Restless Legs Syndrome (RLS) describes a condition that causes an uncontrollable urge to move the legs due to a sensation of severe discomfort. The discomfort can take the form of feelings of aching, tingling (‘pins and needles”), itching, a “buzzing” sensation, an unpleasant tickle, a “crawling of the flesh” feeling, and even limbs jerking or twitching.  These symptoms generally occur in the late afternoon or evening, and are triggered by resting, such as when sitting down for a while or when lying in bed.  Symptoms can make it difficult to fall asleep and can interfere with sleep during the night, when the symptoms tend to increase in severity.

It follows that RLS is classified as a sleep disorder, and at times also as a movement disorder, as some people with RLS also experience Periodic Limb Movement of Sleep (PLMS). The PLMS symptoms are involuntary twitching or jerking of the legs (sometimes also the arms) during sleep and usually occurs every 15 to 40 seconds.   Most people with PLMS do not experience RLS as well.


What causes restless legs syndrome?


While there are a number of known triggers for restless legs, in most cases the cause is unknown. Known causes include the following:

  • A genetic predisposition means that in 60% of cases this condition runs in the family, especially in families where the onset of the condition is before age 40.
  • A dysfunction can occur in the basal ganglia area in the brain that utilize the brain chemical dopamine and controls movement. The body needs dopamine to produce smooth, purposeful muscle activity and movement. Parkinson’s disease is another disorder that is linked to the basal ganglia’s dopamine pathways.
  • Medical conditions such as Parkinson’s disease or diabetes can include symptoms of restless legs.
  • Iron deficiency is a well-known cause of restless legs. Iron levels in the body can easily be determined with blood tests for ferritin and transferrin saturation levels.
  • End-stage renal disease and hemodialysis can lead to iron deficiency, which may cause restless legs. Iron stores in the blood can decrease when kidneys don’t function properly.
  • Certain medications can contribute to or cause restless legs, such as anti-nausea drugs; antipsychotic drugs; antidepressants and some cold and allergy medications.
  • The use of alcohol, nicotine and caffeine can each result in restless legs in some people.
  • Restless legs can occur during pregnancy.
  • Nerve damage can result in restless legs.
  • Underlying medical conditions such as varicose veins, kidney disease or thyroid disease can cause restless legs.
  • Spinal cord conditions such as lesions have been linked to restless legs and a spinal block (anesthesia) can increase the risk of developing restless legs.


Can restless legs be treated?


The condition can only be properly diagnosed by means of a doctor’s evaluation, as there is no specific test for the condition. The evaluation would typically include the patient’s description of the symptoms, medical history, family history, any known triggers or relieving factors, and what time of day the symptoms occur.  A physical and neurological examination can assist the doctor, as well as laboratory tests for signs of kidney failure, pregnancy, iron deficiency, venous disorders, nerve damage from diabetes, or any other medical disorder that can be linked to restless legs.

Depending on the nature of any underlying medical disorder that may be determined, the doctor will prescribe medication that may treat the condition successfully. For example, low ferritin levels can be treated with iron supplements and should be carefully monitored, as iron overload can have adverse effects on the body.

When the doctor’s evaluation rules out any underlying medical condition, treatment would usually focus on relief for the symptoms. Treatment would depend on the severity of the condition and the likely cause of restless legs and can take the form of medical intervention and/or lifestyle changes.



  • Dopaminergic drugs are usually the first medication prescribed by doctors to increase the release of dopamine in the brain, as dopamine enables normal body movements. These drugs can improve restless legs, but can become less effective over the long term or even worsen the symptoms.
  • Anti-seizure medication has shown to be effective in a few small studies.
  • Benzodiazepines are usually used to treat anxiety and sleep problems. These drugs may benefit people with restless legs through improved sleep.
  • Opioids are drugs that are usually used to treat pain and in low doses can assist with the treatment of restless legs.
  • When blood tests show deficiencies, iron and vitamin supplements can ease symptoms, as iron deficiency is deemed to be one of the main causes of restless legs. Iron levels should however be carefully monitored via blood tests, as elevated levels of iron has been linked to a variety of medical problems. Vitamin D deficiency has also been linked to restless legs.
  • Trials of different medications may be necessary for each individual.


Lifestyle changes:

  • Studies have shown that regular exercise can significantly decrease the symptoms of restless legs.
  • Self-help treatment can be tried to ease the symptoms, such as stretching at the start and end of each day, temperature treatment such as hot or cold baths and applying hot or cold packs, massaging the legs, and relaxation techniques before bedtime.
  • Certain substances or foods that have proved to cause or worsen the symptoms should be avoided, such as alcohol, caffeine, nicotine, chocolate, energy drinks, as well as refined sugar found in processed foods and sweetened drinks.
  • High stress and anxiety levels can increase the symptoms of restless legs. Relaxation techniques can be tried, for instance meditation, yoga, tai chi, or breathing exercises.
  • Avoid sitting still for long periods and take regular breaks if possible.
  • Implement a regular bedtime routing to ensure that you get enough sleep, as lack of sleep can worsen the symptoms. In this regard avoid blue light emitted from electronic screens (cellphone, computer screens) for at least two hours before bedtime. Blue light affects your circadian rhythm, which assists you in keeping a natural sleep cycle. Also avoid or limit the amount of alcohol or caffeine in the evening. Regular healthy sleeping habits will improve your sleep and help minimize some of the effects of restless legs.


Long term prognosis


Restless legs syndrome may be resolved if an underlying medical condition is determined and successfully treated.

In many cases restless legs can be a lifelong condition for which there is no cure and treatment is aimed at minimizing the symptoms and increasing periods of restful sleep.



Restless legs syndrome fact sheet.  Published online.  National Institute of Neurological Disorders and Stroke.  National Institutes of Health.  (USA)  (

Restless legs syndrome.  Published online 17 July 2018.  Mayo Clinic.  (

The 11 best treatments for restless legs syndrome.  Published online and information reviewed 27 February 2018.  Healthline.  (

Restless legs syndrome. / Restless legs syndrome (RLS): Know your triggers. / Treatment for restless legs syndrome. / 10 Tips to ease restless legs syndrome.  Series of articles published online.  WebMD.  (




February 2019


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