Overview
Restless legs syndrome (RLS), also called Willis-Ekbom disease, is a neurological condition causing an irresistible urge to move the legs, usually accompanied by uncomfortable sensations described as crawling, creeping, pulling, or tingling. Symptoms worsen at rest and at night, severely disrupting sleep. Moving the legs provides temporary relief.
How common is it?
RLS occurs in both adults and children. Symptoms range from occasional discomfort to persistent sleep disruption; estimates vary with the population and diagnostic criteria.
Causes and risk factors
Primary RLS has a strong genetic component and is linked to abnormal dopamine signalling and iron metabolism in the brain. Secondary RLS has identifiable underlying causes.
Common risk factors
- Genetic (primary RLS — often familial, onset before 45)
- Low iron stores, sometimes without anaemia; a clinician interprets iron studies in context.
- Pregnancy (third trimester)
- Chronic kidney disease
- Peripheral neuropathy
- Medications: dopamine antagonists (metoclopramide, antipsychotics), antidepressants (SSRIs, TCAs), antihistamines
- Caffeine and alcohol worsening severity
Symptoms
- Uncomfortable sensations in the legs (rarely arms) described as crawling, creeping, pulling, throbbing, or itching inside the limbs
- Irresistible urge to move legs to relieve the sensation
- Symptoms start or worsen during rest or inactivity, particularly in the evening or at night
- Partial or temporary relief by movement
- Sleep disturbance and daytime fatigue
- Some people also have repeated leg movements during sleep; these alone do not diagnose RLS.
When to see a doctor
See a GP for symptoms disrupting sleep consistently. RLS is commonly misdiagnosed as circulatory problems, muscle cramps, or anxiety. Correct identification leads to effective treatment.
Diagnosis
Assessment considers the urge to move, worsening at rest and at night, and relief with movement. Other explanations, including cramps and diabetic neuropathy, must be considered. Tests may check iron stores and underlying conditions.
Treatments
Iron supplementation
Iron treatment depends on blood tests and clinical context. Do not start supplements without advice; ferritin and transferrin saturation help guide oral or intravenous treatment.
Dopamine agonists
Dopamine agonists are no longer routine first-choice long-term treatment because they can worsen RLS over time. Selected use needs shared review. Do not stop or change an existing prescription abruptly.
Alpha-2-delta ligands
Gabapentin or pregabalin may be used for persistent RLS. A clinician checks kidney function, sedation, interactions and suitability; do not change or stop treatment without advice.
Low-dose opioids
A specialist may consider an opioid for selected refractory RLS, with monitoring for dependence, sedation and breathing suppression.
Self-care and lifestyle
- Reduce caffeine and alcohol if they worsen symptoms. Ask a clinician to review possible medicine triggers; do not abruptly stop prescribed medicines.
- Moderate exercise during the day reduces symptoms (but vigorous exercise close to bedtime may worsen them)
- Gentle stretching, massage or a comfortably warm bath may help. Avoid hot water or direct heat if sensation is reduced.
- Mental distraction activities (reading, word puzzles) reduce symptom awareness
Prevention
Primary RLS cannot reliably be prevented. Treating an underlying cause and reviewing medicine triggers with a clinician may help symptoms.
Sources for targeted updates
Updated: 24 October 2026. Targeted corrections to frequency, risk factors, symptoms, diagnosis, treatment, self-care, prevention, key facts. This update covers the named sections; a full review of the remaining guide is pending.