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What is Restless Leg Syndrome?  

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a common movement disorder that affects 2-4% of children and 5-10% of adults in the U.S. 

People with restless leg syndrome experience an unpleasant sensation in their legs, leading to an uncontrollable or overwhelming need to move their legs. RLS symptoms are described as uncomfortable with itching, prickling, or crawling sensation, and in some cases, painful. 

While RLS affects people of all ages, severe cases of RLS tend to occur in older adults. The symptoms tend to get worse with age. Notably, RLS is more common in women. 

Lifestyle changes, such as avoiding stimulants, self-care measures like regular exercise, and medications, can help relieve RLS symptoms. Taking certain vitamin supplements may also help to treat RLS. 

What Are RLS Symptoms?

The primary symptom of restless legs syndrome is an uncontrollable urge to move the legs due to unpleasant sensations that are variously described as crawling, itching, aching, throbbing, pulling, electric, or creeping feelings. These sensations tend to affect both legs or feet and, less commonly, the arms, and the feelings are within the limbs instead of on the skin. RLS consists of a wide range of sensations. However, the urge to move the limbs is reported by most, if not all, people with RLS. 

RLS symptoms are usually worse at night or when sitting still or lying down. Moving around can ease the uncomfortable sensations. Therefore, severe RLS symptoms can disrupt sleep and lead to daytime sleepiness and difficulty concentrating. 

Restless Legs Syndrome (RLS) vs Periodic Limb Movement Disorder (PLMD)

Restless legs syndrome is sometimes associated with a sleep disorder called periodic limb movement disorder (PLMD), in which there is leg twitching and jerking during sleep. With this sleep disorder, periodic limb movements cause muscle contractions every 20 to 40 seconds during sleep. 

Sleep specialists can help you to distinguish between PLMD and RLS. Keep in mind that a lot of people with RLS also have PLMD. However, you can have PLMD without RLS.

Periodic limb movement disorder also differs from RLS in the fact that it does not cause these uncomfortable sensations, and people with PLMD typically are not aware of these movements in their sleep. Your healthcare provider may refer you to a specialist in Sleep Medicine for an accurate diagnosis.

Causes of Restless Legs

The exact cause is unclear, but it is believed that an imbalance in dopamine levels in the brain causes restless legs syndrome/Willis-Ekbom disease. There may also be genetic components responsible for the symptoms of restless legs syndrome. Research has shown that 40 to 90% of RLS cases have at least one first-degree relative with RLS. 

Some pregnant women develop RLS in the third trimester of pregnancy, but the symptoms usually go away after delivery. For unclear reasons, restless legs syndrome is more common in women than men. 

Link Between RLS and Other Conditions

Other health conditions that can contribute to the development of secondary RLS include:

• Iron deficiency: An iron deficiency or low blood iron alone can cause or worsen RLS. Iron deficiency anemia is a condition when your iron level is so low that your body does not make enough red blood cells to carry oxygen-rich blood to vital organs. In other words, you can have iron deficiency without being diagnosed with iron deficiency anemia.

• Immune system conditions such as rheumatoid arthritis.

• Advanced kidney disease including hemodialysis patients.

• Neuropathy, health conditions causing poor circulation, or any disorders affecting blood vessels.

• Spinal cord disorders, multiple sclerosis.

• Parkinson’s disease.

Note: Idiopathic RLS is a type of RLS that has no known cause.

What Can Worsen RLS Symptoms?

Side effects of certain medications such as antidepressants, anti-nausea drugs, and allergy medicines, especially older antihistamines, can aggravate or worsen symptoms of restless legs syndrome. Caffeine, alcohol, and nicotine can also make RLS symptoms worse.

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Vitamins and RLS

What Is Your Body Lacking When You Have Restless Legs?

Studies have shown possible associations between restless legs syndrome and deficiencies of certain vitamins and minerals such as iron, magnesium, and vitamins B, C, D, and E.

Does Iron Deficiency Cause Restless Leg Syndrome?

Iron deficiency anemia is commonly found in people with restless leg syndrome. It is believed to be a known cause of this movement disorder. Studies have shown that iron supplementation in pill or injection form can help to reduce the severity of RLS symptoms even in people with normal blood iron levels. However, larger studies and placebo-controlled trials are needed to confirm the role of iron therapy in RLS symptoms. 

If you have a deficiency, your healthcare provider may recommend iron pills or injections. Experts recommend iron pills if your ferritin levels are 50 mcg/L or lower; about 50% of people experience significant RLS symptom relief with supplementation at these ferritin levels. 

Does Magnesium Stop Restless Legs?

Research suggests that many RLS patients have low magnesium levels. The lower the magnesium level, the greater the severity of RLS symptoms. Therefore, magnesium supplementation (oral or intravenous) may help to control severe symptoms of restless leg syndrome and improve sleep quality. There are case reports of patients who recovered completely from RLS after taking magnesium supplementation. 

One small study found that magnesium and B6 supplements alleviate symptoms of severe RLS. However, due to the very small size of this study, more research is necessary to establish the role of magnesium supplementation. 

You should only use mineral supplements after consulting your healthcare provider especially if you are 65 years and older or if you have kidney disease.

Does Vitamin D Deficiency Cause RLS?

There is a possible association between vitamin D deficiency and restless leg syndrome. Vitamin D deficiency can lead to dopamine dysfunction, and a reduction in the body’s production of dopamine may cause RLS. Again, further studies are needed to confirm the link between vitamin D deficiency and restless legs. If your blood work shows a vitamin D deficiency, your doctor may recommend taking vitamin D supplements to see if they can provide relief from RLS symptoms. Certain foods like red meat, egg yolks, sunflower seeds, and oily fish or fatty fish are good sources of vitamin D.

Does Vitamin B12 Help Restless Legs?

Systematic review of studies have shown that people with restless legs syndrome have low levels of B vitamins, especially vitamin B6 and vitamin B12. We know that vitamin B and other vitamins play a role in sleep quality. Therefore, taking a supplement to increase vitamin levels may help to relieve restless leg syndrome.

Do Vitamin E and Vitamin C Help With RLS?

Studies suggest short-term treatment with vitamin C and vitamin E in hemodialysis patients can significantly relieve RLS symptoms. More research is needed to find the exact link between these vitamins and restless leg syndrome. If you experience symptoms of RLS, it is worth asking your healthcare provider about vitamin supplementation.

How Do You Calm Down Restless Legs?  

According to the RLS Foundation, the following natural remedies, self-care measures, and non-pharmacologic (non-drug) treatments can help to calm restless legs.

Regular Sleep and Stress Management

• Practice healthy sleep habits. Get 7-9 hours of sleep daily. Avoid screen time for at least 2 hours before bedtime.

• Limit your alcohol, nicotine, and caffeine intake, especially in the hours before bedtime.

• Manage stress with meditation, yoga, music, and other stress-reducing techniques.

• Try relaxation techniques like soaking in warm water, massage, or acupressure.

Exercise and Physical Activity  

• Get regular moderate exercise, including lower body resistance training. 

• Avoid intense exercise in the hours leading up to bedtime. 

• Instead, perform light stretches or walk before going to bed.

Diet and Nutrition Tips

• Eat a healthy diet that gives you all the vitamins and minerals you need to support healthy circulation and protect against nerve damage.

• Take supplements such as iron, magnesium, zinc, B vitamins, and other vitamins if you do not get enough of these nutrients from dietary sources.

Natural Remedies 

• Use heat or cold to get relief from leg discomfort. You can try using a cold compress or ice pack or apply a heating pad at the lowest setting.

• Try a warm bath or cold bath to see if either helps.

• Massage, acupressure, and light stretching benefit some people with RLS.

• Distract your mind when you’re sitting still or lying in bed by watching TV or playing video games.

• Avoid extreme temperatures. Some people find their RLS symptoms are worse in hotter or colder climates.

What is the Best Medication for Restless Legs?

The American Academy of Neurology and International Restless Legs Syndrome Study Group (IRLSSG) have published evidence-based and best practice guidelines for the long-term treatment of restless legs syndrome/Willis-Ekbom disease.

Over-the-Counter Options  

Dietary supplements (mineral and vitamin supplements) are available over-the-counter and can provide relief to some people with restless legs. However, you should check with your healthcare provider before taking any supplements to avoid drug interactions leading to harmful side effects. 

Prescription Medications  

If lifestyle modifications, self-care measures, and other treatments like supplements do not relieve RLS symptoms, your healthcare provider may prescribe one or more of the following medications to treat severe RLS symptoms:

• Dopaminergic medications that increase dopamine levels in the brain. Examples of dopamine agonists include ropinirole (Requip), pramipexole (Mirapex), rotigotine (Neupro patch), and cabergoline (Dostinex).

• Anticonvulsants that regulate calcium channels such as gabapentin enacarbil (Horizant — this is the extended-release formulation of gabapentin; Horizant is only available as brand name), gabapentin (Neurontin), and pregabalin (Lyrica).

• Benzodiazepines such as clonazepam (Klonopin) for severe restless legs.

• Non-benzodiazepine sedative-hypnotics such as zolpidem (Ambien) are sometimes used if RLS is causing severe sleep disruption. 

• Opioids such as oxycodone, codeine, or methadone may be an effective treatment for severe symptoms that do not respond to other medications.

• Short-term or initial treatment with the Parkinson’s medicine, levodopa, in people with intermittent RLS symptoms. 

Possible Side Effects and Risks

Common side effects of dopaminergic agonists include nausea, vomiting, headache, dizziness, low blood pressure, and irregular heartbeat.

Possible side effects of anticonvulsants (seizure medications) like gabapentin and pregabalin include changes in mental status, weight gain, drowsiness, and dizziness leading to an increased risk of falls.

Benzodiazepines (such as clonazepam) can cause side effects such as drowsiness, headache, impaired balance, nausea, vomiting, diarrhea, difficulty concentrating, memory problems, and dependence (with long-time use).

Non-benzodiazepine sedative-hypnotics (Z drugs) can cause adverse effects and safety issues such as daytime sleepiness and parasomnias (sleepwalking).

Diagnosis of Restless Leg

Your healthcare provider can diagnose restless legs syndrome based on your symptoms and medical history. A diagnosis of RLS is made based on criteria outlined by the International Restless Legs Syndrome Study Group (IRLSSG).

When to Seek Treatment for RLS

Make an appointment to see your healthcare provider if you suspect you have restless legs syndrome and the condition is interfering with sleep, causing daytime sleepiness, and affecting your quality of life. Your healthcare provider will discuss different treatment options that work best for you. Effective treatments are available for RLS. In addition to medication, making healthy lifestyle changes is vital for positive treatment outcomes.