Restless Legs Syndrome (RLS)

author

Medically Reviewed by

Dr. Heather Wright

Written by

Danielle Pacheco

If you are experiencing leg pain at night, you may be wondering if you have restless leg syndrome (RLS). Nighttime leg pain can be caused by a variety of conditions, including RLS. However, it can also occur if you spend too much time sitting during the day, or sleeping in a way that restricts blood flow to your lower limbs. Leg pain can be common during pregnancy, or be a side effect of medication. Leg pain can also be caused by a chronic condition, like arthritis, peripheral artery disease, or diabetes.

How do you know that RLS is behind your leg pain, and not something else? Below we explain the symptoms that separate RLS from other conditions related to leg pain, and what you can expect during the diagnostic process.

What Does Restless Leg Syndrome Feel Like?

Also known as Willis-Ekbom disease, restless leg syndrome has been described as both a neurological sensory disorder and a sleep movement disorder, characterized by uncomfortable sensations in the legs, usually when lying down, and an overwhelming urge to move them to experience relief.

How do you know if you have RLS? You may experience these symptoms:

  • You have an irresistible urge to move or stretch, often due to uncomfortable sensations in the legs. These sensations are distinct from numbness, or the cramps associated with a charley horse. Rather, patients with RLS describe them as twitching, itching, aching, crawling, tingling, or tugging. Symptoms range from uncomfortable  to painful. Restless leg syndrome is so-called because sensations are primarily felt in the legs, although up to 57 percent of people may experience similar sensations in their arms. Sensations usually affect both legs, but can appear in just one, or alternate between legs.
  • Moving partially or temporarily relieves these sensations. Individuals with RLS may find relief from kicking, rubbing, pacing, walking or moving around. Once you stop moving, the sensations may reoccur.
  • Symptoms begin or worsen when you are inactive, particularly when you are lying down, sitting, or resting. For example, you may be lying in bed, resting on the couch, or sitting on a plane.
  • The symptoms primarily occur at night, or worsen during the evening and night. It’s common for the morning to be relatively symptom-free, with symptoms  worse at night .
  • Your symptoms are not caused by another medical or behavioral condition, such as arthritis, leg cramps, or habitual foot tapping.
  • Your symptoms disrupt your sleep, cause you distress, or otherwise impair your wellbeing or ability to function normally. Poor sleep is the main reason people seek out care for their RLS symptoms, and affects 60 to 90 percent of individuals with RLS. In turn, poor sleep can have negative mental, physical, or behavioral impacts that make coping with RLS difficult.

If you’ve experienced these symptoms, you should consult a doctor.

Is There a Test for Restless Leg Syndrome?

There is no specific diagnostic test for restless leg syndrome. If you think you may have RLS, you should schedule an appointment with your doctor. They will perform a thorough history and physical exam to determine what’s causing your symptoms. Other tests and studies may be required to rule out medical conditions presenting with similar symptoms. Until then, you can track your RLS symptoms at home using a sleep diary.

How to Self Test for RLS

Find a notebook or use the notes app on your phone to use as a sleep diary. Each night when you go to bed, and each morning when you wake up, answer the following questions. You’ll use this information to answer questions the doctor asks you during your appointment.

Sleep Quality Questions: 

  • What time did you fall asleep? Did it take you longer than usual to fall asleep due to RLS symptoms?
  • What time did you wake up? Did you wake naturally or due to an alarm clock?
  • How much time did you spend asleep in total?
  • Did you wake up at all during the night? Note down how many times you woke up, for how long, and what caused you to wake up, if applicable (such as a need to urinate or a nightmare).
  • Did you nap at all during the day? How many times, and for how long?

RLS-Specific Questions:

  • What symptoms of RLS are you experiencing? Write down what they feel like.
  • What time did the symptoms occur, and what were you doing?
  • Where did you feel the symptoms (e.g. in your lower legs or arms)?
  • How severe were the symptoms?
  • How long did the symptoms last?
  • What helped relieve your symptoms, if anything?

Lifestyle Questions:

  • What type of exercise, if any, did you do each day?
  • Did you take any medications? List them out, along with the dose.
  • Did you have any caffeine, alcohol, or nicotine?
  • How did you feel during the day? Mentally, physically, and emotionally?

Within a few weeks, you may notice certain trends. For example, your symptoms may worsen when you drink caffeine. Make note of these trends to share with your doctor.

How a Doctor Diagnoses RLS

In general, the following Diagnostic Criteria must be met for a doctor to diagnose RLS:

  1.  An urge to move the legs, usually accompanied by or caused by uncomfortable and unpleasant sensations in the legs
    1. These must begin or worsen during periods of rest
    2. Be partially or totally relieved by movement
    3. Occur exclusively or predominantly during the evening or night, not the day
  2. The above features are not solely accounted for as symptoms of another medical or behavioral condition
  3. The RLS symptoms cause concern, distress, sleep disturbance, or impairment in mental, physical, emotional, social, occupational, educational, behavioral or other important areas of functioning.

A challenge of diagnosing RLS is, at least in part, the reliance on reporting of subjective symptoms, which makes use of a sleep diary critical in documenting one’s experiences.

When you meet with your doctor, they will perform an initial diagnostic interview for RLS. They may ask you screening questions like the ones below:

  • In the past week, have you experienced unpleasant sensations in the legs, accompanied by an irresistible urge to move them to feel relief?
  • How would you describe the sensations you feel in your legs?
  • Do your symptoms begin or worsen when you are resting, sitting, or lying down?
  • Do your symptoms occur at night, or get worse in the evening?
  • Do you have difficulty staying or falling asleep due to your symptoms?
  • Are your symptoms relieved by movement?
  • Do you have any existing medical conditions?
  • Are you taking any medication?
  • Does anyone in your family have RLS?
  • What’s your typical diet and exercise routine?
  • Is it possible you have an iron deficiency?
  • Are you pregnant?

Your doctor will ask these questions to rule out other potential causes behind your RLS symptoms, like pregnancy, iron deficiency, or end-stage renal failure. Pregnant women are two to three times more likely to report RLS symptoms, especially during the third trimester, and individuals with chronic renal failure are two to five times more likely. A family history of RLS is another risk factor for RLS. Caffeine, alcohol, and nicotine use can also exacerbate symptoms, as can some medications, including anti-nausea drugs, antipsychotics, and antidepressants.

Based on your answers, your doctor may order a blood test or refer you to a sleep specialist. A blood test will help rule out an iron deficiency, a risk factor for RLS. An overnight sleep study, known as a polysomnogram, may be ordered if your doctor thinks your symptoms may be related to another sleep disorder, like periodic limb movement disorder or sleep apnea. These disorders can coexist with RLS or worsen symptoms.

Depending on your diagnosis, your doctor will develop a treatment plan for you. For example, a regimen of over-the-counter iron supplements may help address an underlying iron deficiency. Some mild to moderate symptoms of RLS can be relieved with lifestyle changes, such as reducing your alcohol and nicotine intake, or practicing better sleep hygiene. Other at-home remedies can be helpful in reducing symptoms, including leg massage, warm baths, RLS foot wraps, and hot/cold therapy.

For many people, RLS is a lifelong condition, but symptoms can be managed to enable you to experience less discomfort and get more sleep.