a wearable device to stimulate the nerves in the legs before bedtime. This treatment has received conditional recommendation of support. A vibrating pad device that delivers vibratory counterstimulation to the legs as you lie in bed has also received approval for improving sleep quality in people with RLS.^[8][13]

If your symptoms get worse or do not improve, you may be referred to a specialist for more tests and treatment. Some people find that RLS can be hard to live with, and if it is affecting your mental health, treatments such as talking therapies may help.^[3][11]

Self-care and lifestyle strategies

If your symptoms are mild, lifestyle changes and self-care steps may help relieve symptoms. These strategies can also be used alongside medical treatment to improve effectiveness.^[1][3]

Things you can do to help:

• Exercise during the day—regular exercise, especially low- to moderate-intensity activities like walking or stretching, can help. Avoid vigorous exercise close to bedtime^[3][16]
• Try to go to bed and wake up at the same time every day to maintain a regular sleep schedule^[3][5]
• Make sure your bedroom is dark and quiet—use curtains, blinds, an eye mask, or ear plugs if needed^[3]
• Try having a warm bath or using heat pads on your legs before you go to bed^[3]
• Try walking, stretching, or massaging your legs when you are having symptoms^[3][5]
• Try doing things to distract yourself from your symptoms, such as reading or doing a game or puzzle^[3]
• Get help to stop smoking^[3]
• Use relaxation techniques such as yoga or meditation^[16]

Things to avoid:

• Do not have caffeine, such as tea, coffee, or energy drinks, after midday. Caffeine can aggravate RLS symptoms^[3][5][16]
• Do not drink alcohol for at least 2 hours before going to bed. Alcohol can worsen symptoms^[3][5]
• Do not eat a big meal or do strenuous exercise late at night^[3]
• Do not use electronic devices, like smartphones, right before going to bed^[3]
• Do not nap during the day^[3]

It is important to examine all prescription drugs, over-the-counter medications, or herbal remedies you may be taking, as some can trigger or worsen RLS symptoms. These include drugs commonly used to treat high blood pressure, nausea, colds, allergies, and depression.^[5][10]

If you have symptoms of restless legs syndrome and it is stopping you from sleeping, affecting your mental health, or you have tried self-care steps but they have not helped, see a doctor.^[3][11]