Restless Legs Syndrome

Ryan Fiorenzi, BS, Certified Sleep Science Coach - Updated on July 12th, 2023

Restless legs syndrome (RLS) is a condition that causes people to move their legs to get rid of an uncomfortable sensation. This usually occurs at night, and often while sleeping, which reduces the quality of sleep.

There are two main types of RLS, the first of which is primary RLS, which has no known cause. The other is secondary RLS, which is associated with chronic kidney failure, iron deficiency, spinal cord damage, or peripheral neuropathy (damage to the nerves in your hands and feet, often due to diabetes).

Risk Factors

RLS is also known as Willis-Ekbom disease, and according to Sleep Medicine, it occurs between 4% and 29% of the population of North America and Europe and is more common in women and in older people (though it can occur at any age). There is also a genetic link, as researchers have found sites on chromosomes where the RLS genes may exist.

Pregnant women may find a worsening of symptoms, with some women experiencing RLS during their last trimester, though the symptoms usually go away after delivery.

RLS Symptoms

The main symptom is the desire to move the legs, and sufferers of RLS often describe the sensation as itching, crawling, or throbbing. It usually occurs at night or after someone has been lying or sitting for an extended period, such as during driving or flying. Moving the legs gives temporary relief. RLS may also be associated with periodic limb movement of sleep, which makes the legs kick and twitch while you sleep.

RLS can lead to anxiety and depression. Over time the symptoms can worsen and spread to other parts of the body, such as the arms.

Health Risks

The risks of RLS aren't grave, except if it is decreasing the quality of sleep. Some sufferers of RLS report sleeping only 2-4 hours per night, instead of the recommended 7-9 hours. Low-quality sleep for long periods can have many negative health consequences.

What is Restless Legs Syndrome (RLS)?

Your doctor will evaluate your symptoms, medical history, and may check your iron levels. You may also be advised to complete a sleep study to see if there are other causes related to your sleep disruption.

The Restless Legs Syndrome Foundation has a great diary that you can share with your doctor that will track approximately when they occur, for how long, the severity, and possible triggers.

Possible RLS Triggers

  • alcohol
  • caffeine
  • nicotine
  • carbohydrates and refined sugars
  • foods high in sodium
  • strenuous exercise
  • stress
  • supplements
  • wearing tight clothing
  • over-the-counter as well as prescribed medications

It's recommended to share with your doctor the following list of medications that can aggravate the condition.

Medications and supplements that can aggravate RLS symptoms include:

  • Diphenhydramine (Benadryl)
  • Pseudoephedrine (Sudafed)
  • Metoclopramide (Reglan)
  • Prochlorperazine (Compro)
  • Olanzapine (Zyprexa)
  • Melatonin
  • St. John’s Wort
  • Haloperidol (Haldol) and seroquel (antipsychotic drugs)
  • Phenergan and compazine (anti-nausea drugs)
  • Mirtazapine, amitriptyline (Elavil), and amoxapine (Asendin) (antidepressants)
  • Fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro) (selective serotonin reuptake inhibitors)
  • Levothyroxine (Levoxyl)
  • Tramadol (Ultram)
  • Lithium (Lithobid)

If you're taking any prescribed medication, talk to your doctor to find out if there are any alternative drugs that won't worsen the symptoms of RLS.

Management and Treatments

1. Drugs

The FDA has approved 4 drugs for treating RLS:

  1. Ropinirole (Requip)
  2. Pramipexole (Mirapex)
  3. Gabapentin enacarbil (Horizant)
  4. Rotigotine (Neupro)

There are several other drugs that are used for other diseases that have been used successfully to deal with the symptoms of RLS, which is called "off label." This is a practice approved by the FDA.

2. Moderate Exercise

The National Institute of Neurological Disorders and Stroke claims that moderate exercise may reduce mild RLS symptoms. Other studies have come to the same conclusion. But be careful not to work out too hard, as excessive strenuous exercise could make symptoms worse.

3. Yoga and Stretching

Yoga and stretching have also been found to relieve RLS symptoms. Researchers aren't sure why it can help, but light stretching of the calves, thighs, hamstrings, and glutes before bed can also help relax you before bed.

4. Massage

Massage is also used by some with RLS to relieve symptoms. Researchers aren't sure if it's because of the increased levels of dopamine or increased circulation, or if the relaxation aids in getting restful sleep.

5. Near-Infrared Spectroscopy (NIRS)

Near-infrared spectroscopy (NIRS) is the use of long-wavelength light that penetrates the skin and causes blood vessels to dilate which increases circulation. A couple of studies have found this treatment effective for RLS, and symptoms were improved up to four weeks after treatment stopped.

6. Footwrap

A footwrap called Restiffic puts pressure on the bottom of your foot (specifically on the abductor hallucis and flexor hallucis brevis) that helps relax the muscles affected by RLS to relax. The Journal of the American Osteopathic Association published a study with 30 patients where patients had better results than with ropinirole.

7. Pneumatic Compression

Pneumatic compression is a sleeve that goes over your leg and inflates and deflates to stimulate better circulation and prevent blood clots. A 2009 study found that people that used pneumatic compression for an hour per day for a month had noticeably improved symptoms.

8. Iron, Vitamin D, & Magnesium Supplementation

Iron deficiency has been associated with RLS, so finding out if you are iron deficient is a good idea. If so, you can eat more iron-rich foods and supplement iron. Vitamin D deficiency could be linked to RLS as well. A study published in Sleep and Breathing found that supplementing vitamin D reduced RLS symptoms.

Magnesium helps regulate nerve and muscle function, and magnesium deficiency is known to cause muscle cramps, muscle contractions, and problems with nerve impulse conductions. Early research into RLS suggested that magnesium deficiency may be a cause of RLS.

9. Good Sleep Hygiene

It's recommended to follow all of the rules for good sleep hygiene, such as going to bed and waking up at the same time every day, exercising 30 minutes per day, and avoiding exposure to blue light 90 minutes before bed.

10. Acupuncture

A study published by the National Institutes of Health involving 38 patients showed that their excessive leg movement was reduced.

11. Varicose Vein Surgery

A 2008 study found that of the 35 patients that had both RLS and superficial venous insufficiency (SVI, commonly known as "spider veins") who received treatment for the SVI with endovenous laser ablation, 84% had significant improvement in their symptoms or their RLS was completely eliminated.

12. Hot and Cold Packs

The Restless Legs Syndrome Foundation recommends putting hot or cold packs on your legs before sleep or taking a hot or cold bath. You may have to experiment with both hot and cold to see if one or either works.