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Restless Leg Syndrome (RLS)

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The Urge to Keep You Awake

Restless Legs Syndrome (RLS) is a neurological sleep disorder that causes an overwhelming urge to move the legs, usually in the evening or at night when lying down. The sensations are often described as creeping, crawling, tingling, or pulling—and while movement provides temporary relief, the condition disrupts sleep and quality of life. Despite being common, RLS is frequently underdiagnosed or misdiagnosed, particularly in minority and underserved populations.

What is RLS?

RLS is a condition involving uncomfortable sensations in the legs, typically worse at rest and at night. It affects both sleep quality and daytime functioning.

Key Features

  • Strong urge to move the legs, often accompanied by unpleasant sensations

  • Symptoms worsen during periods of inactivity (e.g., sitting, lying down)

  • Movement (e.g., walking, stretching) temporarily relieves symptoms

  • Symptoms are worse in the evening or at night

  • Can cause difficulty falling or staying asleep, leading to insomnia

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Causes and Risk Factors

RLS can be primary (idiopathic) or secondary to another condition.

 

Primary RLS:

  • Likely has a genetic component

  • Tends to run in families

  • Begins earlier in life and worsens over time

 

Secondary RLS:

  • Iron deficiency or low ferritin levels

  • Chronic kidney disease

  • Pregnancy (especially 3rd trimester)

  • Peripheral neuropathy or diabetes

  • Certain medications (e.g., antihistamines, antidepressants)

  • Sleep deprivation or other sleep disorders

What Does it Feel Like?

People with RLS often describe the sensations as:

  • Crawling, creeping, or pulling

  • Tingling or “electric” feeling

  • Aching or itching

  • A deep discomfort inside the legs that’s hard to describe

  • Urge to stretch, bounce, or constantly move legs

 

These symptoms may extend to the arms in more severe cases. RLS often results in fragmented sleep, frequent awakenings, and next-day fatigue or brain fog.

Diagnosis

Diagnosis is primarily clinical (made by describing your symptoms and history to your doctor). Key tools include:

 

• Patient sleep logs and symptom tracking

• Iron panel blood tests to check for deficiency

• Evaluation for other conditions like sleep apnea or peripheral neuropathy

• A sleep study may be done to rule out other causes of nighttime movement

Treatment Options for RLS

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Iron Supplementation

  • For patients with low ferritin, iron therapy may reduce or eliminate symptoms

  • Always done under a healthcare provider’s guidance to avoid overload

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Medications

  • Dopamine agonists (e.g., pramipexole, ropinirole) – help relieve symptoms but may cause side effects or augmentation

  • Anti-seizure medications (e.g., gabapentin, pregabalin) – effective for nerve-related symptoms

  • Opioids or benzodiazepines – used in severe, treatment-resistant cases

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Lifestyle Approaches

  • Regular exercise (but not close to bedtime)

  • Warm baths, massages, or heating pads

  • Good sleep hygiene and consistent sleep schedules

  • Avoiding caffeine, nicotine, and alcohol

Sources

1. Allen, R. P., Picchietti, D. L., Garcia-Borreguero, D., et al. (2014). “Restless legs syndrome/Willis–Ekbom disease diagnostic criteria: Updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria.” Sleep Medicine, 15(8), 860–873. https://doi.org/10.1016/j.sleep.2014.03.025 2. National Institute of Neurological Disorders and Stroke (NINDS). (2023). Restless Legs Syndrome Fact Sheet. https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome 3. American Academy of Sleep Medicine (AASM). (2021). Clinical Practice Guideline: Treatment of Restless Legs Syndrome in Adults. https://aasm.org/clinical-resources/practice-standards/restless-legs-syndrome/ 4. Garcia-Borreguero, D., Silber, M. H., Winkelman, J. W., et al. (2013). “Guidelines for the first-line treatment of restless legs syndrome/Willis–Ekbom disease, prevention and treatment of augmentation: The International RLS Study Group.” Sleep Medicine, 14(7), 675–684. https://doi.org/10.1016/j.sleep.2013.01.016 5. Thorpy, M. J., & Adler, C. H. (2005). “Restless legs syndrome.” Neurology, 64(12 Suppl 3), S19–S23. https://doi.org/10.1212/01.wnl.0000165695.93445.5c 6. Berger, K., Luedemann, J., Trenkwalder, C., John, U., & Kessler, C. (2004). “Sex and the risk of restless legs syndrome in the general population.” Archives of Internal Medicine, 164(2), 196–202. https://doi.org/10.1001/archinte.164.2.196 7. Trotti, L. M. (2017). “Restless Legs Syndrome and Sleep-Related Movement Disorders.” Continuum (Minneap Minn), 23(4), 1005–1016. https://doi.org/10.1212/CON.0000000000000497 8. National Sleep Foundation. (2021). What Is Restless Legs Syndrome? https://www.sleepfoundation.org/restless-legs-syndrome

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