Restless leg syndrome (RLS) is a disorder characterized by disagreeable leg sensations, usually prior to sleep onset, that cause an almost irresistible urge to move the legs. RLS can be a temporary problem (such as during pregnancy or while taking antidepressant medication) or a chronic, long-term issue.

Restless Leg Syndrome Symptoms

The core symptom of RLS is an irresistible urge to move the legs. Some people describe this symptom as a sense of unease and weariness in the lower leg. Others say it feels like a “crawling” or “creeping” sensation inside the calves.

The sensations are aggravated by rest and relieved by movement. Specific characteristics of RLS include:

  • Uncomfortable feelings of "pulling, searing, drawing, tingling, bubbling, or crawling" beneath the skin, usually in the calf area, causing an irresistible urge to move the legs. These sensations occur mostly in the lower legs, but they can sometimes affect the thighs, feet and even the arms. These may be the first symptoms of RLS in some people.
  • Semi-rhythmic movements during sleep known as periodic limb movement disorder (PLMD), which occurs in about 4 out of 5 patients with RLS.
  • Itching and pain, particularly aching pain.
  • Symptoms usually occur at night when patients are most relaxed, with their legs at rest, lying down. In more severe cases, symptoms also occur during the day while sitting. Movement relieves the symptoms.
  • Symptoms are often worse shortly after midnight and disappear by morning. If the condition becomes more severe, people may begin to have symptoms during the day, but the problem is always worse at night.
  • Disruption of nighttime sleep due to the unpleasant sensations and uncontrollable urge to move the legs. Ignoring the urge to move the legs usually leads to tension build up until the legs jerk uncontrollably. Individuals who experience daytime symptoms may find it difficult to sit during air or car travel, or through classes or meetings.

The main cause of RLS is unknown. Scientists are researching nervous system problems that may arise in either the spinal cord or the brain. One theory suggests that low levels of the brain chemical dopamine causes RLS.

Who is at Risk?

RLS affects 3 to 15 percent of the general population and can occur in both children and adults. It is more common in women than in men and its frequency increases with age.

RLS rarely results in any serious consequences. However, recurring severe symptoms may cause considerable mental distress, loss of sleep, and daytime sleepiness. Because the condition is worse while resting, people with severe RLS may avoid activities that involve extended periods of sitting, such as attending movies or traveling long distances.

Restless Leg Syndrome Diagnosis

There is no specific test for RLS. Your health care provider will take your medical history and do a physical exam. A diagnosis of RLS often relies mainly on the patient's description of symptoms. Your doctor may ask you to keep a sleep diary and record all sleep-related information.

You may be referred to a sleep specialist at an accredited sleep disorders center. You may have blood tests and other exams to rule out conditions that can cause similar symptoms. Some patients are sent to a sleep lab to undergo a sleep study (polysomnography).

Restless Leg Syndrome Treatment

RLS can’t be cured so treatment focuses on improving sleep and eliminating possible causes of RLS. Initially, your doctor may try to achieve these goals without the use of drugs. Certain lifestyle changes may help you cope with the condition and ease the symptoms.

  • Take a warm bath or use hot or cold packs on your legs.
  • Help your muscles relax with gentle stretches, or massage. Try doing calf stretching exercises at bedtime.
  • Take time out of your day to just relax. Try yoga, meditation, or other ways to ease tension.
  • Use ergonomic measures. For example, try working at a high stool where your legs can dangle. Also, try sitting in an aisle seat during meetings or airplane travel to allow for more leg movement.
  • Avoid caffeine, alcohol and tobacco. They may make symptoms worse.
  • Get enough exercise during the day. Exercise early in the day helps achieve healthy sleep. Vigorous exercise too close to bedtime (1 to 2 hours before) may worsen RLS.
  • RLS is often associated with iron deficiency, so talk to your doctor about ways to increase the iron in your diet.

Your provider may decide to prescribe medicines to help control the symptoms or RLS or to help you sleep. Treating conditions with similar symptoms such as peripheral neuropathy or iron deficiency can also help relieve symptoms.

Wake Forest Baptist Sleep Disorders Center

The Wake Forest Baptist Sleep Disorders Center is accredited by the American Academy of Sleep Medicine. Our multidisciplinary team is made up of board-certified sleep specialists from neurology, pulmonary disease and pediatrics. Our team of sleep experts performs sleep studies and multiple sleep latency tests (MSLT), and provides education, advice and assistance to patients and referring physicians regarding the latest testing and treatments available for all types of sleep disorders.