What is Restless Legs Syndrome? Understanding Symptoms, Causes, and Relief

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological disorder characterized by an irresistible urge to move the legs. This urge is typically accompanied by uncomfortable sensations in the legs, often described as creeping, crawling, or pulling. These symptoms predominantly occur during periods of rest, especially in the evening or at night, and are temporarily relieved by movement.

RLS can emerge at any age, although its prevalence tends to increase with age. The condition can significantly disrupt sleep patterns, leading to daytime fatigue and impacting overall quality of life. While simple lifestyle adjustments and self-care strategies can offer some relief, medical treatments are often necessary for managing more persistent or severe symptoms.

Symptoms of Restless Legs Syndrome

The hallmark symptom of restless legs syndrome is the compelling need to move the legs. Individuals with RLS frequently experience the following:

• Sensations Triggered by Rest: The uncomfortable feelings and the urge to move typically arise or intensify when you are resting, such as lying down or sitting for prolonged periods. This might occur during activities like driving, flying, or attending movies.
• Relief Through Movement: Moving the legs provides temporary relief from the discomfort. Activities such as stretching, shaking the legs, pacing, or walking can alleviate the unpleasant sensations.
• Evening and Nighttime Worsening: RLS symptoms are often more pronounced during the evening and nighttime hours. For many, symptoms are minimal during the day and intensify as the day progresses.
• Nocturnal Leg Twitching: Restless legs syndrome is frequently associated with periodic limb movement of sleep (PLMS). PLMS involves involuntary leg twitching and kicking during sleep, potentially occurring throughout the night, further disrupting sleep quality.

The sensations associated with RLS are often described as intense and unpleasant, affecting primarily the legs and feet, and commonly occurring on both sides of the body. In less frequent cases, the arms may also be involved. These sensations are felt internally, not on the skin’s surface, and are characterized in various ways, including:

• Crawling
• Creeping
• Pulling
• Throbbing
• Aching
• Itching
• Electric shocks

It’s important to note that individuals with RLS typically do not describe their symptoms as muscle cramps or numbness. The consistent feature is the overwhelming desire to move their legs to alleviate the discomfort. The intensity of RLS symptoms can fluctuate, with periods of remission followed by symptom exacerbation.

When to Seek Medical Advice

If you experience symptoms consistent with restless legs syndrome, consulting a healthcare professional is recommended. RLS can significantly interfere with sleep, leading to daytime sleepiness and a diminished quality of life. Seeking medical advice can help in diagnosis and management of the condition.

Causes of Restless Legs Syndrome

In many instances, the exact cause of restless legs syndrome remains unidentified. However, researchers believe that an imbalance of dopamine, a neurotransmitter in the brain, may play a crucial role. Dopamine is involved in transmitting signals that control muscle movement. Disruptions in dopamine pathways are thought to contribute to the development of RLS.

Hereditary Factors

There is evidence suggesting a genetic component to RLS, particularly when the condition manifests before the age of 40. Studies have identified specific regions on chromosomes that may harbor genes associated with RLS, indicating a potential inherited predisposition.

Pregnancy and Hormonal Changes

Pregnancy and hormonal fluctuations can exacerbate RLS symptoms. Some women may experience RLS for the first time during pregnancy, especially in the third trimester. While the exact mechanism is not fully understood, hormonal changes are believed to be a contributing factor. Fortunately, symptoms related to pregnancy-induced RLS typically resolve after childbirth.

Risk Factors for Restless Legs Syndrome

Restless legs syndrome can affect individuals of any age, including children, but its occurrence becomes more frequent with advancing age. Women are also more likely to develop RLS compared to men.

While RLS is often not indicative of a serious underlying medical issue, it can sometimes be associated with other health conditions, including:

• Peripheral Neuropathy: Damage to peripheral nerves, which can result from conditions like diabetes and chronic alcohol use disorder, can sometimes be linked to RLS.
• Iron Deficiency: Insufficient iron levels in the body, known as iron deficiency, can either trigger or worsen RLS symptoms. Individuals with a history of gastrointestinal bleeding, heavy menstrual periods, or frequent blood donation may be at risk of iron deficiency and subsequent RLS.
• Kidney Failure: Kidney failure can lead to iron deficiency and anemia. Impaired kidney function can disrupt iron storage and alter body chemistry, potentially contributing to or worsening RLS.
• Spinal Cord Conditions: Spinal cord damage or injury has been implicated in the development of RLS. Spinal anesthesia procedures, such as spinal blocks, have also been associated with an increased risk of RLS.
• Parkinson’s Disease: Individuals with Parkinson’s disease who are treated with dopaminergic agonists have a higher likelihood of developing RLS as a side effect of these medications.

Complications of Untreated Restless Legs Syndrome

The impact of restless legs syndrome can vary significantly, ranging from mild inconvenience to substantial disruption of daily life. Sleep disturbances are a common and significant complication. Many individuals with RLS experience difficulty falling asleep and staying asleep due to the discomfort and urge to move.

Severe RLS symptoms can profoundly affect overall quality of life, potentially leading to depression and anxiety. The sleep deprivation associated with RLS can also result in excessive daytime drowsiness and fatigue, impacting work, social activities, and general well-being. Ironically, while nighttime sleep is disrupted, RLS symptoms may also interfere with the ability to nap during the day, further compounding fatigue issues.

By Mayo Clinic Staff

Restless legs syndrome care at Mayo Clinic

Request an appointment

Diagnosis & treatment

Jan. 26, 2024

Print

References

1. Restless legs syndrome fact sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet. Accessed Nov. 16, 2021.
2. Ondo WG. Clinical features and diagnosis of restless legs syndrome and periodic limb movement disorder in adults. https://www.uptodate.com/contents/search. Accessed Nov. 16, 2021.
3. Silber MH. Management of restless legs syndrome and periodic limb movement disorder in adults. https://www.uptodate.com/contents/search. Accessed Nov. 16, 2021.
4. Garcia-Borreguero D, et al. Guidelines for the first-line treatment of restless legs syndrome/Willis-Ekbom disease, prevention and treatment of dopaminergic augmentation: A combined task force of the IRLSSG, EURLSSG, and the RLS-foundation. Sleep Medicine. 2016; doi:10.1016/j.sleep.2016.01.017.
5. Winkelman JW, et al. Practice guideline summary: Treatment of restless legs syndrome in adults — Report of the guideline development, dissemination and implementation subcommittee of the American Academy of Neurology. Neurology. 2016; doi:10.1212/WNL.0000000000003388.
6. Silber MH, et al. The appropriate use of opioids in the treatment of refractory restless legs syndrome. Mayo Clinic Proceedings. 2018; doi:10.1016/j.mayocp.2017.11.007.
7. Trenkwalder, et al. Comorbidities, treatment and pathophysiology in restless legs syndrome. The Lancet Neurology. 2018; doi:10.1016/S1474-4422(18)30311-9.
8. Ferri FF. Restless legs syndrome. In: Ferri’s Clinical Advisor 2024. Elsevier; 2024. https://www.clinicalkey.com. Accessed Nov. 27, 2023.
9. Ami TR. Allscripts EPSi. Mayo Clinic. Nov. 14, 2023.
10. AskMayoExpert. Restless legs syndrome (RLS). Mayo Clinic; 2020.
11. Xu XM, et al. Complementary and alternative therapies for restless legs syndrome: An evidence-based systematic review. Sleep Medicine Reviews. 2018; doi:10.1016/j.smrv.2017.06.003.
12. Find a sleep facility near you. American Academy of Sleep Medicine. https://sleepeducation.org/sleep-center/. Accessed Nov. 27, 2023.
13. Gonzalez-Latapi P, et al. Update on restless legs syndrome: From mechanisms to treatment. Current Neurology and Neuroscience Reports. 2019; doi:10.1007/s11910-019-0965-4.
14. Silber MH, et al. The management of restless legs syndrome: An updated algorithm. Mayo Clinic Proceedings. 2021; doi:10.1016/j.mayocp.2020.12.026.
15. Olson EJ (expert opinion). Mayo Clinic. Nov. 28, 2023.