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Restless Legs Syndrome

What is Restless Legs Syndrome?

Restless legs syndrome (RLS) is a neurological sleep disorder associated with leg movement during sleep or rest. Patients have an overwhelming urge to move their legs along with unpleasant or uncomfortable sensations in the legs. Symptoms occur when a person is not active, usually in the evening or at night. The syndrome is also known as Willis-Ekbom disease.

RLS can make it hard to fall asleep or stay asleep. Treatment includes lifestyle changes to help manage symptoms and improve sleep patterns. Some patients may also need medication.

Symptoms of Restless Legs Syndrome

Symptoms of restless legs syndrome (RLS) include:

  • Overwhelming urge to move the legs while at rest
  • Unpleasant sensations of itching, crawling, pulling, or aching in the legs
    • Symptoms tend to be worse at night; improve or go away with movement or pressure; usually occur on both sides of the body, but may be on one side or switch side to side; can range in severity and frequency; and may come and go

The symptoms of restless legs syndrome can be hard to describe, especially for children. The sensations usually feel like they are within the legs instead of on the surface of the skin. Children may describe the sensation as:

  • Needing to move, kick, or stretch their legs
  • Feeling like ants or bugs are crawling in or on their legs
  • Legs feel “tingly,” “squirmy,” “twitchy,” “creepy-crawly,” or “wiggly”

Causes of Restless Legs Syndrome

Certain factors increase risk of RLS. These include:

  • Low ferritin (iron storage) levels
  • Medicines including certain antidepressant medications and anti-nausea medicines
  • Family history of RLS
  • ADHD
  • Anxiety
  • Depression
  • Kidney disease
  • Sickle cell disease
  • Peripheral neuropathy

Diagnosis of Restless Legs Syndrome

Assessment of restless leg syndrome (RLS) includes:

  • Medical history and physical exam
  • Patient and family interview or questionnaire to explore symptoms
  • Review of medicines to find out if sleep problems might be a side effect of certain drugs
  • Laboratory tests to measure iron levels in the blood

Doctors look for 5 criteria to diagnose RLS:

  1. Irresistible urge to move the legs usually associated with uncomfortable or unpleasant sensations.
  2. Symptoms develop or worsen during inactivity or rest.
  3. Symptoms improve with movement.
  4. Symptoms are most noticeable in the evening or at night.
  5. Symptoms are not due to another condition.

Treatment of Restless Legs Syndrome

Treatment of restless legs syndrome (RLS) depends on the cause, severity of the condition, and age of the patient. No one treatment works for every patient, and treatment needs may change over time.

Lifestyle and behavioral changes – Mild to moderate RLS symptoms are first managed with lifestyle changes. Recommendations include:

  • Healthy sleep habits
  • Moderate-intensity physical activity and stretching exercises
  • Avoiding caffeine and nicotine
  • Massage, hot baths, heating pads, or ice packs to relax leg muscles (check with the care team first, especially if the patient is on treatment)
  • Relaxation techniques such as deep breathing and meditation 

Iron supplements - A doctor may recommend an iron supplement if the patient has low levels of ferritin in the blood (low serum ferritin). Supplements are available over the counter. However, families should check with their doctor or pharmacist to make sure the proper type and dose of iron is given. Side effects may include upset stomach and constipation. Too much iron can be dangerous, especially for small children.

Other Medications – For more severe RLS symptoms, several types of drugs have been shown to have benefit in treating RLS symptoms in adults. However, most medicines have not been approved for treating RLS in children. Many of the medicines used for RLS are also used for other conditions.

Medicines used to treat seizures can be used for RLS. Gabapentin given before bedtime is often a first medicine tried for RLS in both children and adults.

Benzodiazepine drugs are often used to lower anxiety, control seizures, and treat nausea. They may be used to help with sleep and decrease muscle spasms. A low-dose benzodiazepine given before bedtime may be prescribed to reduce symptoms of RLS.

Medicines that increase the neurotransmitter dopamine may be prescribed for RLS. Many of these medicines have been traditionally used in the treatment of Parkinson’s disease. These medicines are not used as often for RLS in children.

It is important to follow dosing instructions carefully. The dose and timing of the medicine may be different when used for sleep and RLS symptoms than when used for other reasons. These medicines can be unsafe if taken more often or in greater amounts than prescribed. Families should make sure to store medicines safely and keep out of the reach of children.

Resources for More Information on Restless Legs Syndrome


Reviewed: June 2019