Restless Legs Syndrome

  • What Is Restless Legs Syndrome?

    Restless legs syndrome is a neurological disorder whose primary feature is an irresistible urge to move the legs when the individual is at rest, referred to as focal akathisia. The sensation is worse at night. Relief from the sensation is almost immediate when the individual moves the legs or walks around. However, if the individual stops moving or walking, the sensation may return. The sensation will usually lead to insomnia. The bed partner may notice periodic or rhythmic movements of the legs when the individual is asleep.

    Restless legs syndrome affects 4% to 29% of the general population. Although the syndrome can occur in all age groups, its incidence seems to increase with age. The condition, though unpleasant and annoying, is not a major health risk, nor is it an early warning sign of a more serious neurological disorder such as Parkinson’s disease.


    Who Gets Restless Legs Syndrome?

    Although restless legs syndrome may sound merely bizarre, it is a serious disorder.

    Some cases of restless legs syndrome can result from conditions that include iron deficiency, kidney failure, peripheral neuropathy or pregnancy. But in most cases the cause is unknown. Often, other family members are affected as well, and more than half of the cases of unknown origin are thought to have a genetic basis.



    • Unpleasant crawling and/or aching sensation inside the calf muscles while lying down. Similar sensations may also be felt in the thighs, feet, and arms.
    • Irresistible urge to move the legs, which worsens at night or in the evening.
    • Relief is felt immediately upon walking.
    • Difficulty falling or staying asleep.

    • Involuntary jerking of the limbs during sleep and occasionally when awake.
    • Some people have severe symptoms all day long, which may affect work, travel, or the ability to concentrate.


    Causes/Risk Factors

    • The exact cause of restless legs syndrome is unknown, but some studies suggest the symptoms are related to low levels of the neurotransmitter dopamine in the brain.

    • Hereditary factors may play a role.

    • Emotional stress or regular use of caffeine, antihistamines, or tobacco may trigger or worsen symptoms.
    • It is associated with iron deficiency, pregnancy, dialysis, and peripheral neuropathy.
    • Certain medications may also induce restless legs syndrome, including lithium and antidepressants.


    What If You Do Nothing?

    Restless legs syndrome is extremely unpleasant and if left untreated can bring on an exhausting chronic insomnia. But if you’re healthy, as most people with restless legs syndrome are, simple changes in lifestyle may be enough to bring some relief from a condition that can last for years. It’s also worth talking to your doctor about restless legs syndrome, since some medications are being used to successfully treat the problem.



    • Diagnosis is based upon symptoms as described by the patient.
 Because restless legs syndrome presents no external secondary symptoms, it can be difficult to identify.
    • A polysomnagram may be conducted to study sleep behavior if symptoms occur only during sleep.
    • Physical examination may be performed to rule out other disorders such as neuropathy, myopathy, or arthropathy.

    • Blood tests (ferritin and percent iron saturation) to measure iron status should always be conducted. Iron and calcium deficiencies often produce symptoms that mirror restless legs syndrome, such as leg cramping and tenderness.



    • Although some nondrug therapies are outlined below, the only consistently successful treatments are with medications.

    • Walk around for 10 to 15 minutes prior to going to bed, to stretch the leg muscles and promote restful sleep. Contracting, massaging, or keeping the leg muscles warm before going to bed may relieve symptoms.
    • If symptoms strike while you’re in bed, get up and walk around. Try doing a few simple exercises.
    • Wearing long, heavy socks in bed to keep your feet and legs warm may help relax your muscles.
    • Some people may find relief by soaking their feet in cold water. A cold compress applied to the shins and calf muscles may also help.
    • Sleeping on your side with a pillow between your knees may help relax leg muscles.
    • Stress management techniques or psychological counseling may help relieve anxiety that triggers restless legs.
    • Antipsychotic medications (neuroleptics), anti-emetics (nausea preventives), and antidepressants may aggravate the symptoms, as may long-term use of levodopa (see your doctor for an alternative).

    • Some cases caused by iron deficiency may respond to iron supplements, but these should not be taken without your doctor’s guidance.
    • Ropinirole hydrochloride (e.g., Requip), which also is used to treat Parkinson's disease, is approved by the Food and Drug Administration (FDA) to treat moderate-to-severe (i.e., 15 or more episodes per month) restless legs syndrome.
    • Gabapentin enacarbil (Horizant Extended Release Tablets) is also FDA-approved to reduce symptoms of moderate-to-severe restless legs syndrome.
    • Many other medications may be effective, including other dopamine-related medications (such as levodopa and pramipexole), analgesics (such as codeine, propoxyphene, and tramadol), and clonazepam.



    • There is no way to prevent restless legs syndrome.
    • Nicotine and large amounts of caffeine may trigger restless legs syndrome in some people. Consequently, avoid products containing caffeine, and if you smoke, stop.


    When To Call Your Doctor

    Make an appointment with a doctor if restless legs symptoms interfere with sleep.


    Reviewed by Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network.