How to Identify and Treat Restless Leg Syndrome

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If you have trouble sleeping at night because you can’t seem to keep your legs still, you may have restless leg syndrome (RLS). It’s a condition of the nervous system that causes an overwhelming urge to move your legs. This sensation can happen at any time, but it tends to be worse at night. No one knows what causes it, but thankfully there are ways to reduce symptoms. Keep reading to learn more.

How do I know if I have restless leg syndrome?

The symptoms of RLS are pretty straightforward: 

• The main sensation is an unpleasant, irresistible urge to move your legs that is relieved by moving them.

• It can also cause sensations described as throbbing, crawling, or pulling. 

• The arms and trunk can also be affected, but less commonly so. 

RLS is worse at night, but it can also occur during the day, especially after sitting still for a length of time. Up to one-third of people with RLS also report the urge to eat at night, leading to night binging. RLS can interfere with sleep and negatively affect your mood, ability to concentrate, and performance in daily activities. To make matters worse, reduced sleep can worsen symptoms. 

There is no one specific test for RLS, although testing may be done to rule out other things. The diagnosis can often be made based on your symptoms alone. If you’re suffering with symptoms that sound like those of RLS, be sure to contact your healthcare provider.

What are some triggers of restless leg syndrome?

The exact cause of RLS is unknown. It tends to run in families, suggesting it could be inherited, but it has also been linked to iron deficiency and a chemical in the brain called dopamine. 

RLS has also been linked to certain medical conditions. These include: 

• Pregnancy

• Kidney disease requiring hemodialysis

• Nerve damage

• Iron-deficiency anemia

• Parkinson’s disease

In addition to medical conditions, other triggers have been identified. This is good news because when triggers can be avoided or reduced, it can provide some relief of symptoms. 

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Some RLS triggers include: 

• Prescription medications, such as antipsychotics and some antidepressants

• Over-the-counter medications, such as diphenhydramine, an antihistamine used to treat allergies, but sometimes also used to treat insomnia 

• Alcohol

• Caffeine

• Nicotine

• Sleep deprivation

How is restless leg syndrome treated?

Treatment often begins with finding and addressing any medical conditions or medications (described above) that might be contributing to RLS. It’s important to speak with your healthcare provider before stopping any prescription medications or starting supplements. 

Self-care and lifestyle adjustments to manage restless leg syndrome

Another major step in treating RLS is establishing good sleep hygiene. This means going to bed at the same time each night, trying to clear your mind and destress, and avoiding caffeine and electronics right before bed.

Next, it’s helpful to avoid triggers that may be making your symptoms worse. If you’re not sure what your triggers are, try keeping a diary to see if you notice a pattern between activities or habits and symptoms. Quitting smoking and cutting back on alcohol are often recommended.

Does exercise help restless leg syndrome?

Research suggests that regular, daytime exercise does help with symptoms of RLS, although few studies have evaluated this closely. At the very least, regular exercise can improve sleep quality. 

What type of medications work on restless leg syndrome?

If your symptoms are severe or interfering with your activities, medication may be recommended. Your provider can help decide which treatment is best for you, but several options are available:

• Iron supplementation (if applicable)

• Anti-seizure medications, such as gabapentin enacarbil (Horizant), pregabalin (Lyrica), and gabapentin (Neurontin)

• Dopaminergic medications, such as ropinirole (Requip), pramipexole (Mirapex), and rotigotine (Neupro)

The anti-seizure medicines are quickly becoming favored as a first-choice treatment option because they seem to be as effective as the dopaminergic medications, with fewer side effects. There is also a risk of symptoms worsening with long-term use of dopaminergic medications.

Sometimes, other medications like benzodiazepines may be prescribed for more restful sleep, but these can be addictive so it’s best to avoid them if possible. 

Could restless leg syndrome be a sign of a different disorder or disease?

Most people with RLS are believed to have a condition called periodic limb movements in sleep (PLMS), which causes involuntary movement of the legs (and sometimes arms) during sleep. However, not all people with PLMS have RMS. 

Research has also suggested links between RLS and other conditions, such as cardiovascular disease, diabetes, migraine, and Parkinson’s disease. More research is needed to confirm and understand these links.

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Written by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. A pulmonologist and hospitalist, she practiced and taught clinical medicine at hospitals in London for a decade before entering a career in health education and technology.

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