Restless legs syndrome

Also called restless legs or periodic limb movements of sleep

Restless legs syndrome is an urge to move your legs due to uncomfortable and unpleasant sensations in them.

Key points

  1. Restless legs syndrome (RLS) affects about 7 in 100 adults. It is twice as common in women and gets worse with age.
  2. It can sometimes also affect your arms or other body parts.
  3. The common symptom is a strong, overwhelming urge to move the affected part of your body, which will usually make you feel better for a short time.
  4. Treatment usually involves treating the underlying cause, lifestyle changes for milder symptoms or medicines for severe symptoms.
  5. RLS is a common cause of sleep problems and daytime sleepiness.

What is restless legs syndrome (RLS)?

RLS is a condition in which you have an unpleasant feeling or sensation, usually in the calves of your legs, that results in a strong, uncontrollable urge to move your legs.

  • The symptoms are usually brought on by rest and are worse in the evening or night.
  • Movement such as walking or stretching brings relief for a short time, but the symptoms usually return once you settle into a restful state.
  • Both legs may be affected or one may be worse than the other.
  • Sometimes other parts of your body, such as your arms or lower back, may be affected.
  • RLS can affect your sleep and lead to tiredness, feeling sleepy or trouble concentrating. If this happens, see your doctor and get help to manage your symptoms.

Note: Nocturnal (night-time) leg cramps are different from restless legs. A single jerky movement in the early stages of sleep is common in one third of people and is normal.

What causes RLS?

The exact cause of RLS is uncertain, but it is thought to involve your nervous system. It may be genetic (a condition that runs in families). If your parents had RLS, your risk of having it is 30–50% higher. 

Some medical conditions may trigger or be associated with RLS

Pregnancy (usually in the last trimester), can also cause RLS. RLS due to pregnancy often gets better on its own within a month after delivery.

Some medicines may cause RLS, eg, some antidepressants, sedating antihistamines and antipsychotics such as haloperidol, quetiapine or olanzapine.

What are the symptoms of RLS?

The common symptom of RLS is that you have a strong, overwhelming urge to move the affected part of your body, usually your leg. Symptoms can range from a mild feeling of restlessness in your legs on some evenings, to a more severe problem that occurs every evening and night (and, sometimes, during the day) which regularly disturbs sleep. Many people fall somewhere in between these extremes.

  • You may also get an uncomfortable or tingling sensation such as 'pins and needles', prickling, pulling or crawling.
  • These feelings begin about 15 minutes after you lie down to sleep or to relax or when you have not moved for long periods, such as when travelling in a car or airplane.
  • Moving will usually make you feel better, at least for a short time. 

How is RLS diagnosed?

Most of the time RLS can be diagnosed by your GP or neurologist without any special tests. However, blood tests may be required to look for possible triggers.

How is RLS treated?

If you have a medical condition causing or aggravating RLS, such as iron deficiency, treating it may resolve your symptoms. A change of medication may be advised if a side effect from a medicine is thought to be responsible.

Lifestyle changes

Sometimes a few lifestyle changes may be enough to control your symptoms such as:

  • stopping smoking
  • limiting or avoiding alcohol and caffeine
  • keep your bedroom cool, quiet and comfortable, and using it only for sleeping, not for watching TV or scrolling through social media
  • getting regular exercise – try walking before bedtime or doing gentle leg stretches for 5 minutes before you sleep
  • eating a healthy diet
  • massaging or soaking the affected leg or arm
  • using heat or ice packs on the affected leg or arm
  • doing distracting activities such as reading to reduce awareness of symptoms.

Medication

When symptoms are more severe, medicines may help control the urge to move and help you sleep. Different types of medicine may help, such as pramipexole, ropinirole, carbamazepine, gabapentin and pregabalin. You may have to try a few to find the one that works best for you. They each have their own risks and benefits.

Learn more

The following links provide further information on restless legs syndrome. Be aware that websites from other countries may contain information that differs from New Zealand recommendations:

Restless legs syndrome Patient Info, UK
Restless legs syndrome fact sheet National Institute of Neurological Disorders and Stroke, US

Reviewed by

Jeremy Steinberg is a GP with special interests in musculoskeletal medicine, evidence-based medicine and use of ultrasound. He's been reviewing topics for Health Navigator since 2017 and in his spare time loves programming. You can see some of the tools he's developed on his website.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Jeremy Steinberg, FRNZCGP Last reviewed: 20 May 2020