Restless Legs Syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological and sleep-related disorder that causes an uncontrollable urge to move the legs, usually due to uncomfortable sensations. These sensations typically occur in the evening or at night while at rest, making it difficult to fall asleep or stay asleep. RLS can affect both men and women but is more common in women and becomes more likely with age.

It’s estimated that 7% to 10% of the U.S. population experiences some form of RLS. While the condition isn’t life-threatening, it can severely affect a person's quality of life if left unmanaged.

Types

RLS is classified into two main types based on its cause:

Primary (Idiopathic) RLS
This type has no identifiable cause but is thought to have a genetic component. It usually begins before age 40 and tends to progress slowly over time. People with primary RLS often have a family history of the condition.

Secondary RLS
This form occurs due to an underlying condition or factor, such as:

  • Iron deficiency

  • Kidney failure

  • Pregnancy (especially the third trimester)

  • Neurological disorders like multiple sclerosis or Parkinson’s disease

  • Use of certain medications such as antidepressants or antihistamines

Pregnancy-related RLS usually resolves after delivery, but it may increase a person’s risk of developing chronic RLS later in life.

Symptoms

The hallmark symptom of RLS is a strong urge to move the legs, often accompanied by strange sensations such as:

  • Crawling

  • Tingling

  • Pulling

  • Aching

  • Creeping

These sensations:

  • Occur or worsen during rest or inactivity

  • Are temporarily relieved by movement (e.g., walking, stretching)

  • Are most severe in the evening or night

RLS can vary in frequency and severity:

  • Mild: Symptoms appear once or twice per week

  • Moderate to severe: Symptoms appear three or more times per week and disrupt sleep

Other possible effects include:

  • Insomnia

  • Daytime fatigue or sleepiness

  • Difficulty concentrating

  • Mood changes, anxiety, or depression

  • Memory issues

Some people also report symptoms in the arms, chest, or head, especially in advanced or untreated cases.

Causes

The exact cause of RLS is not fully understood, but several contributing factors have been identified:

  • Dopamine imbalance: Dopamine is a neurotransmitter that regulates muscle movement. Low levels or dysfunction can trigger RLS.

  • Iron deficiency: Iron is essential for dopamine production. People with low iron levels (especially ferritin) are more likely to have RLS.

  • Neurological dysfunction: Conditions affecting the spinal cord or peripheral nerves can contribute to symptoms.

  • Genetics: Up to 65% of individuals with RLS have a family history. Twin studies show up to 80% concordance in identical twins.

  • Hormonal shifts: Pregnancy and menopause can trigger or worsen symptoms.

  • Chronic health conditions: Diabetes, kidney disease, Parkinson’s disease, and rheumatoid arthritis are linked with RLS.

Triggers

Certain external factors can exacerbate RLS symptoms:

  • Alcohol, caffeine, and nicotine

  • Sedentary behavior

  • Stress and anxiety

  • Medications:

    • SSRIs and tricyclic antidepressants

    • Antipsychotics

    • Beta-blockers

Understanding and avoiding these triggers can significantly reduce symptom frequency.

Diagnosis

There are no laboratory tests to definitively diagnose RLS. Diagnosis is clinical and based on five core criteria:

  1. Urge to move the legs, often accompanied by unpleasant sensations

  2. Symptoms begin or worsen during rest

  3. Symptoms are relieved by movement

  4. Symptoms are worse in the evening or at night

  5. Symptoms are not solely due to another condition

Additional tests may include:

  • Blood tests: To check iron levels or rule out anemia

  • EMG and nerve conduction studies: To assess for neuropathy

  • Polysomnography (sleep study): To evaluate sleep quality and leg movements during sleep

Diagnosing RLS in children can be challenging due to their limited ability to describe symptoms. It may also be confused with other conditions like growing pains or ADHD.

Treatment

RLS treatment depends on symptom severity and underlying causes. The goals are to relieve discomfort and improve sleep.

Medications:

  • Iron supplements: If ferritin levels are below 75 ng/mL

  • Anti-seizure drugs:

    • Gabapentin (Neurontin)

    • Pregabalin (Lyrica)

  • Dopaminergic agents:

    • Pramipexole (Mirapex)

    • Ropinirole (Requip)

    • Carbidopa-levodopa (Sinemet)

  • Benzodiazepines (e.g., clonazepam): For sleep support in severe cases

  • Opioids: Reserved for treatment-resistant RLS due to addiction risk

Note: Dopaminergic drugs may cause augmentation—worsening of symptoms over time. Close monitoring is essential.

Lifestyle

Many mild to moderate RLS cases can be managed through behavioral and lifestyle changes:

  • Maintain regular sleep-wake cycles

  • Avoid caffeine, alcohol, and nicotine

  • Exercise regularly, but not close to bedtime

  • Take warm baths or leg massages before bed

  • Use compression socks or vibrating leg massagers

  • Practice relaxation techniques (e.g., yoga, meditation)

Even small adjustments to sleep routines and stress levels can lead to major improvements.

Prevention

While not all cases are preventable, flares can be minimized by:

  • Identifying personal triggers (e.g., caffeine or specific medications)

  • Addressing iron deficiency early

  • Staying physically and mentally active

  • Prioritizing sleep hygiene

  • Managing stress proactively

Related Conditions

RLS may occur alongside or as a result of the following conditions:

  • Chronic kidney disease

  • Iron-deficiency anemia

  • Pregnancy (3rd trimester)

  • Parkinson’s disease

  • Neuropathy

  • Sleep disorders, such as insomnia or sleep apnea

Left unmanaged, RLS can lead to complications such as:

  • Chronic fatigue

  • Depression

  • Poor job performance

  • Decreased quality of life

Living With RLS

RLS is a long-term condition that can fluctuate in intensity. While there’s no cure, the majority of people can manage symptoms effectively through a combination of medications and lifestyle interventions.

Support groups, sleep specialists, and neurologists can be invaluable resources. Tracking symptoms and treatments with a journal can also help personalize management plans.

Conclusion

Restless Legs Syndrome is more than just a nighttime annoyance—it’s a legitimate neurological condition that can significantly disrupt daily life. Fortunately, with growing awareness and advancements in treatment, most individuals can find relief.

If you suspect you may have RLS, speak to a healthcare provider for diagnosis and a customized treatment plan.