Restless Legs Syndrome (RLS)
Symptoms, Self-Help, and Treatment Alternatives
Do strange and unpleasant sensations in your legs keep you up at night? Are you bothered by an almost irresistible urge to move your legs when you lie down or relax? If so, you may have restless legs syndrome (RLS). The tingling, aching, and itching of RLS can last for hours and prevent you from getting the sleep you need. But help is available. In recent years, experts have discovered better ways to manage and relieve symptoms—including simple lifestyle changes and self-help remedies you can practice at home to quiet your restless legs and enjoy a peaceful, refreshing sleep.
What is restless legs syndrome (RLS)?
Restless legs syndrome (RLS) is a neurological disorder characterized by uncomfortable leg sensations that can interfere with resting or falling asleep. Experts believe that low levels of iron in the brain may be responsible for RLS. An imbalance of dopamine is also believed to contribute. About 60% of people with restless legs have a family member with the condition, indicating a strong genetic component.
Anyone can have restless legs syndrome, but it’s more common in older adults and women. Mild symptoms of RLS may start in early adulthood and then increase with age. After age 50, RLS symptoms often increase in severity and significantly disrupt sleep. Restless legs syndrome is also common during pregnancy (approximately 40% of pregnant women experience it).
Restless legs syndrome: It’s real
Studies estimate that 1 out of 10 people suffer from restless legs, yet it’s not always easy to find help and support. Many people with RLS never receive proper treatment. Part of the problem is that it’s hard to explain and sufferers are often dismissed as being “nervous.” Those who haven’t experienced the distressing symptoms may not understand how severely they can impact the quality of your life. Even doctors may not take restless legs seriously, recognize the symptoms, or realize that they point to a real medical condition.
The good news is that recent research has increased our understanding of restless legs syndrome, leading to more effective treatments. At the same time, RLS is becoming more widely recognized. If you or your partner suffers from restless legs, there’s never been a better time to find relief.
A night in the life of RLS
If you have restless legs syndrome, a typical night might go like this: You lie down in bed, ready to go to sleep, and just as your body begins to relax, the crawling, tingling, or itching in your legs begin. You try to ignore the uncomfortable sensations, hoping they will go away, but eventually the urge to move is too much. You get out of bed to stretch and pace the floor and, for a moment, you find relief. But when you lie down again, the restless sensations in your legs start all over again.
Signs and symptoms of restless legs syndrome
Not only do the signs and symptoms of restless legs syndrome differ from person to person, but they can be tricky to describe. Common descriptions include: a “creepy-crawly” feeling, tingling, itching, prickling, burning, pulling, tugging, and aching. Some people have said it feels like bugs are crawling up their legs, a fizzy soda is bubbling through their veins, or they have a “deep bone itch.” Sometimes the symptoms are painful, but usually they are simply uncomfortable and disturbing.
Common signs and symptoms of RLS
Leg discomfort combined with strong urge to move – Uncomfortable sensations deep within the legs, accompanied by a strong, often irresistible urge to move them.
Rest triggers the symptoms – The uncomfortable leg sensations start or become worse when you’re sitting, lying down, or trying to relax.
Symptoms get worse at night – RLS typically flares up at night. In more severe cases, the symptoms may begin earlier in the day, but they become much more intense at bedtime.
Symptoms improve when you walk or move your legs – The relief continues as long as you keep moving.
Leg twitching or kicking while sleeping – Many people with RLS also have periodic limb movement disorder (PLMD), which involves repetitive cramping or jerking of the legs during sleep.
The symptoms of RLS can range from mildly annoying to severely disabling. You may experience the symptoms only once in a while, such as times of high stress, or they may plague you every night. In severe cases of RLS, you may experience symptoms in your arms as well as your legs.
RLS self-help tip 1: Avoid triggers
Avoiding known RLS triggers is a smart first step to overcoming the problem.
Manage stress. RLS symptoms get worse when you’re anxious and overwhelmed. Anything you can do to keep stress in check will help, including relaxation techniques such as meditation and deep breathing.
Cut back or eliminate alcohol. Alcohol is known to worsen the symptoms of restless legs, so be cautious about drinking in the evening. Alcohol also disrupts sleep, so you’re more likely to wake up in the middle of the night and be bothered by RLS symptoms.
Don’t over exercise. While moderate daily exercise can significantly ease RLS symptoms, it’s important not to overdo it. Strenuous exercise can sometimes exacerbate the symptoms of RLS, especially close to bedtime, so avoid exercising to the point where your joints or muscles become painful or ache.
Stop smoking. Nicotine is a stimulant that impairs blood flow to muscles and can make restless legs worse, so it’s best to avoid cigarettes, vaporizers, and e-cigarettes.
Experiment with caffeine. For some people with RLS, caffeine is a trigger. However recent research shows that it may actually benefit others. To see which camp you fall into, try cutting out coffee, tea, and soft drinks and monitor your symptoms.
Check your medicine cabinet
There are many common medications—both prescription and over-the-counter—that can trigger the symptoms of RLS or make them worse. Medications to watch out for include:
- Over-the-counter sleeping pills
- Cold and allergy medications containing antihistamines (such as Benadryl, NyQuil, and Dimetapp)
- Anti-nausea medications (such as Antivert, Compazine, and Dramamine)
- Calcium channel blockers (used for high blood pressure, migraines, and heart problems)
- Antidepressants (such as Prozac, Effexor, and Lexapro)
- Antipsychotics (used for bipolar disorder and schizophrenia)
Get checked for iron and vitamin deficiencies
A number of vitamin and mineral deficiencies are linked to restless legs syndrome.
Iron. Iron deficiency (anemia) is a well-known cause of RLS, so ask your doctor to test you for anemia. However, supplementing with iron can also improve RLS symptoms in those who aren’t anemic.
Magnesium. Magnesium can improve sleep and some studies have shown it to be beneficial for restless legs. Try experimenting with a magnesium supplement (250 to 500 mg) at bedtime to see if your symptoms improve.
Vitamin D. Recent studies show that RLS symptoms are more frequent and more severe in people with vitamin D deficiency. Your doctor can easily test your vitamin D levels or you can simply make it a point to get out more in the sun.
Folate (folic acid). Folate deficiency has been linked to RLS, which may explain why restless legs are so common in pregnant women (folate plays a key role in healthy fetal development). When folic acid is low, B12 is often low as well, so you may want to try supplementing with a B-complex vitamin.
Tip 2: Get daily exercise
Daily activity, including aerobic exercise and lower-body resistance training, can significantly reduce the symptoms of restless legs syndrome in most people. Choose activities you enjoy, especially those that emphasize using the legs. Try to exercise for at least 30 minutes on most days, although not too close to bed time.
The exercise doesn’t need to be intense. Simple daily activities such as walking can often deliver all the benefits you’re looking for. In fact, highly vigorous exercise—like training for a marathon—can sometimes backfire and make RLS symptoms worse.
Stretches for RLS
Simple stretching can help stop the symptoms of restless legs syndrome in their tracks. Here’s a handful to help you get started:
Calf stretch – Stretch out your arms so that your palms are flat against a wall and your elbows are nearly straight. Slightly bend your right knee and step your left leg back a foot or two, positioning its heel and foot flat on the floor. Hold for 20 to 30 seconds. Now bend your left knee while still keeping its heel and foot flat on the floor. For a deeper stretch, move your foot back a bit farther. Switch legs and repeat.
Front thigh stretch – Standing parallel to a wall for balance, grab and pull one of your ankles toward your buttock while keeping the other leg straight. Hold for 20 to 30 seconds. Switch legs and repeat.
Hip stretch – Place the back of a chair against the wall for support and stand facing the chair. Raise your left foot up and rest it flat on the chair, with your knee bent. (Or try placing your foot on a stair while holding the railing for balance.) Keeping your spine as neutral as possible, press your pelvis forward gently until you feel a stretch at the top of your right thigh. Your pelvis will move forward only a little. Hold for 20 to 30 seconds. Switch legs and repeat.
The yoga cure for restless legs
According to research published in the Journal of Alternative and Complementary Medicine, women with RLS who practiced yoga reduced their symptoms and experienced less stress, an elevated mood, and better sleep habits.
Tip 3: Improve your sleep
The symptoms of restless legs syndrome can make it hard to get to sleep. When you’re sleep deprived, you not only feel terrible, but you’re more vulnerable to stress. Stress and fatigue can worsen RLS, making it a vicious cycle, so doing what it takes to get enough sleep is crucial.
Try sleeping with a pillow between your legs. It may prevent nerves in your legs from compressing and result in fewer nighttime RLS symptoms.
Stick to a regular sleep schedule. Support your body’s natural sleep rhythms by going to bed and getting up at the same time every day (including weekends).
Optimize your bedroom for sleep. Make sure the room is dark (no lights from electronic devices), quiet, and cool.
Wind down with a relaxing bedtime routine. Try curling up in bed with a book, listening to calming music, or taking a hot bath (the heat has the added bonus of relieving restless legs).
Power down electronics 1-2 hours before bed. The blue light from screens (TVs, phones, tablets, computers) suppresses sleep-promoting hormones and stimulates your brain.
Keep a sleep diary of RLS symptoms
Logging changes in your diet, lifestyle, sleep habits, and routine might help you make helpful connections between your daily activities and the quality of your sleep at night.
Click here to download HelpGuide’s sleep diary.
Relieving restless legs in the moment
Sometimes, despite your best self-help efforts, the symptoms of restless legs flare up. The following tips will help you find quick relief:
- Get up and walk around. Fighting the urge to move can make the feelings worse.
- Distract yourself with a game or activity.
- Apply hot or cold packs to your legs.
- Try calf stretches, yoga poses, knee bends, or a simple ankle or foot rotation.
- Relax your muscles with massage or a hot bath.
- Pressure can help relieve the discomfort of restless legs syndrome. Try wearing compression socks or stockings or wrap your legs in bandages (but not so tight you’ll cut off circulation).
Avoid extended periods of inactivity
Sitting still for too long can make the symptoms of RLS worse, so try to break up periods of sitting with movement or stretches.
- Find or create a work setting where you can be active. If you work at an office, look into a desk that lets you stand and type, or walk while talking on the phone.
- Tell friends, family, and coworkers why you have to move around more than others. They’ll likely try to accommodate you and want to help you create a healthy environment.
- Schedule activities that may require long periods of sitting—such as car journeys, flights, or waiting for appointments—in the morning rather than late in the day.
- Choose an aisle seat at movies and on planes so that you can get up and move.
- Give yourself stretch breaks at work and during long car rides.
Seeking medical treatment for RLS
If you suffer from restless legs syndrome and self-help strategies simply aren’t cutting it, you may benefit from medical treatment.
Diagnosing restless legs syndrome
No laboratory test can confirm a diagnosis of restless legs syndrome. To diagnose RLS, your doctor will need:
- A complete medical history
- A diagnostic interview, to rule out other medical conditions
- A blood test for low iron levels
- A list of medications and supplements you’re taking
- A survey to see if anyone else in your family has similar symptoms
If a medical condition, such as iron deficiency, diabetes, or nerve damage is triggering your restless legs, treating the underlying problem may relieve your symptoms. If not, you may benefit from medication or other treatments.
Health conditions linked to restless legs
- Iron deficiency (anemia)
- Kidney disease
- Rheumatoid arthritis
- Parkinson’s disease
- Thyroid problems
- Neurologic lesions (spinal cord tumors, peripheral nerve lesions, or spinal cord injury)
- Sleep apnea or narcolepsy
- Varicose veins or trouble with the nerves in the hands or feet
There are a number of non-pharmaceutical treatments that have shown promise for treating restless legs syndrome.
Relaxis vibrating pad. The FDA-approved Relaxis pad is placed under your legs and vibrates at different intensities for 30-minute periods to provide counter-stimulation to the restless legs sensation. While it doesn’t work for everyone, the device does seem to help some RLS sufferers get better sleep without the unpleasant side effects of medication. In the U.S., the device is offered only with a prescription and can be either rented or purchased.
Transcutaneous electric nerve stimulation (TENS). Fifteen to 30 minutes of daily TENS therapy (using low-voltage electrical current) appears to help people who experience a lot of muscle spasms. You can purchase a portable, bedside TENS unit online. They are relatively inexpensive and don’t require a prescription.
Positional release manipulation. A small medical trial in the United Kingdom found that an osteopathic exercise technique known as positional release manipulation (PRM) could benefit people with restless legs syndrome. PRM involves holding different parts of the body in a position that reduces feelings of discomfort and pain.
Alternative therapies such as acupuncture, massage, hypnotherapy, and reflexology may also help relieve RLS symptoms.
If you have severe RLS symptoms that haven’t improved with lifestyle changes or other treatments, you may benefit from medication. However, no single medication works for everyone with RLS. In fact, a drug that relieves one person’s restless legs may actually make your symptoms worse. In addition, drugs used to treat RLS come with serious side effects, so it’s important to weigh the benefits against the risks.
The following types of medications are most commonly used to treat RLS:
- Parkinson’s medications that affect dopamine
- Benzodiazepines (a type of anti-anxiety medication)
- Prescription painkillers (opiates)
- Anti-seizure medications
Many people with restless legs syndrome find that medications that work initially become less effective over time, so experts recommend also pursuing self-help remedies to give yourself the best chance of effectively relieving symptoms over the long term.
Where to turn for help
Find a Doctor in the U.S. – Search for a doctor from a directory of healthcare providers who have special interest in the treatment of restless legs syndrome. (RLS Foundation)
Support Groups in the U.S. and Canada – Search for a restless legs syndrome support group in your area. (RLS Foundation)
International RLS Groups – Find support groups worldwide. (RLS Foundation)
RLS UK – Support and information in the UK. (RLS-UK)
Understanding RLS – Learn about symptoms, diagnosis, and treatment. (Restless Legs Syndrome Foundation)
Restless Legs Syndrome – Signs and symptoms, causes, diagnosis, and treatment. (National Heart Lung and Blood Institute)
Restless Legs Syndrome – Symptoms, causes, and treatment. (Cleveland Clinic)
Medical devices for restless legs syndrome – Academic review of vibration pads used for treating RLS. (NIH)
Comprehensive Review of Medications used in Treating RLS and PLMD – Medications and supplements used in the treatment of restless legs syndrome. (Southern California RLS Support Group)
Treatment Restless Legs Syndrome – RLS treatments including lifestyle changes and medications. (NHS)
Authors: Melinda Smith, M.A., Lawrence Robinson, and Robert Segal, M.A. Last updated: October 2018