Restless Legs Syndrome: From Symptoms To Treatment

image of a man with restless legs syndromeIs your sleep disturbed by sudden arm or leg movements which you can’t control? Or perhaps you experience strange twitching or burning sensations in your legs?

If so, it could be that you have a sleep disorder called restless legs syndrome.

Like many other sleep disorders, the actual causes aren’t very well understood. However, recent research into drug treatments and other techniques has led some experts to question the current thinking about possible causes.

In this article you’ll find out about the symptoms, possible causes and treatment of restless legs syndrome. I’ll also suggest some practical home remedies which might help reduce the distressing symptoms.

Finally, I’ll highlight the recent research on the effectiveness of different medications used to treat more severe cases. It would appear that some of these drugs can have significant and worrying side-effects.

Symptoms

Uncontrollable leg movements

restless legs syndrome pictureRestless legs syndrome is also known as Willis-Ekbom disease. The main problem or symptom is an overwhelming urge to move your legs.

Lots of people have an urge to shake their legs from time to time, but normally you can easily stop the shaking if you wish.

Restless legs syndrome, however, often results in jerky or twitchy leg movements that you can’t control. It’s important to note that this motion is different from the occasional ‘jolt’ which many people experience as they’re falling asleep – known as hypnic Jerks.

The symptoms are generally more common at night. The leg movements can occur every 10-60 seconds and may be so strong that they stop you sleeping or may wake you or a sleeping partner. In some cases the problem can result in severe disruption to your overall sleep.

Sensations

The uncontrollable limb movement may be accompanied by other uncomfortable sensations in your legs and, less frequently, arms, chest and face. Sensations you experience might include:

  • Tingling, burning, itching or throbbing in your legs.
  • A crawling or creepy feeling in your legs.
  • A feeling like bubbling water in the leg blood vessels.
  • Cramps in the legs.
  • Electric tingling feeling in the legs.

Often these feelings can be relieved by moving or rubbing your legs, but for some people the relief can be short-lived. The symptoms can range from mild to unbearable, and are usually worse in the evening and the night.

Some people experience symptoms now and again, while others have them every day. And it may also make it difficult to sit for long periods in a car, cinema or airplane.

Sleep disturbance and well-being

The various symptoms can result in frequent disturbance of your sleep. This can result in a lack of quality sleep and a general tiredness throughout the day.

Research into restless legs syndrome has also shown that people with moderate or severe symptoms can also suffer from anxiety and depression.

This may be partly due to the effects on their general well-being from a lack of sleep. But also an understandable worry about whether they might have a serious physical or mental problem.

Around half of people with restless legs syndrome may also experience episodes of lower back pain.

How common is restless legs syndrome?

With the range of severity of symptoms, I suspect many sufferers never seek medical help. According to the International Classification of Sleep Disorders, restless legs syndrome affects more than 5% of the population of the United States.

But some studies have found that nearly 10% of adults report that they have experienced the condition. The more severe cases profoundly disturbs sleep and overall well-being, requiring long-term medication treatment.

Women are twice as likely as men to experience it. The condition is also more common in middle age. But the symptoms can develop at any age, including childhood. There does also appear to be a possible genetic factor, so it may be passed from parents to children.

Pregnancy

It also appears that this problem can be more common during pregnancy. An Italian study of nearly 600 pregnant women reported that about 25% described symptoms of restless leg syndrome.

Fortunately, in most cases the symptoms disappear or reduce in the last couple of months of pregnancy or shortly after giving birth.

The association with periodic limb movement disorder

Over 80% of people with the problem are also likely to experience periodic limb movement disorder during the night. Restless leg syndrome and periodic leg movement disorder are classified as two different sleep disorders – even though the symptoms are often very similar.

The main distinguishing feature is that periodic leg movement disorder only occurs whilst you’re sleeping. You may produce involuntary and repetitive movements, and probably won’t be aware of it.

It can range from the gentle movement of toes and ankles to more pronounced kicking and full leg movements. It may also disturb your sleep quality resulting in you feeling sleepy during the daytime. 

In contrast, restless legs syndrome can occur at any time, including when you’re awake or asleep. It may be accompanied by more symptoms, including possibly limb movements similar to those experienced with periodic leg movement disorder.

Restless legs syndrome can also prevent you from falling asleep in the first place, as well as waking you up.

Causes

Generally, the problem is referred to as either secondary or primary, depending on whether or not you have another underlying medical condition.

Secondary restless legs syndrome causes

Secondary restless legs syndrome can actually be one of the symptoms of an underlying medical condition. The most common cause is Iron-deficiency anemia. But other long-term health conditions can cause similar symptoms. These may include:

  • Kidney disease.
  • Diabetes.
  • Parkinson’s disease.
  • Rheumatoid arthritis.
  • Thyroid gland problems.
  • Fibromyalgia.

Your doctor would want to ensure you aren’t suffering from any of these conditions before considering treatment.

Certainly the possible connection between iron-deficiency anemia and the syndrome seems to have increasing support from some medical professionals, for example as reported in this 2011 study.

The condition could also be a side-effect of other medication, such as:

  • Antidepressants.
  • Antipsychotics.
  • Dopamine antagonists (see below for a list of drugs in this category).
  • Antihistamines.
  • Calcium-channel blockers.
  • Phenytoin.
  • Steroids.

If taking any of these, you may wish to discuss your medication options with your doctor to see if they’re having an effect on your symptoms.

Primary restless legs syndrome causes

Assuming that the possibility of an underlying medical condition has been eliminated, then the problem is referred to as primary restless legs syndrome. Unfortunately, the exact cause of the problem is very uncertain.

Based on responses to some existing drug treatments, there’s some suggestion that the cause may be neurological related, perhaps due to low levels of dopamine in the brain.

The level of Dopamine in the body also reduces towards the end of the day. This then lends some weight to the neurological theory since people’s symptoms are often worse in the evening and night.

However, the most recent medical trial casts doubt on the influence of dopamine on restless legs syndrome. This research may well result in changes to recommended treatments in the future. See below for more details about this recent research.

Wider health implications

Medical research in 2015 identified that restless legs syndrome can also be associated with significantly higher risks of suffering from heart problems, stroke, kidney disease and even death. You can read more about the research findings in this article.

Restless legs syndrome treatment

Increasing your iron levels

iron rich meat graphFor secondary restless legs syndrome the aim will be to treat the underlying medical condition.

If an iron deficiency is suspected then it should be possible to treat this, perhaps with simple iron tablet supplements or even iron rich foods.

It’s also important to remember that the body is better at absorbing ‘Heme’ iron found in meat and fish, including some shell fish.

Vegetable sources are termed non-Heme and are less effective in raising your iron level. What better excuse for treating yourself to a steak or oysters!

Here’s a list of other iron-rich food that you may like to include in your diet:

  • White and red meat, such as beef, lamb and chicken.
  • Fish like sardines, clams, oysters and mussels.
  • Eggs.
  • Dark-green leafy vegetables, such as watercress and curly kale.
  • Cereals or bread fortified with iron.
  • Brown rice, pulses and beans.
  • Nuts and seeds.
  • Dried fruit, such as dried apricots, prunes and raisins.
  • Tofu.

Before taking supplements, doctors do recommend having your ‘ferritin’ levels tested first, as taking too much iron can also have adverse effects.

It may not be as easy as just changing your diet though, as monitoring by your doctor may also be needed to ensure you are getting the right amount of iron.

And in severe cases if might also be possible to have iron intravenously, as this has been found by researchers to be effective.

Therefore, I suggest that if you’re suffering from restless legs syndrome you might wish to consider having your blood iron level tested before trying other medications.

No cure for primary restless legs syndrome

There are unfortunately no reported cures for primary restless legs syndrome. Therefore, any medication you might be prescribed is really aimed at trying to reduce and manage the symptoms.

If the symptoms are mild or infrequent then no treatment may be necessary. Indeed many people may be reassured just to know that they don’t have a serious underlying medical condition or disorder.

If the condition is affecting your quality of sleep, there are many self-help options you can try. You may find it useful to read our articles about sleep hygiene for more about this. You can also find out about lifestyle and dietary choices which disrupt sleep such as caffeine, smoking and alcohol.

Home remedies

There are various home treatments you could try to reduce the level of discomfort, for example:

  • Massaging your legs or arms, especially before going to bed. Even just 5-10 minutes might be enough to help.
  • Applying a hot or cold compress to your leg muscles.
  • Having a hot and relaxing bath in the evening.
  • Some non-vigorous exercise – walking or stretching rather than jogging. Or an exercise bike if you have one.
  • Gently stretching your legs before going to bed.
  • Trying to relax by doing activities such as reading, puzzles or watching television.
  • Relaxation techniques such as yoga, meditation or tai-cha.
  • There are relaxation techniques you can do in bed to focus your mind elsewhere.
someone having a relaxing bath

A hot bath could be an effective home remedy for some symptoms of restless legs syndrome.

These home remedies may only provide temporary relief. But they may still be worth trying to see if they allow you to relax, reduce the discomfort or even hopefully fall asleep.

You could also try a technique called ‘Counterstrain Manipulation’, which a small trial in the UK has reported can be effective. You would need to find a local chiropractor, osteopath or perhaps masseur who provide this treatment.

There are some chiropractors who also believe that restless legs syndrome originates in the pelvic area of the lumbar and sacral regions of the lower back. These chiropractors may be able to help improve the pelvic instability with adjustments, exercises and stretches.

Other small scale studies have suggested that using a Pneumatic Compression Device can also reduce the symptoms. But these devices are very expensive and require you to use them for around 1 hour each evening. Thus this treatment doesn’t appear to have gained popularity.

Electronic medical device treatment

There’s a growing range of electronic devices which aim to help with RLS. They don’t yet have a strong body of evidence to support the effectiveness, but some patients and researchers are optimistic about their use.

To find out about these, you can read our article discussing new restless legs syndrome treatments.

Could magnesium deficiency play a role?

A number of patients and professionals have suggested that magnesium deficiency can also contribute to restless legs syndrome.

The first comment on this article (see below) is an interesting personal story. And four people also commented on a different magnesium article that it had helped their symptoms.

However, there don’t appear to have been many specific trials to look at the impact of a low level of magnesium on restless legs syndrome.

One trial in 1998 looked at a small sample of 10 people, and did find some evidence that magnesium can help. They found that increased magnesium can reduce the frequency of mild restless legs syndrome and also periodic limb movement disorder symptoms.

In theory healthy people with a good diet shouldn’t suffer from magnesium deficiency. However, there are a number of health conditions that can result in low magnesium levels, and an unbalanced diet may also be a factor.

Low magnesium can also cause a large number of other symptoms as reported here. I suspect that most people with low magnesium levels would notice other symptoms, in addition to restless leg syndrome ones.

So it certainly seems that low levels of magnesium could be a cause of restless leg syndrome in some people. Indeed some professionals believe that low magnesium can be the cause of a large number of medical conditions. Accordingly you might want to raise this possibility with your doctor.

Equally, you could try changing your diet and even taking supplements for a short period to see if it helps. Many of the iron-rich foods mentioned above are also good for magnesium, especially green leafy vegetables and other food with a high fiber content.

Medication

There are a number of drugs that your doctor may prescribe for primary restless legs syndrome. Currently drugs which are classified as ‘dopamine agonists’ can be prescribed.

Dopamine is one of the important neurotransmitters in the brain. A dopamine agonist is a compound that activates dopamine receptors in the absence of dopamine.

There are a number of brands of dopamine agonist medicines used to treat restless legs syndrome, including:

  • Levodopa.
  • Pramipexole.
  • Ropinirole.
  • Rotigotine.

These drugs can have significant side-effects in some (though not all) people including:

  • Nausea and vomiting.
  • Constipation.
  • Headaches.
  • Drowsiness and sudden ‘attacks’ of sleepiness.
  • Dizziness or fainting due to low blood pressure.
  • Hallucinations or delusions and confusion.

So whilst not a cure, these drugs may be effective in relieving the symptoms of restless legs syndrome. However, between 5% and 7% of people taking these drugs over a long period can experience ‘augmentation’ or significantly increased symptoms.

A medicine called Pregabalin may also be prescribed by your doctor. This is an anti-epileptic medicine, although it is prescribed for the treatment of several different conditions. But you need to be aware that this drug can also have worrying side-effects in some people, including making you feel sleepy.

Doctors may also prescribe Benzodiazepines, a class of sedative medications, or painkillers aimed at reducing stress or the discomfort. Again you may experience side-effects with these medications and, in some cases, they can be addictive. Thus long-term use of such medications may need careful and on-going consultation with your doctor.

Recent research

In February 2014 a group of researchers compared the effect of a dopamine agonist drug (pramipexole) with one which does not have a dopamine enhancement function (pregabalin as mentioned earlier).

The results were reported in the New England Journal of Medicine. Some of their findings appear to raise important questions about the use of medication to alleviate symptoms of restless legs syndrome. Some of their key findings included:

  • Pregabalin, which has no effect on dopamine levels, was as effective in controlling the symptoms as the dopamine agonist drug.
  • The effectiveness of the alternative medication raises doubt about the relationship between dopamine levels in the brain and restless legs syndrome.
  • Dependent on the dosage level, the long-term use of dopamine agonist medication appears to have a higher probability of symptoms in some patients getting worse, compared to the non dopamine related drug.
  • They also reported that this long-term worsening or ‘augmentation’ of symptoms was a side-effect of the drug, rather than a natural progression of the condition.
  • Many side effects were also less severe when using pregabalin. But some other, worrying, mental state related side effects were seen with the use of this medication.

In October 2014, it was reported in a Reuters Health article that the Institute for Safe Medication Practices in Alexandria, Virginia, had found the following:

Dopamine receptor agonist drugs were linked with higher risks for pathological gambling, hyper-sexuality and compulsive shopping in a new study.

These strong drugs are used mainly for Parkinson’s Disease. But the report does mention that they are sometimes also used to treat restless legs syndrome. Clearly this is a complicated area.

If you’re already taking these types of medications, you may wish to discuss the implications of these recent studies with your doctor. If you’re suffering significant side-effects, or you think the symptoms are getting worse, then your doctor may change your medications or dose.

More research is definitely needed to identify the best drug options to relieve restless leg syndrome symptoms. Hopefully this research may also help to improve the very limited understanding of this sleep disorder.

And if the ‘Counterstrain Manipulation’ technique discussed above is effective, then this might cast doubt on the role of dopamine in restless legs syndrome.

Conclusion

Restless legs syndrome is a fairly common condition. It can occur as a symptom of other medical conditions or a side-effect of other medication. The causes of the condition are not well understood and there’s no known cure.

There are home remedies you can try to see if they alleviate the symptoms, improve your well-being and sleep. There are also medications prescribed, but recent research is challenging the current thinking on the best drugs to use.

Unless you have another medical condition, it may be worth considering having tests done to ensure you aren’t suffering from iron deficiency.

Your views

It’s always helpful to hear your experiences of a sleep disorder, and efforts you’ve made to try to manage it. Have you tried any of the medications or techniques discussed above? If so, did they help at all?

22 CommentsLeave a comment

  • I am glad to have found this article. I am suffering with/from RLS and insommia for many years now every night. I am taking 7.5 mg Oxycodon, 900 mg Gabapentine and 50 mg Amitriptyline And 1,5 mg Lorazepam. This cocktail has helpt me, but the last months it doesn’t anymore. Looks like augmentation of the meds to me. I want to get rid of them and try the THC med oil. Anyone who has experience with this transition traject?

  • Well, round and round on the RLS merry-go-round. Severe RLS about a year ago. I had no clue what it even was – Drs had no clue, offered me Requip – no thanks. Search and search – finally, thankfully, found Johns Hopkins Neurology Dept online. Just this one sentence “Since the 1950s, it has been known that iron therapy, even without the presence of anemia has benefits for RLS symptoms.” So – I eliminated the symptoms of RLS, but crushing insomnia remains. What caused the iron deficiency in the first place? Magnesium also – but I take Mg and have a paradoxical reaction – excitable not relaxing. RLS is a VERY complex neurological disorder. Your article is very complete.

  • Just buy JEUNESSE product like RESERVE, AM for morning and PM for evening. Its herbal. I just take it everynight the PM and my restless leg is gone now and I can say that I can sleep well.

  • I have had the problem on occasions but last night my legs were moving for what seemed like hours. I am now 55 – my mum also suffered badly in her later years. Thanks for the advice – I will have a look at some of the supplements and also see the doctor for advice.

  • I experience restless body. I get it in my arms shoulders upper back as well as hips, legs and feet. It was a night only, then it started to happen in the day.
    I already take a lot of magnesium. My naturopath recommended Kava Kava.
    I use it as needed, when I have the sensation. Likely 2-3 times a week, one week per month. It works very well for me. She says it’s a sympathetic nerve response to stress, either physical or mental. So I stretch my body more often, meditate more often observe good sleep habits. The restless body certainly is lessening nor does it ‘bother’ me as much when I do have it , now that I have a solution for it.

    • Hi Mary-Jane
      Thanks for your comment. It’s very interesting to hear that you’re managing to deal with this through natural means like this. I’m sure other readers will be grateful for your ideas too.
      Regards
      Ethan

  • Magnesium supplements have greatly improved my sleep. I started taking it for my asthma but a wonderful side affect is it took away my severe RLS that kept me awake for hours every night.

  • I can definitely say that magnesium tablets has helped me overcome restless legs syndrome. I used to be up marching on the spot and stretching my legs sometimes till 2am. Hope this helps.

  • I have had primary RLS my entire life, as have my grandmother, father, aunts, daughter and more grandchildren, it has no underlying cause. I wish the medical world would listen to those of us who have to live with this insidious disease. Instead they come up with all kinds of possible solutions that do not help at all. And the drugs that do help with the least amount of side effects are very hard to get because they are pain pills.. Tramadol is one of the best meds for RLS, believe me in 66 years, I have tried probably everything. But we are lumped in the group with irresponsible druggies who use it not because they need it but because they want to get high. The DEA has put such control on it that they are condemning many of us to a life of suffering from the result of not sleeping, heart issues, anxiety, high blood pressure, fatigue, depression, just to name a few. I am so tried of those who have no idea of the heartache this causes, get to control what we are able to take, especially since the meds they allow, don’t work, make many sicker, cause augmentation, etc.,
    this just doesn’t make sense. As long as I or any patient is found to be responsible, not abusing, they should be allowed to take a med that gives them their life back… It is so sad. Read the rls sites, people suffer with this so terribly, and a group of people who probably have no idea of the reality of it, control what we can take to better our physical well being.

    • Hi Peggy
      Thanks for your comment. I’m sorry to hear you’ve suffered so much due to this sleep disorder. It’s also a shame that you feel you can’t get the best treatment. I assume you’ve seen a sleep specialist or had a sleep study done at some point during the years. What did they recommend?
      Regards
      Ethan

  • Many medical conditions are associated with restless legs syndrome, including iron deficiency, diabetes, end-stage kidney disease, Parkinson’s disease, and even pregnancy. These cases account for a minority of people with restless legs syndrome, however.

    • Hi Bryant
      Thanks for your comment. You’re right in that there are several medical associated medical conditions. Even though individually they may only account for a small minority, it’s still useful to be able to identify an underlying cause if it exists. Hopefully the treatment would then make a difference to the RLS.
      Regards
      Ethan

  • My eldest son, is very pale, has sleep disorder issues but can sleep all day Saturday and Sunday! He is anxious at school, but recently I moved him to a fantastic school which alleviated his leg night pains which disrupted his sleep totally. Now he can stay awake at school. His diet has been compromised also due to poor financial issues and school dinners not being substantial enough in so far as the child may not eat it all. Thank you for your research and I will try to change the diet, add a supplement and seek help from an osteopath perhaps.
    Regards,

    Bernice Walsh

    • Hi Bernice

      Thanks for your comment, and I’m sorry to hear your son’s been having sleep problems. It sounds like anxiety might have been a big factor then. Hopefully by continuing to take action to improve his quality of life and happiness, his sleep will continue to improve. Well done for trying to help him through what I imagine has been a difficult period for him.
      All the best
      Ethan

  • Just want to say that I started taking prescription iron “Ferralet 90 tabs” supplements about 5 weeks ago. They were prescribed by a GYN doctor who also specializes in nutrition and bioidentical hormones.
    I’ll have to say that this has already helped get rid of my restless legs, muscle twitches and mild circulation sensations in my legs.
    I’ve also improved my diet with more iron (in the last 4 mos.) by eating more red meat, liverwurst, dark salad greens, broccoli, etc. Myoclonic jerks and head zaps have also decreased, allowing me to take less Clonazopam for getting to sleep.

    Thanks Ethan for creating these no sleep sites, they’ve been helpful to me and I’m sure a lot of others.

    • Hi Sylvia,

      Thank you for your comment, and I’m glad you found the articles helpful. That’s fantastic news that you’ve found something which has had such a positive effect on your various different sleep disorders and symptoms.
      I hope it continues to stay that way, and that things improve to the point of not having any problems sleeping.
      All the best
      Ethan

  • As a clue: I am fairly addicted to nightly Ambien. On nights I miss a dose, not only do I go into serious insomnia, but I will quickly fall into RLS. Any thoughts?

    • Hi Gary

      Thank you for your comment. If you think that there is such a clear link, then it’s possible there may be. I would therefore suggest talking to your doctor about it and seeing what they have to say. Did you have RLS in the past, before you started taking ambien, or is something which has started since starting taking it? Those are questions the doctor would want to know, and could help explain a possible relationships between the Ambien, insomnia and RLS.
      All the best
      Ethan

  • I’ve been dealing with this, hypnic jerks and insomnia for going on 20 years now, and am just coming to really understand that the main underlying issues with me is my body’s inability to hold on to magnesium. I had a top naturopath tell me my body doesn’t hold on to nutrients, and probably doesn’t hold on to toxins either which is good.

    The tingly creepy crawly sensation of RLS is a symptom of low magnesium levels. So are jerking muscles of all types up to and including epilepsy. Insomnia is also made worse by low magnesium levels. One of the strangest symptoms I’ve had with my hypnic jerks is that I’ll get an electric zap in my toe about 30 seconds before a huge hypnic jerk occurs. This can happen any time I’m tired, and is very creepy. In my reading up on the role of magnesium in the body, I found that zips and zaps are yet another symptom of low magnesium! Who would have ever imagined? Certainly not me!

    One of the reasons RLS is associated with so many diseases is because they’re associated with low magnesium levels so it follows that you’re going to have all the symptoms of low magnesium plus the illness. Fibromyalgia is the perfect example with a list of symptoms as long as your arm that half are probably related to low magnesium levels. I have a form of fibromyalgia without the pain that I think is genetic [been diagnosed with fibro], and in researching it I came across an article speculating that fibromyalgia is caused by mineral deficiencies. Given that I’ve had this for 32 years now, and only improved when I started taking magnesium, I think there’s something to this. I’m amazed at how much better I do when I get enough magnesium versus when I slack off and forget to use my magnesium oil or soak in epsom salts.

    A lot of the meds block the body’s ability to use various nutrients leading to a deficiency over time. And to think we get all the nutrients we need in our foods is just delusional thinking. If you think white bread is nutritious, leave a piece out and if how long it takes to mold. I doubt it will as there’s nothing for the mold to live on!

    Not all magnesium is created equally. The most inexpensive and common is magnesium oxide that does little more than act as a powerful laxative to keep you cleaned out. Only about 3% of it is absorbed so it’s impossible to take enough to help resolve your sleep and other issues. Magnesium oil made from magnesium chloride is probably most easily absorbed when applied transdermally. The great thing about using that is that you can replenish your magnesium supplies at the cellular in a matter of weeks whereas it would take 6 months of oral supplementation to do so.

    • Hi Hayley,

      Thanks for your comment – it’s good to hear from you again, and on this new article, as I know you’re part of the on-going conversation about hypnic jerks.

      Magnesium has certainly received a lot of attention in the comments after the hypnic jerks article, and from several readers. I hadn’t included it here due to a lack of research about how much of an impact magnesium deficiency might have on restless legs syndrome.

      I will have a look at the article you sent me, though I won’t publish the link – I rarely do as you rightly guessed! But the information was certainly interesting and I’ll give it a good read. I’ll also have another look at the possible role magnesium plays and get back to you in the near future.

      Thanks again!
      Ethan

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