Home Health Topics What Is Restless Legs Syndrome? Symptoms, Causes, Diagnosis, Treatment, and Prevention

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What Is Restless Legs Syndrome? Symptoms, Causes, Diagnosis, Treatment, and Prevention

July 25, 2020

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Causes and Risk Factors of Restless Legs Syndrome

While the direct cause of RLS is often unknown, changes in the brain’s signaling pathways likely contribute to the disease. It’s thought that impaired transmission of dopamine signals in the brain’s basal ganglia may play a role.

Dopamine is needed to produce smooth, purposeful muscle activity and movement. Disruption of these pathways frequently results in involuntary movements. Individuals with Parkinson’s disease, another disorder of the basal ganglia’s dopamine pathways, have an increased chance of developing RLS.

There is a genetic component, and the disorder can be found in families where the onset of symptoms is before age 40.As many as 40 to 90 percent of people with RLS report having at least one affected first-degree relative, such as a parent or sibling, and many families have multiple affected family members.

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When the cause is unknown, the disorder is called primary RLS. When restless legs syndrome is caused by another disease or condition, or is a side effect of certain medications, the disorder is known as secondary RLS.

Certain conditions seem to be associated with the development or worsening of restless legs syndrome, including:

Iron deficiency (with or without anemia)
Kidney failure
Diabetes
Parkinson's disease
Damage to the nerves in the hands or feet (peripheral neuropathy)
Rheumatoid arthritis
Pregnancy

Medications that may aggravate RLS symptoms include:

Antinausea drugs (such as prochlorperazine or metoclopramide)
Antipsychotic drugs (such as haloperidol or phenothiazine derivatives)
Some cold and allergy medications that contain older antihistamines (for example, diphenhydramine)

Alcohol, nicotine, and caffeine can also trigger symptoms.

How Is Restless Legs Syndrome Diagnosed?

There are no medical tests to diagnose RLS, but your doctor may perform blood tests and other exams to rule out other disorders.

Your doctor may also order blood tests to look for underlying conditions that can cause RLS, such as diabetes or kidney disease.

In addition, your doctor may use a neurological and a physical exam, information from your medical and family history, and a list of your current medications to make a diagnosis.

In some cases, sleep studies such as polysomnography (a test that records the individual’s brain waves, heartbeat, breathing, and leg movements throughout the night) are used to identify the presence of other causes of sleep disruption (such as sleep apnea), which may impact management of RLS.

Diagnosing RLS in children can be especially difficult, since it may be hard for children to describe what they are experiencing, when and how often the symptoms occur, and how long symptoms last. Pediatric RLS can sometimes be misdiagnosed as "growing pains" or attention deficit hyperactivity disorder.

As a result, this condition often goes undiagnosed in children.

Treatment and Medication Options for Restless Legs Syndrome

The goals of treatment for RLS are to relieve symptoms, increase the amount and quality of sleep, and treat any underlying condition that may be causing RLS.

Treatment options for RLS include:

Iron A trial of iron supplements is often recommended as a first treatment if your blood test indicates low or low-normal ferritin, a protein in the body that binds to iron.
Anti-seizure drugs These can be effective in decreasing sensory disturbances such as creeping and crawling as well as nerve pain. The U.S. Food and Drug Administration (FDA) has approved gabapentin enacarbil for the treatment of moderate to severe RLS.
Dopaminergic agents These have been shown to reduce symptoms of RLS when taken at nighttime. The FDA has approved ropinirole, pramipexole, and rotigotine to treat moderate to severe RLS.
Opioid drugs Methadone, codeine, hydrocodone, or oxycodone are sometimes prescribed to treat individuals with more severe symptoms of RLS who do not respond well to other medications.
Benzodiazepines Medications such as clonazepam and lorazepam are sometimes prescribed to treat anxiety, muscle spasms, and insomnia.

Symptoms can also be alleviated by:

Hot baths
Massages
Lifestyle changes, including implementing a regular exercise program, maintaining regular sleep patterns, and limiting use of tobacco, alcohol, and caffeine

Being active throughout the day helps alleviate symptoms for some. This gives your muscles the chance to exert the energy that they would otherwise exert at night.

Regular exercisers are 3.3 times less likely to have RLS than non-exercisers.

Some people find that good sleep habits can also help with symptoms of RLS.

These habits can include:

Only using your bedroom for sleep (not for watching TV or using a computer or cell phone)
Going to bed at the same time every night and waking up at the same time every morning
Making sure you get enough sleep so that you feel rested when you wake up

If RLS symptoms are mild, do not produce significant daytime discomfort, or do not affect an individual’s ability to fall asleep, the condition does not have to be treated.

Alternative and Complementary Therapies

Several studies have shown that acupuncture can improve symptoms of RLS. One recent study found that patients treated with acupuncture in combination with a low dose of gabapentin reported greater improvement in symptoms than did those who were treated with gabapentin alone.

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In addition, studies have shown that certain other nonpharmacological therapies, including exercise and pneumatic compression devices, which improve circulation, can be effective in alleviating symptoms of RLS.

Relaxation techniques such as meditation or yoga may alleviate symptoms as well, but more studies are needed to determine exactly how effective these practices are.

Prevention of Restless Legs Syndrome

There is no known way to prevent RLS, because doctors aren’t sure what causes it.

Research and Statistics: How Common Is Restless Legs Syndrome?

According to the National Institute of Neurological Disorders and Stroke (NINDS), up to 7 to 10 percent of the U.S. population may have RLS.

The number of cases of RLS rises with age and many people with RLS are diagnosed in middle age. But in up to two out of every five cases, the symptoms of RLS begin before age 20.

According to Restless Legs Syndrome Foundation, research suggests that RLS affects an estimated 1.5 million children and adolescents in the United States.

RLS occurs in both men and women, although women are more likely to have it than men.

According to a review published in January 2020 in the International Journal of Environmental Research and Public Health, changes in hormone levels may play a role in explaining why women are more vulnerable to RLS. This theory is based on the fact that both pregnancy and menopause appear to increase rates of occurrence. Another theory is that the higher prevalence in women is because RLS is comorbid with several disorders to which women are particularly prone, such as migraines, depression, and anxiety.

Resources We Love

Restless Legs Syndrome Foundation

On this organization's site, you can find the latest information about RLS treatments and share your experience with others in the RLS community. Their “Find a Healthcare Provider” tool can help you find a doctor in your area who works with RLS patients.

American Sleep Association (ASA)

This group was founded by physicians and scientists in 2002 with a mission to increase the awareness of the importance of sleep and the harmful effects of sleep disorders. On their site you can find lots of useful information on many sleep-related topics, including RLS. You can also find tips on how to choose a sleep doctor, sleep specialist, or clinic.

National Sleep Foundation

This foundation dedicates itself to improving health and well-being through sleep education and advocacy. On their site, you can find informative articles on many sleep-related subjects, such as tips for making more time for sleep and getting a better night's sleep in addition to articles on RLS and other sleep disorders.

National Organization for Rare Disorders (NORD)

This is a great site to explore the latest research on RLS, including links to clinical trials.

Additional reporting by Joseph Bennington-Castro.

Editorial Sources and Fact-Checking

Restless Legs Syndrome (RLS) in Children and Adolescents. Cleveland Clinic. January 1, 2020.
Restless Legs Syndrome Fact Sheet. National Institute of Neurological Disorders and Stroke (NINDS). March 17, 2020.
Restless Legs Syndrome. MedlinePlus. September 18, 2020.
Restless Legs Syndrome. American Sleep Association (ASA).
Restless Leg Syndrome. Disease InfoSearch.
Howard H, Kamat D. Restless Legs Syndrome in Children. Pediatric Annals. December 13, 2018.
Lifestyle. Restless Legs Syndrome Foundation.
Raissi GR, Forogh B, Ahadi T, et al. Evaluation of Acupuncture in the Treatment of Restless Legs Syndrome: A Randomized Trial. Journal of Acupuncture and Meridian Studies. October 2017.
Guay A, Houle M, O’Shaughnessy J, Descarreaux M. Current Evidence on Diagnostic Criteria, Relevant Outcome Measures, and Efficacy of Nonpharmacologic Therapy in the Management of Restless Legs Syndrome (RLS): A Scoping Review. Journal of Manipulative and Physiological Therapeutics. November–December 2020.
Restless Leg Syndrome. American Academy of Family Physicians. September 2020.
Restless Legs Syndrome. National Organization for Rare Disorders (NORD). 2018.
RLS & Kids. Restless Legs Syndrome Foundation.
Seeman M. Why Are Women Prone to Restless Legs Syndrome? International Journal of Environmental Research and Public Health. January 2020.
RLS & Kids. Restless Legs Syndrome Foundation.
Darvishi N, Daneshkhah A, Khaledi-Paveh B, et al. The Prevalence of Restless Legs Syndrome/Willis-Ekbom Disease (RLS/WED) in the Third Trimester of Pregnancy: A Systematic Review. BMC Neurology. April 13, 2020.