Restless legs syndrome (RLS) is a common condition that causes an overwhelming urge to move your legs. Because symptoms are typically worse at night, many people find that, beyond general discomfort, RLS affects sleep too.
While there’s currently no cure for RLS, many people can manage their symptoms with lifestyle changes.
Here, we’ll cover everything you need to know about restless legs syndrome, including symptoms, causes, and ways to cope.
What is restless legs syndrome and what are the symptoms?
Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a common condition of the nervous system that’s mainly characterised by a strong – often irresistible – urge to move your legs (sometimes your arms too).
Many people also experience unpleasant creeping, itching, or crawling sensations in their feet, calves, and thighs. Symptoms are generally described as more uncomfortable and distracting than painful.
According to the Restless Legs Syndrome Foundation, other signs of RLS include…
- Symptoms begin or become more pronounced when you’re inactive or resting – for example, when sitting or lying down.
- Symptoms improve as you move, for example, when stretching or walking – but may return once you stop.
- Symptoms are more intense at night than during the day, or only occur at this time.
- Symptoms aren’t solely accounted for by another condition such as arthritis, leg cramps, or leg swelling.
Many people with RLS also experience insomnia and periodic limb movement disorder (PLMD) as a result of, or in line with, their symptoms. We’ll look at these below.
Restless legs syndrome and insomnia
Experiencing an overwhelming urge to move your legs can make falling and staying asleep difficult for many people with RLS. In this study, 88% of people with RLS reported some kind of sleep disruption.
It’s common for symptoms to appear shortly after getting into bed, and many people with RLS feel compelled to get up and kick, stretch, or massage their legs.
As a result, research has identified a strong link between RLS and sleep deficiency – both in terms of quality and quantity of sleep. This can lead to daytime fatigue which, if left unchecked, can increase the risk of various health concerns, including depression, anxiety, obesity, and heart disease.
Restless legs syndrome and periodic limb movement disorder
According to research, most people with RLS also have periodic limb movement disorder (PLMD) – a condition that causes repetitive twitching or flexing of limbs during sleep.
PLMD differs from RLS because movements happen during sleep and aren’t typically accompanied by uncomfortable sensations. However, because PLMD can cause people to wake up during sleep, it can exacerbate existing sleep issues linked with RLS.
Although most people with RLS also have PLMD, PLMD can occur independently of RLS.
What causes restless legs syndrome?
While RLS can affect anyone, it’s more common in people over 40, and symptoms tend to progress with age.
According to the NHS, the exact cause of many RLS cases is unknown. When no cause can be found, it’s known as idiopathic or primary RLS.
However, experts have identified several potential causes, risk factors, and triggers. These include…
Dopamine
According to the NHS, RLS may be linked to a problem in the area of your brain called the basal ganglia, which is responsible for causing movement.
The basal ganglia uses a neurotransmitter called dopamine (which acts as a messenger between the brain and nervous system) to control muscle activity and regulate how your body moves. If nerve cells become damaged and communication between the brain and nervous system affected, the amount of dopamine in the brain is reduced. This can affect the brain’s ability to control movement – sometimes resulting in muscle spasms and involuntary movements.
Dopamine levels naturally decrease towards the end of the day, which may help to explain why RLS symptoms are often more intense during the evening and nighttime.
Genetics
There’s evidence that genetics may play a role in the development of RLS. According to the Sleep Foundation, between 40% and 90% of people with RLS have at least one first-degree relative (parent, child, or sibling) with the condition.
Other research suggests that certain genetic mutations may increase the risk for RLS. However, further research is needed to confirm this link.
Underlying medical conditions
In some cases, RLS can occur as a complication of other health conditions. This is known as secondary RLS.
Examples of health conditions that can cause secondary RLS include…
- Iron deficiency anaemia – a lack of iron can lead to a fall in dopamine, triggering RLS
- Long-term health conditions like diabetes, late-stage kidney disease, rheumatoid arthritis, and Parkinson’s disease
Research has also found that RLS can also temporarily occur during pregnancy – with around 20% of women experiencing RLS during the third trimester. However, symptoms typically fade or resolve soon after delivery.
Potential triggers for restless legs syndrome
Many people find that certain triggers exacerbate symptoms. Some of the most common RLS triggers include alcohol, caffeine, nicotine, stress, and taking antihistamines.
How is restless legs syndrome diagnosed?
If you suspect you have RLS, it’s important to speak to your GP.
While there isn’t a single test for RLS, your GP should be able to diagnose RLS by discussing your symptoms and medical history. For example, they’ll ask you about the frequency and severity of your symptoms and the effect on your quality of life.
In some cases, your GP may refer you for further tests to rule out any potential underlying causes of RLS. This can include blood tests and sleep tests.
You can read more about how RLS is diagnosed on the NHS website.
How is restless legs syndrome treated?
Treatment for RLS will vary depending on its cause and the severity of your symptoms.
According to the NHS, secondary RLS (RLS caused by an underlying health condition) can often be cured by treating the underlying condition. For example, iron deficiency anaemia can be treated by taking iron supplements.
If your symptoms are severe, you may be prescribed medication, such as dopamine agonists. However, mild RLS that isn’t linked to an underlying health condition can often be managed with lifestyle changes. We’ll cover some of these below.
5 lifestyle tips and changes for coping with restless legs syndrome
1. Take steps to improve sleep
Because of the effect that RLS can have on sleep, taking steps to improve your sleep can be helpful. If you’ve been struggling to get enough good quality rest recently, you could try things like sticking to a regular sleep schedule, reducing screen time before bed, and avoiding alcohol and caffeine.
Check out our articles, 8 tips for better sleep, How to design the perfect bedroom for sleep, and 8 natural remedies for sleep, for more guidance. Or, head over to the sleep and fatigue section of our website.
2. Try leg massage
Research suggests that poor circulation may play a role in RLS symptoms. As a result, massage is often recommended to provide relief.
The pressure applied by massage moves blood through congested areas – allowing new blood in and improving the circulation of lymph fluid, which removes waste from your muscles and organs.
This study found that massage alone significantly reduced the severity of RLS symptoms compared to no intervention; and another study noted the benefits of massage for improving RLS symptoms.
Check out our article, 10 health benefits of massage, for information on different types of massage and how to find a massage therapist.
3. Stick to a regular workout routine
Many people with RLS find that symptoms are heightened when they’re inactive, so exercise can be a helpful tool for managing the condition.
In this study, RLS patients experienced a 39% reduction in symptom severity after six weeks of following an exercise programme, compared to an 8% reduction in symptoms in patients who didn’t exercise.
Research suggests that light to moderate-intensity exercise – such as yoga, cycling, swimming, and stretching – may be the most beneficial. In this study, people with RLS found that a 12-week course of light yoga helped reduce symptoms. Another study found that doing aerobic and stretching exercises three times a week resulted in 21% and 18% improvements in RLS symptoms, respectively.
In contrast, strenuous exercise and bursts of excessive energy close to bedtime may intensify RLS symptoms. According to experts, this is because it increases heat in leg muscles and may contribute to inflammation.
Research also suggests that consistency is key. This study found that when people with RLS abruptly changed their exercise habits (such as stopping a routine workout), they almost always experienced symptom recurrence. Meanwhile, those who stuck to a consistent exercise pattern had improved symptoms.
If you’re yet to find a form of exercise you enjoy, head over to the fitness and exercise section of our website for inspiration. Here, you’ll find information on everything from team sports and Pilates to tips for joining the gym.
4. Try heat therapy
Some people find heat therapy useful for RLS symptoms because it soothes muscles, improves circulation, and distracts the brain.
Why not try taking a hot bath or covering your legs with a warm compress or heating pad? This can be particularly beneficial before bed because it encourages relaxation and can make falling asleep easier.
5. Consider using a pneumatic pressure device
Pneumatic compression devices work to improve blood flow by pumping air into and out of sleeves that wrap around your legs.
Research has found that they can significantly improve RLS symptoms. For example, in this study, pneumatic pressure devices were found to improve RLS symptoms, quality of life, and fatigue after one month of daily use compared to a control group. One-third of patients also experienced a complete resolution of symptoms.
Pneumatic compression devices are available to buy on Amazon.
Final thoughts…
Restless legs syndrome can be frustrating and difficult to live with – particularly if it affects your ability to sleep. However, while there’s currently no cure, many people find that they can manage symptoms with things like massage, heat therapy, and sticking to a regular workout routine.
For further reading, head over to the general health section of our website. Here, you’ll find information on everything from lung and bone health to important health checks for over 50s.
Do you have any more tips for living with restless legs syndrome? We’d be interested to hear from you in the comments below.
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