What Is Restless Legs Syndrome and What Can You Do About It?

You’re settling in for the evening, getting ready to watch a movie or go to bed. And then it begins: that creepy, crawly feeling in your legs that makes it impossible to relax.

There’s a very appropriate name for this distress. It’s called restless legs syndrome (RLS), and it’s more than just an annoyance — it’s a medical condition that can benefit from treatment. 

“Because many people don’t view these symptoms as serious concerns, some wait years before they seek treatment for RLS,” says neurologist Nestor Galvez-Jimenez, M.D., director of the autonomic neurology program at Baptist Health Miami Neuroscience Institute. “Timely diagnosis and commencement of treatment are vital to achieving successful patient outcomes.”

RLS is characterized by a nearly irresistible urge to move the legs. Symptoms tend to be worse in the evening and when inactive. Walking, stretching or shaking the legs can provide temporary relief. However, the bothersome sensations usually return once the person goes back to resting.

May is Better Sleep Month, a good time to learn what you can do about this condition, which often comes on in middle age. Because RLS can significantly impair sleep, it can have a negative impact on quality of life and mental health — particularly when diagnosis and treatment are inadequate.

For some people, RLS may be related to an underlying medical condition, emphasizing the importance of seeing a doctor for an accurate diagnosis and appropriate treatment. 

“Clinically significant RLS is underdiagnosed, although it can substantially affect sleep and quality of life,” Dr. Galvez-Jimenez says.

New Guidelines for Treatment

In recent months, new research-based guidelines from the American Academy of Sleep Medicine updated the treatment recommendations for restless legs syndrome.

The guidelines advise that the first step in the management of RLS should be to address exacerbating factors including the use of alcohol, caffeine, certain antidepressant and antihistamine medications, as well as physical activity and untreated obstructive sleep apnea.

The guidelines also emphasize the importance of iron evaluation and possible intravenous supplementation for adults. Researchers believe RLS may be caused in part by a reduced level of iron in the brain, which differs from iron deficiency in the blood. “Even if blood iron levels appear normal, brain iron deficiency can still contribute to RLS,” Dr. Galvez-Jimenez explains.

Another suggested solution is high-frequency peroneal nerve stimulation, an innovative treatment that involves a wearable device to stimulate the nerves. The system— worn on the lower legs—activates the muscles to simulate the sensation of movement, thereby reducing RLS discomfort and improving sleep.

In a reversal of the standard of care for the last 20 years, the new guidelines advise against using dopamine agonists to treat RLS due to concerns about adverse effects. Patients typically experience resolution of RLS symptoms when they begin taking dopamine agonists, a class of medications that mimic the effects of dopamine, a neurotransmitter in the brain. With time, however, they need higher doses to get the same relief. Long-term use can backfire; dopamine agonists are now associated with the risk of “augmentation,” the gradual worsening, not improvement, of RLS symptom intensity and duration.

Patients already using these medications should not discontinue their use without consulting a physician. Dopamine agonists can still be a safe treatment, but only if used for selective, short-term purposes, such as for a patient who is taking a long flight and needs symptom relief. Other medications are available for long-term use, but any changes in medications should be supervised by a physician.

Restless Legs Syndrome Causes and Risk Factors

Restless legs syndrome is considered a neurological condition because it involves dysfunction in the nervous system. “The uncomfortable sensations in the legs and the irresistible urge to move them originate in the brain and spinal cord rather than in the muscles themselves,” explains Dr. Galvez-Jimenez, who has extensive expertise in movement disorders.

RLS can range from isolated occurrences to daily, near around-the-clock discomfort. Some people may experience remissions — periods in which symptoms decrease or disappear for weeks or months — especially during the early stages of the condition. However, symptoms often reappear and become more severe over time.

The exact cause of RLS is not fully understood, but research suggests it is linked to several factors, including genetics, brain chemistry imbalances, dopamine dysfunction and underlying health conditions.

Roughly 7-10 percent, and possibly more, of the American population has RLS. The condition occurs in both men and women but is more common in women. It also affects up to 4 percent of children. The most severe cases tend to affect adults who are middle-aged or older. Early-onset RLS, before age 45, tends to progress more slowly and often has a family history; late-onset RLS, after age 45, may progress more rapidly.

Many people who have RLS may also have a condition called periodic limb movement disorder (PLMD), which involves repetitive flexing or twitching of the limbs during sleep. People are often not aware of this movement, although it can disrupt rest — and disturb bed partners. Some people have PLMD without RLS, so it’s important to have a sleep evaluation if it is suspected.

“There are many different facets to sleep health including sleep duration, sleep quality, sleep efficiency, your habits around sleep and how sleep affects your quality of life,” says Harneet Walia, M.D., medical director of sleep medicine for Baptist Health Miami Cardiac & Vascular Institute. “We can troubleshoot the issues. All these factors should be a part of the conversation.”

The Connection Between Sleep and Good Health

Research has proven that over time, poor or inadequate sleep is associated with high blood pressure, stroke, heart failure, hardened arteries, arrhythmias, heart attack, diabetes, depression, dementia, obesity and weakened immunity.

“Optimal quantity and quality of sleep are of the utmost importance for overall health,” says Dr. Walia, who also serves as chief of clinical transformation for Baptist Health Medical Group.

During sleep, the body undergoes restorative processes, including lowering blood pressure, reducing heart rate and balancing hormone levels. These changes help reduce cardiovascular stress and repair daily wear-and-tear on the heart and blood vessels.

Sleep also provides an opportunity for the brain to restore and repair itself. During sleep, the brain clears out waste products and toxins that accumulate throughout the day. Sleep also plays a crucial role in memory consolidation, the process of integrating newly acquired information into long-term memory.

“We used to take sleep for granted,” Dr Walia says. “But science has proven time and again that sleep is central to so many functions of our bodies. We can no longer ignore its importance. The good news is that most sleep disorders can be treated quite effectively, offering improved health and a better quality of life.”

Nestor Galvez-Jimenez, M.D., neurologist and director of the autonomic neurology program at Baptist Health Miami Neuroscience Institute

Harneet Walia, M.D., medical director of sleep medicine for Baptist Health Miami Cardiac & Vascular Institute and chief of clinical transformation for Baptist Health Medical Group