It’s been a long day and you’re heading to bed… but no matter how tired you are, your legs just can’t seem to settle down with you.
Sound familiar? You might be experiencing restless legs syndrome (RLS). Like any sleep disorder, RLS can impact your waking hours too, and leave you feeling fatigued, unmotivated, and generally unlike yourself.
Learn more about what causes restless legs syndrome and what can help treat it, so you can sleep easy at night and stay on top form during the day.
What is restless legs syndrome?
Officially known as Willis-Ekbom disease, restless legs syndrome (RLS) is a nervous system disorder that creates an overwhelming urge to move your legs. It can also be known as ‘twitchy legs” or tired leg syndrome.
You might feel a “creeping” or itching sensation or need to stretch or move around, even if you’ve recently been active.
There are two types of RLS:
This means that the cause is unknown.
This means there is a specific cause, and it may be down to an underlying health condition or certain factors in your lifestyle.
Restless legs syndrome usually happens at night when you’re in bed, or when you’ve been sitting or lying down for a while.
While it’s not dangerous, RLS may be related to other health conditions and could have detrimental effects on other areas of your life.
Symptoms of restless legs syndrome
Different people describe restless legs syndrome in different ways. Put simply, it’s when you get restless legs at night.
- “Pulling”, “itching”, “aching”, and “burning” are all ways you might explain what’s going on: that’s why it’s also known as “irritable leg syndrome”.
- Sometimes, it can also affect your arms, chest, or face. ¹
- More than 80% of people with RLS will also have periodic limb movements disorder (PLMD), where you twitch suddenly – usually when you’re drifting off to sleep (more on this later!).¹
These symptoms might happen occasionally or every day. They might be mild or unbearable.
How else could RLS affect me?
At best, RLS is annoying and could interrupt a good night’s sleep.
In more severe cases, or over time, it could have detrimental effects on your physical and mental health.
Although anxiety might be a trigger for your restless legs syndrome, it can also work the other way around, too.²
It could cause you to experience anxiety in other situations outside your normal bedtime routine.
For example, you could become nervous in public situations because of your RLS, such as worrying about seeming “professional” in an important meeting or being concerned about sitting on public transport for extended periods.
RLS could also cause somebody to experience depression if their sleep is affected for a long time. It can be hard to explain restless legs syndrome, so some people may feel alone.
Most people with RLS experience it at night when they’re trying to sleep.
Sleep deprivation can affect you more than feeling a little tired. Over time, it can affect your memory and increase your likelihood of developing chronic illnesses.
Slower reaction times could also mean you’re less safe while driving or out and about.
Not only do your restless legs at night make it difficult to get to sleep, but they can impact your sleep quality once you’ve drifted off.
One study found that, once patients were asleep, they slept 13% less efficiently. People without RLS achieved a mean sleep efficiency score of 86.6%, while those with RLS had 73.2%.³
People with RLS also woke up more, with an average of 12 times per night.³
Just like anxiety, insomnia can affect your work and social life and leave you feeling unlike yourself.
We’re also less healthy with a lack of sleep: our cognitive functioning, immune system, heart health, and hormone levels all suffer the effects.⁴
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Who’s likely to get restless legs syndrome?
Twitchy legs are fairly common: RLS affects 5-10% of adults and about 2-4% of children.5,6
Anyone can have it and it can develop at any age.
However, certain demographics are more at risk – for example, it’s more common in middle aged people.
Young men and women are equally likely to experience restless leg syndrome.
But the older women get, the more likely they are to develop it than men are. This statistic could be down to pregnancy, though, since you’re more likely to have RLS if you’re pregnant.
Restless legs syndrome causes
If you’re pregnant, there’s a 1 in 5 chance you’ll experience restless leg syndrome in the last 3 months of your pregnancy.¹ We don’t always know why this is, though sometimes it’s down to iron deficiency anaemia.
The amount of blood in your body increases when you’re pregnant, so you need extra red blood cells. And that requires more iron…
As a result, many people become iron deficient when they’re expecting a baby. Speak to your GP about taking an iron supplement, as this may help to restore your energy levels and ease your nervous legs.
Restless legs syndrome in pregnancy usually goes away once you have your baby.
Even if you are not pregnant, general iron deficiency could be a cause of restless legs syndrome. Low iron levels can decrease your dopamine (the “feel-good hormone”). In turn, low dopamine can cause the muscle spasms that signify RLS.¹
Again, talk to your GP and they can decide whether an iron supplement is right for you. You might even find that your restless legs calm down.
Research has found links between genetics and idiopathic restless legs syndrome. If you’ve got an immediate family member with RLS, you’re also much more likely to experience tingly legs at night.⁷
While they may not directly cause it, chronic conditions like:
- Kidney disease (since you’re more likely to be anaemic and/or iron deficient)⁸
- Diabetes (if you have damage to your nerves)⁹
- Rheumatoid arthritis (RA): present in up to 30% of people with RA¹¹
all increase your likelihood of RLS.
What’s the difference between RLS & PLMD?
As mentioned earlier, RLS could also occur alongside a similar condition - periodic limb movements disorder (PLMD). PLMD refers to periodic, repetitive movements of the legs and feet during sleep.
PLMD symptoms include muscle twitches, jerking movements, cramping, or twitching of the lower limbs.
This differs from RLS as PLMD provokes more rhythmic and repetitive movements, whereas RLS refers to an irresistible urge to move your legs.
With PLMD, the individual also may not know they have the sleep disorder – their limbs move without their control, so they may wake up feeling fatigued not understand why.
Restless legs syndrome treatment
You might have seen a whole range of tricks and home remedies to provide instant relief for restless legs, such as massaging your legs, taking a hot bath, or going for a walk.
But unfortunately, it seems that these home remedies work for some and not others.
Depending on whether you have primary or secondary RLS, your GP may advise one or more of the following:
- Lifestyle changes
Hygiene isn’t all about soap and water - who knew? The behaviours we practise to help us sleep well are called “sleep hygiene".
Everyone needs a different amount of sleep, but most adults will need anywhere from 7 to 9 hours a night.¹²
Practising healthy sleep habits can help you get a better night’s sleep overall and may reduce some of the stress that’s contributing to your restless legs syndrome.
- Find out how much sleep you should be getting for your age and stick to it!
- Try to go to bed and wake up at the same time each day
- Do your best not to oversleep, even if you’re still tired
- Avoid coffee, energy drinks, and other forms of caffeine in the afternoon and evening
- Keep your bedroom cool and your bed comfortable. Invest in the right mattress and pillows for you, or try out some cosy sheets or a weighted blanket - make your space “yours”
- Keep the room as dark as possible while you’re trying to sleep
- And we’ve all heard it - but no more phone scrolling until you pass out! This includes if you wake up at night
Some people prefer to get up and stretch their restless legs while others prefer to stay in bed. Do what feels best for you.
Trying to kick smoking or stick to the gym? Your everyday habits could contribute to your restless legs. We advise:
- Quitting smoking: as well as affecting your general health, it’s believed that it can aggravate RLS symptoms¹³
- Cutting down on caffeine, and not drinking it at all in the 6 hours before going to bed¹⁴
- Exercising regularly - even a daily walk can make all the difference.
Low blood sugar can also be a trigger for RLS. Try to avoid high-carbohydrate and high-sugar snacks before bed, and opt for something high in protein (like nuts, yoghurt, a protein shake, or certain cereals) to curb your sweet tooth and help keep your sugar levels stable.¹⁵
Treating an underlying health condition
It’s always ideal to practice the healthy habits above. But your restless legs might be down to other health conditions.
Iron deficiency anaemia is a common restless legs cause, but luckily, it’s fairly easy to treat. Your GP may prescribe you iron supplements to help with your iron deficiency.
In this case, your anaemia should start to go away and your restless legs may ease.
Some people may receive enough iron through supplements or their diet, but they might have a condition which means their body can’t use it properly.
In severe cases, your GP may prescribe you medication to help your body absorb iron (instead of, or on top of, iron supplements).
Dopamine agonists are a type of medication that can increase your dopamine levels. Low dopamine is thought to be a cause of RLS, so these may help with your restless legs.
However, discuss this thoroughly with your GP before taking any prescribed medicines. Some people find that dopamine agonists make them nauseous or very tired throughout the day.
There’s early research to suggest that magnesium deficiency is another reason we might develop RLS.¹⁶
Magnesium helps us maintain strong bones and muscles, a healthy heart, and it can help to regulate our stress levels.¹⁷ ¹⁸ ¹⁹
First, make sure you’re getting enough magnesium in your diet. You can find it in:
- Legumes (like edamame and black beans)
- Nuts and seeds
- Whole grains
- Fortified cereals
- Green leafy veg
- Milk and yoghurt
It’s important to focus on diet for most of your nutrition, but if you think you need some extra help, magnesium supplements can supply your daily recommendation.
You can also try home remedies for RLS using magnesium. Magnesium bath flakes, bath salts, gels, and magnesium oil spray could all help relieve your symptoms.
Regular bar soap also contains plenty of magnesium. We can’t prove or disprove this one, but some people swear by placing a bar of soap under the pillow for when their legs are feeling restless at night…²⁰
You might get some relief by:
- Massaging your legs
- Applying a warm compress
- Taking a warm bath
- Light walking, stretching, or yoga
RLS isn’t just annoying - it can be painful, too. If you’re experiencing restless leg pain, your usual painkillers should help to relieve them a little.
Please note that this isn’t a long-term solution, as you shouldn’t take painkillers often or for long periods. If you’re experiencing painful restless legs often, please speak to your GP instead.
It’s also important to note that if you are experiencing leg pain at night rather than the itching, restless feeling, this could be a symptom of an entirely different health condition, such as peripheral artery disease (PAD) or Chronic venous insufficiency (CVI). If you have any concerns about leg pain at night, please speak to your GP.
The final say
- Restless legs syndrome (RLS) is the uncontrollable and/or uncomfortable need to move your legs
- It most often happens when you’re in bed at night or sitting still for long periods
- You might experience pain, tingling, discomfort, or hot feet and restless legs at night
- RLS affects about 5-10% of the adult population - though you’re more susceptible the older you get, or if you’re pregnant
- It’s classified as a sleep disorder and can affect other areas of your life, like your mental health
- The cause of your RLS could be due to your lifestyle or another health condition you have
- Cutting down caffeine, practising good “sleep hygiene”, quitting smoking, and exercising regularly can all help with the triggers of RLS
- Your RLS may also benefit from magnesium or iron supplements if you’re deficient
- RLS treatment is usually a combination of lifestyle changes and medication or supplements, but you should always speak to your GP first
The advice in this article is for information only and should not replace medical care. Please check with your GP or healthcare professional before trying any supplements, treatments or remedies. Food supplements must not be used as a substitute for a varied and balanced diet and a healthy lifestyle.
Last updated: 17 January 2023