Restless legs syndrome

What is restless legs syndrome?

Restless legs syndrome is a condition linked to the nervous system that brings on the feeling of fidgety, tingling or itchy legs with an uncontrollable urge to move them. 

For many people, it’s worse at night, causing problems with sleep and sometimes causing insomnia. That’s why it can be classed as a sleep disorder. Some people get restless legs in the day, too, making it hard to sit still for long periods. In severe cases, it can lead to anxiety and depression. 

Although it’s called restless legs syndrome, it can affect other parts of your body, including your arms, torso (upper body) and head.

What is restless legs syndrome?

Restless legs syndrome is a condition linked to the nervous system that brings on the feeling of fidgety, tingling or itchy legs with an uncontrollable urge to move them. 

For many people, it’s worse at night, causing problems with sleep and sometimes causing insomnia. That’s why it can be classed as a sleep disorder. Some people get restless legs in the day, too, making it hard to sit still for long periods. In severe cases, it can lead to anxiety and depression. 

Although it’s called restless legs syndrome, it can affect other parts of your body, including your arms, torso (upper body) and head.

Who gets restless legs syndrome?

Restless legs syndrome affects people of all ages, including children, but it’s more common in women over 40. Some women develop restless legs syndrome in pregnancy or find their symptoms worsen if they had it before getting pregnant.

Symptoms of restless legs syndrome

For most people, the most disruptive symptom of restless legs syndrome is the urge to move your legs. 

This is usually a reaction to an itchy, crawling or tingling sensation from the thighs down to the feet. Moving or rubbing your legs can help to ease it for a little while.

Some people describe the sensation as: 

• An itchy or pins and needles feeling under the skin

• A creepy-crawly sensation

• Burning, throbbing or prickling

• Cramping, especially in the calves

Restless legs symptoms are often worse as you get tired in the evening and during the night. You might only get it mildly once in a while or have intense episodes every day.

Most people with restless legs syndrome experience arm or leg spasms during sleep. This is known as periodic limb movement in sleep (PLMS). These jerky limb movements can happen over and over again, around every 30 seconds, sometimes waking you up. PLMS can also occur while you’re awake.

What causes restless legs syndrome?

There are two types of restless legs syndrome:

• Primary restless legs syndrome – Starts gradually and gets worse over time. It runs in families, and there’s no known cause

• Secondary restless legs syndrome – Starts suddenly and is linked to another condition, like iron-deficiency anaemia, kidney disease, Parkinson’s or fibromyalgia, or is a side effect of certain medicines, including antihistamines

Some experts believe restless legs syndrome is caused by a low level of dopamine, a chemical made in your body that controls muscle movements. The amount of dopamine in your body naturally falls towards the end of the day, which could trigger the symptoms. 

What can trigger restless legs syndrome?

There are several things that can make restless leg syndrome worse: 

• Being overweight

• Stress

• Drinking alcohol and smoking

• Not getting enough exercise

• Taking certain medicines, including some antidepressants and antihistamines, antipsychotics, and some treatments for high blood pressure 

• Pregnancy, although it tends to resolve once the baby has been born

Diagnosing restless legs syndrome

If you think you have restless legs syndrome, talk to a GP. They’ll ask you about your symptoms and might ask you to keep a sleep diary to keep track of your daily habits and any patterns with your symptoms. 

They may send you for a blood test to rule out other conditions or refer you to a specialist for a sleep test.

Restless legs syndrome treatment

For people with mild restless legs syndrome, a few lifestyle changes can ease or stop the symptoms:

• Create a healthy sleep routine – stick to a regular bedtime and keep your evening calm by doing something relaxing

• Avoid caffeine and alcohol in the evenings

• If you smoke, get help to stop

• Get regular exercise during the day

If you develop a period of restless legs sometimes these measures can help:

• Massage or lightly bang your legs with your fists

• Have a bath

• Use a hot or cold compress 

• Distract yourself with TV or another activity

• Try yoga or tai chi exercises

• Walk and stretch

If your symptoms are more severe or frequent, you might need medicine to manage your dopamine levels, such as ropinirole or pramipexole.

If an underlying condition causes your restless legs symptoms, it’ll usually stop if you have the appropriate treatment, like iron supplements to treat anaemia. 

Medical treatment for restless legs syndrome

If lifestyle changes haven’t helped, a doctor might prescribe medicine to ease your symptoms, like: 

Dopamine agonists

Dopamine agonists work by increasing your dopamine levels. They can make you sleepy, feel sick and give you headaches. Talk to the GP about whether it’s safe to drive or use machinery while taking them.

Painkillers

If your restless legs are painful, a doctor might prescribe codeine or another painkiller like gabapentin to make you more comfortable.

Sleep aids

If your symptoms stop you from sleeping, a GP might prescribe medicine to help you sleep, known as a hypnotic. These include temazepam and loprazolam. 

These medications should only be used on a short-term basis as they can cause addiction and make you feel sleepy the following morning. It's best to try and use natural methods, such as keeping a regular bedtime and routine, to help sleep. 

Restless legs syndrome in pregnancy

Lots of women develop restless legs syndrome in pregnancy, usually in the last trimester. Hormone changes and different iron levels may cause it. It often gets better within a few weeks after the baby is born.

If you had restless legs syndrome before pregnancy, your symptoms might worsen until after you’ve given birth.

Restless legs syndrome in children

Children can get restless legs syndrome, and they’re more likely to have it if it runs in your family. 

It can be hard to diagnose restless legs syndrome in children because they fidget for many reasons and find it hard to describe what they’re feeling. If you think your child may have it, talk to a GP.