Home / Conditions / Restless legs syndrome
An urge to move the legs that is hard to resist, with uncomfortable sensations deep inside them, that comes on in the evening or when you rest and eases when you move. Also called RLS or Willis–Ekbom disease, it is not dangerous, but it can badly disturb sleep — and it often has a treatable cause.
Restless leg syndrome is often confused with other causes of uncomfortable legs at night. The difference lies mostly in what the sensation feels like, and in whether moving helps.
| Restless legs | Night cramps | Nerve damage neuropathy | Trapped nerve in the back | |
|---|---|---|---|---|
| What it feels like | An urge to move, with crawling, pulling or aching deep in the legs | A sudden, painful tightening; the muscle goes hard | Numbness, burning, or pins and needles | Pain running from the back or buttock down the leg |
| When it comes on | Evenings, and whenever you rest | At night, often waking you | Often constant, sometimes worse at night | With certain postures, sitting or bending |
| What eases it | Moving — walking, stretching | Stretching the cramped muscle | Little; moving does not help | Changing position |
| Where | Calves and thighs, usually both legs | Usually one calf or foot | The feet first, spreading upwards | Along one line down one leg |
Restless legs is uncomfortable, not dangerous. But weakness in a leg, numbness that is spreading, or leg symptoms with a change in bladder or bowel control point to the spine instead. Call the clinic the same day; for bladder or bowel changes when we are closed, go to an emergency department.
Although the sensations are felt in the legs, the cause is not in the legs themselves. Restless legs comes from the way the brain and spinal cord control sensation and movement — in particular a chemical messenger called dopamine, which the brain needs iron to make.
It also follows the body clock. That messenger system naturally runs lower in the evening and at night, which is why symptoms build then, and why they ease by morning.
The same system explains the causes that can be treated. Low iron, some medicines and certain health conditions all affect the same system, which is why finding and correcting them can settle restless legs without anything else.
Treatment starts with finding anything that is driving it. Many people improve once a cause is corrected and a few habits are changed; medicine is kept for symptoms that still disturb sleep.
If iron stores are low, replacing them often helps, even where the level is only at the low end of normal. Changing a medicine that makes it worse, or treating a linked condition, can do the same. Restless legs that starts in pregnancy usually settles after the birth.
Regular, moderate exercise — though not late in the evening — a regular sleep routine, and cutting down on caffeine, alcohol and smoking all help. Massaging the legs, a warm bath, or keeping the mind occupied during long spells of sitting can ease an episode.
When symptoms disturb sleep most nights, several kinds of medicine can help, started at a low dose. Some used for restless legs can, over time, make symptoms start earlier in the day, so treatment is reviewed regularly rather than simply continued.
Where restless legs is severe, unclear, or not responding, a sleep specialist or neurologist may be involved in your care. You will be told plainly if that would help.
Restless legs syndrome here is seen by Dr Mathew Tung Yu Yee, a neurosurgeon who treats brain, spine and nerve conditions, including leg pain and sciatica. He trained in neurosurgery in Singapore and the United Kingdom, holds the FRCS (Surgical Neurology) and is a Fellow of the Academy of Medicine, Singapore. He consults in English, Mandarin, Malay and Hokkien.
It is not dangerous, but it can seriously disturb sleep, and poor sleep affects mood, concentration and daytime energy. That is reason enough to have it looked at, especially since a treatable cause is often found.
The brain's messenger system involved in restless legs naturally runs lower in the evening and at night. Lying or sitting still also brings it on, and bedtime combines both.
Yes. Low iron stores are one of the commonest causes, and correcting them often helps — sometimes even when blood levels are only at the low end of normal. It is one of the first things checked.
Usually not. Restless legs comes from the brain and spinal cord rather than the nerves in the legs, though nerve damage can cause similar sensations and sometimes occurs alongside it, which is why the nerves are examined.
Some antihistamines, some antidepressants and some anti-sickness medicines can bring it on or make it worse. Do not stop a prescribed medicine on your own — bring a list, and it can be reviewed.
No. Bring a list of the medicines and supplements you take, and any recent blood test results.
Nerve and leg pain · Neuropathic pain · Sciatica · Nerve or bone?
Bring a list of the medicines and supplements you take. They are often part of the answer.
