What is restless legs syndrome (RLS)?
Restless legs syndrome (RLS)—also known as Willis-Ekbom Disease—is a neurological condition that causes an irresistible urge to move the legs.
RLS is a sleep disorder triggered by resting and attempting to sleep. It is also a movement condition, as people with RLS are forced to move their legs to find relief from symptoms.
Common signs and symptoms of RLS
People with RLS generally feel an irresistible urge to move, accompanied by uncomfortable sensations in their legs. The sensations may feel like aching, throbbing, pulling, itching, crawling, or creeping. They less commonly affect the arms, rarely occur in the chest or head, and most often affect both sides of the body but can also affect only one side.
Common features of RLS include:
- Symptoms after rest—Sensations typically occur when the individual is inactive and sitting for extended periods (e.g., taking a plane trip or watching a movie).
- Relief of discomfort with movement—People with RLS may need to keep their legs (or other affected parts of the body) in motion to minimize or prevent the sensations. They may need to pace the floor or constantly move their legs while sitting.
- Worsening of symptoms at night with a distinct symptom-free period in the early morning—People with RLS may have difficulty falling asleep and staying asleep. Events or activity that further reduce sleep may also worsen their symptoms.
People with RLS commonly feel symptoms in the late afternoon or evening hours. RLS can severely interrupt sleep, making it difficult to fall asleep or return to sleep after waking up. Leg movement or walking typically provides temporary relief from the discomfort, but the sensations often return as soon as movement ceases.
RLS symptoms may vary from day to day and from person to person. With moderately severe RLS, symptoms might only occur once or twice a week but often make it very difficult to fall asleep and cause some problems with function during the day. In severe cases of RLS, the person will have symptoms more than twice a week.
People with RLS may have:
- Changes in mood
- Exhaustion and daytime sleepiness
- Trouble concentrating
- Memory issues (impaired memory)
- Decreased productivity
- Depression and anxiety
Individuals with RLS may experience remissions—periods in which symptoms decrease or disappear for weeks or months—usually during the early stages of the condition. However, symptoms often reappear and become more severe over time.
Who is more likely to have restless legs syndrome?
RLS can develop at any age, however it most often begins in middle age. The condition occurs in men and women but is more common in women.
In most cases, the cause of RLS is unknown. However, RLS often runs in families, and specific gene variants are associated with the condition. Low levels of iron in the brain also may be responsible for RLS.
RLS also may be related to a dysfunction in the basal ganglia—a part of the brain that controls movement. The basal ganglia uses a brain chemical called dopamine to produce smooth, purposeful muscle activity and movement. Disruption of dopamine levels in the brain frequently results in involuntary movements. People with Parkinson’s disease have an increased risk of developing RLS.
RLS may happen alongside other conditions:
- End-stage renal disease and hemodialysis
- Neuropathy (nerve damage)
- Sleep deprivation and other sleep conditions, including sleep apnea
- Pregnancy, especially in the last trimester. In most cases, symptoms usually disappear after delivery.
- Use of alcohol, nicotine, and caffeine
Certain medications may aggravate RLS symptoms, such as some anti-nausea drugs, antipsychotic drugs, antidepressants that increase serotonin, and some antihistamines.
How is restless legs syndrome diagnosed and treated?
Diagnosing RLS
There is no specific diagnostic test for RLS. A healthcare provider can review symptoms, medical history, medications, and family history and perform physical and neurological exams. Doctors can also evaluate the symptoms’ frequency, duration, and intensity.
Blood tests may help rule out other conditions that can cause RLS symptoms, such as kidney failure, low iron levels, and other causes of sleep disruption, like sleep apnea and pregnancy.
Diagnosing RLS in children may be especially difficult as it may be hard for children to describe their symptoms. Doctors sometimes misdiagnose RLS in children as "growing pains" or attention deficit hyperactivity disorder (ADHD).
Treating RLS
RLS has no cure, but treatment can help manage some symptoms. The first step in treatment is to address anything that could be making RLS symptoms worse. This includes treating other conditions the person has, like diabetes, neuropathy, sleep apnea, or iron deficiency.
Lifestyle changes and activities may provide some relief. These include:
- Avoiding or decreasing the use of alcohol, nicotine, and caffeine
- Maintaining a regular sleep schedule
- Exercising moderately and consistently
- Massaging the legs or taking a warm bath
- Applying a heating pad or ice pack
- Using foot wraps specially designed for people with RLS, or vibration pads to the back of the legs
The FDA recently approved a new technology called tonic motor activation (TOMAC) to reduce symptoms of RLS and improve sleep quality. The system—consisting of devices worn on the lower legs—activates the muscles, mimicking the sensation of movement, reducing the discomfort caused by RLS, and improving sleep.
Doctors also may prescribe medications for RLS, such as:
- Anti-seizure medications: Gabapentin enacarbil or pregabalin for moderate to severe RLS
- Iron supplements
- Opioids: For severe RLS cases that don’t respond to other treatments
- Benzodiazepines: To treat anxiety, insomnia, or muscle spasms
- Dopaminergic agents: Drugs like carbidopa/levodopa can help, but long-term use may worsen symptoms.
What are the latest updates on restless legs syndrome?
NINDS, a component of the National Institutes of Health (NIH), is the primary federal funding agency for research on the brain and nervous system. NINDS and other NIH components support research on RLS and related conditions. NINDS provided funding for the development of the FDA-approved TOMAC treatment for RLS.
Scientists do not fully understand how iron gets into the brain and how it’s regulated. NINDS-funded researchers are using animal models and a model of the blood-brain barrier to study how iron is delivered and regulated in the brain. Results may offer insights into the management of iron deficiency and its effect on neurological function.
Other NIH-supported research includes:
- Developing a novel wearable device and mobile application to improve the diagnosis and management of RLS in children with ADHD.
- Discovering biomarkers of Alzheimer’s disease and other related disorders, including Parkinson’s disease, traumatic brain injuries, and RLS. Biomarkers are biological signs of disease found in blood, body fluids, and tissues that can be measured to help diagnose and monitor disease.
- Studying sleep effects on post-stroke rehabilitation with the goal of gaining a more in-depth understanding of how insomnia disorders, RLS, and insufficient sleep impact recovery after stroke.
More information about research on RLS supported by NINDS or other components of the NIH is available through the NIH RePORTER, a searchable database of current and previously funded research. RePORTER also includes links to publications and resources from these projects. For research articles and summaries on RLS, search PubMed, which contains citations from medical journals and other sites.
How can I or my loved one help improve care for people with restless legs syndrome?
Clinical trials increase our understanding of RLS with the goal of improving how doctors treat it. Consider participating in a clinical trial, so clinicians and scientists can learn more about RLS and related conditions. Clinical research with human study participants helps researchers learn more about a disorder and perhaps find better ways to safely detect, treat, or prevent disease.
All types of study participants are needed—those who are healthy or may have an illness or disease—of all different ages, sexes, races, and ethnicities to ensure that study results apply to as many people as possible, and that treatments will be safe and effective for everyone who will use them.
For information about clinical research participation, visit the NINDS Clinical Trials website and NIH Clinical Research Trials and You. Learn about clinical trials currently looking for people with RLS at Clinicaltrials.gov, a searchable database of current and past federal and private clinical trials.
Where can I find more information about restless legs syndrome?
Information also is available from the following organizations: