Overcoming Restless Legs Syndrome: Tips for Better Sleep and Relief

Overview

Restless Legs Syndrome (RLS), also called Willis-Ekbom disease, is a common neurological condition that affects up to 10% of adults, with higher rates in women and older adults. It causes an uncontrollable urge to move your legs, usually accompanied by uncomfortable sensations, and symptoms are almost always worse in the evening or at night, often disrupting sleep and daily quality of life. While there is no cure for RLS, a wide range of evidence-based treatments and self-management strategies can effectively reduce symptoms for most people.

Signs & Symptoms

RLS symptoms are unique to each person, but they almost always follow a specific pattern. The uncomfortable sensations in your legs (and sometimes arms) are often described as crawling, creeping, pulling, itching, tingling, or aching. These feelings are paired with an overwhelming urge to move your legs to get relief, and symptoms get much worse when you are resting, sitting, or lying down. Many people find their symptoms are most severe in the late afternoon, evening, or night, which can make it hard to fall or stay asleep.

• Uncontrollable urge to move your legs to relieve discomfort
• Unpleasant sensations in the legs (crawling, tingling, aching, itching)
• Symptoms that worsen when you are resting, sitting, or lying down
• Symptoms that are more severe in the evening or at night
• Temporary relief of symptoms when you move, walk, or stretch your legs
• In severe cases, symptoms may spread to the arms, torso, or face

Causes & Risk Factors

The exact cause of primary RLS (RLS with no underlying medical cause) is not fully understood, but research points to an imbalance of dopamine, a brain chemical that controls muscle movement. Genetics also play a role: about 40% of people with RLS have a family history of the condition. Secondary RLS is caused by an underlying health issue or factor, including: iron deficiency (even if you are not anemic), chronic kidney disease, pregnancy (especially the third trimester, with symptoms often resolving after delivery), peripheral neuropathy (nerve damage in the hands and feet), and certain medications including some antidepressants, antipsychotics, antihistamines, and anti-nausea drugs. Caffeine, alcohol, and tobacco use can also worsen RLS symptoms.

Diagnosis

There is no specific blood test or imaging scan to diagnose RLS. Your healthcare provider will diagnose the condition based on your symptoms, medical history, and a physical exam. They may order blood tests to check your ferritin (iron storage) levels, kidney function, and blood sugar to rule out underlying causes like iron deficiency or diabetes. The International RLS Study Group has established 4 essential criteria that must be met for an RLS diagnosis:

Treatment & Management

Treatment for RLS is tailored to the cause and severity of your symptoms. If you have secondary RLS, your provider will first treat the underlying condition (for example, prescribing iron supplements if you have low ferritin levels, or adjusting medications that may be triggering symptoms). For mild symptoms, lifestyle changes and self-care strategies are often the first line of treatment. For moderate to severe RLS, medications may be recommended, including dopamine agonists (such as pramipexole or ropinirole) that regulate dopamine levels in the brain, gabapentin enacarbil for people who also have neuropathy or sleep issues, and in rare severe cases, low-dose opioids. Your provider will work with you to find the safest, most effective treatment for your needs.

Living With It

RLS is a chronic condition, but most people are able to manage their symptoms effectively with consistent care. Building a support network, including RLS support groups (in-person or online) can help you cope with the emotional and practical challenges of living with the condition. Prioritizing good sleep hygiene, avoiding known triggers, and sticking to your treatment plan can help you reduce symptom flare-ups and improve your overall quality of life.