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Restless legs syndrome

Key points

  • There are two types of restless legs syndrome (RLS): primary and secondary.
  • The cause of primary RLS is not fully known, secondary RLS is usually caused by an underlying health condition.
  • Symptoms include a crawling, cramping or aching feeling in your legs which causes an irresistible urge to move them to temporarily relieve the unpleasant sensations.

Restless legs syndrome (RLS) is a condition that affects your legs. It starts with a sudden, unpleasant sensation deep inside one or both legs. This is accompanied by an irresistible urge to move your legs to stop the unpleasant feeling.

RLS is a common condition and is estimated to affect up to 15 in 100 people. It can occur at any age, even in children, but is more common as people get older. It affects more women than men.

About restless legs syndrome

RLS is a movement disorder that affects your nervous system (the brain and spinal cord). It causes uncomfortable or unpleasant feelings in your legs and an irresistible urge to move your legs to relieve the sensation. It’s also known as Ekbom syndrome, after the doctor who first described the condition.

The sensation in your leg(s) can be difficult to describe. Some people call it a burning, tugging, creeping feeling or like there are insects crawling under their skin. Other people say it feels like fizzy water in their veins.

The symptoms usually start when you’re inactive or trying to relax, for example when you’re sitting for long periods of time or lying in bed. This is most often in the evening and can sometimes make it difficult for you to fall asleep and stay asleep at night.

Nearly eight out of 10 people with RLS also have a condition called periodic limb movement disorder. This causes your legs to twitch or jerk every 20 to 40 seconds when you’re sleeping. Unlike RLS, you have no control over these movements. The twitches can be strong enough to wake you up, disrupting your sleep, or you may sleep through them.

Symptoms of restless legs syndrome

Symptoms of RLS can vary from very mild and infrequent to so severe that they prevent you from sleeping and interfere with your everyday life.

Common symptoms include:

  • an uncomfortable or unpleasant sensation in one or both of your legs
  • an irresistible urge to move your leg(s), especially when you have the unpleasant sensation
  • a need to keep your legs moving, for example pacing the floor, constantly tapping your feet while sitting or tossing and turning in bed
  • involuntary jerking or twitching of your legs throughout the night
  • disturbed rest or sleep - this can lead to excessive sleepiness during the day

Symptoms normally occur in the evening when you are trying to relax or sleep, and are usually gone by 5 o'clock in the morning. Most people have no symptoms at all during the day. However, in severe cases, you may have symptoms all the time.

Causes of restless legs syndrome

It’s not fully understood what causes RLS. It seems to be related to an imbalance of a chemical (dopamine) in your brain that controls movement.

There are two main types of RLS – primary RLS and secondary RLS.

Primary restless legs syndrome

This is the most common type of RLS and is a disorder of the central nervous system. It's sometimes referred to as idiopathic RLS. It often runs in families – up to three-quarters of people with primary RLS have inherited it. Primary RLS tends to affect people at a younger age (under 45) and usually develops slowly. Tiredness, stress and other psychological factors generally make symptoms worse.

Secondary restless legs syndrome

Secondary RLS is related to an underlying health condition, including any of the following conditions.

Vitamin or mineral deficiency

Low amounts of iron in your blood or anaemia can cause RLS – about a quarter of people with RLS have iron deficiency. Not having enough magnesium or folate, or vitamin B12 in your diet can also cause RLS.


One in five pregnant women get symptoms of RLS, especially during the third trimester (months six to nine of pregnancy). These symptoms usually disappear a few weeks after having your baby.

Kidney disease

Up to half of people with kidney disease have RLS. The symptoms are often particularly bad during dialysis when you need to lie or sit still for long periods of time. Symptoms often improve after a kidney transplant.

Chronic disease

Several chronic diseases have been linked to RLS, including diabetes, peripheral neuropathy, Parkinson's disease, thyroid disorders, rheumatoid arthritis and fibromyalgia.


Certain medicines can cause or worsen RLS. These include:

  • anti-sickness medicines (eg metoclopramide)
  • antidepressants (eg amitriptyline and paroxetine)
  • beta-blockers (eg propranolol)
  • anti-psychotic medicines (eg haloperidol)
  • lithium
  • some antihistamines (eg diphenhydramine)

Alcohol, caffeine and cigarettes may also make your RLS symptoms worse.

Diagnosis of restless legs syndrome

Your GP will be able to diagnose RLS. He or she will ask you about your symptoms and your general wellbeing.

RLS is an under-diagnosed condition because people have difficulty explaining their symptoms. It's important to be open with your GP and describe your symptoms as they feel to you. Your GP may ask you questions using a rating scale to determine if your symptoms are mild, moderate or severe.

Your GP may carry out a physical examination and ask you to have a blood test. This is to rule out any underlying conditions that could be causing secondary RLS.

Usually your GP can diagnose and treat your RLS. But if there is an underlying cause or the treatments don’t improve your symptoms, he or she may refer you to a specialist, such as a neurologist (a doctor who specialises in treating conditions that affect the nervous system, including the brain).

Treatment for restless legs syndrome

If your condition is mild, you may not need any treatment. Your GP will suggest simple lifestyle changes to help keep your symptoms under control.

For secondary RLS, symptoms usually ease or disappear once the underlying condition has been treated.


Simple lifestyle changes can really help to prevent symptoms. These include:

  • cutting out caffeine and alcohol from your diet
  • stopping smoking
  • taking moderate exercise (but not close to bedtime)
  • getting into a good bedtime routine to maintain a regular sleep pattern – for example, going to bed at the same time every evening and getting up at the same time every morning

You may find that self-help techniques can help when you do get symptoms. These include:

  • taking hot or cold baths – try both to see which works for you
  • going for a walk or stretching your legs
  • massaging your legs
  • distracting your mind by watching TV or reading an engaging book
  • practising relaxation exercises or yoga


If your symptoms are interfering with your daily life and lifestyle changes haven't helped, your GP may prescribe you medicines.

If you get symptoms three times a week or less, your GP may offer you levodopa. This is a type of dopaminergic drug which is converted into dopamine in your brain. Levodopa hasn’t yet been licensed for the treatment of RLS and the condition isn't listed in the patient information leaflet that comes with the medicine. Your doctor can legally prescribe outside the licence if he or she feels the medicine will be effective for you. Prescribing outside the license is called ‘off-label’ use.

If your symptoms happen every day, your GP may prescribe a different group of medicines called dopamine agonists. These work by simulating the effects of natural dopamine in your brain. Your GP may prescribe pramipexole, ropinirole or rotigotine. If you see a neurologist, he or she may offer you other types of dopamine agonists that haven’t yet been licensed for the treatment of RLS, such as pergolide. Both types of medicine are commonly used to treat Parkinson's disease, but are also effective for RLS.

Although dopaminergic drugs such as levodopa are an effective treatment for RLS, they can sometimes cause ‘augmentation’ where your symptoms of RLS tend to worsen. They may occur earlier in the day, sooner after rest and may affect your arms as well. Levodopa tends to cause this more than the dopamine agonists, and your specialist may decide to change your treatment if you start to experience this problem.

Other medicines that your GP or neurologist may prescribe, especially if the dopamine medicines haven’t been effective, are listed below.

  • Gabapentin – this is usually used as an anti-epileptic medicine or for pain relief and is especially useful if your RLS is painful.
  • Codeine – this is a painkiller if your symptoms are painful.
  • Hypnotics – these help you sleep if your sleep is being disturbed.

These medicines will relieve symptoms of RLS, but they won't cure your condition.

Anaemia or iron-deficiency is a very common cause of secondary RLS. If a blood test shows that you’re low in iron, your GP will assess the cause and prescribe you iron tablets.


Produced by Natalie Heaton, Bupa Health Information Team, April 2013.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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