Restless Legs Syndrome: How to Stop It and What Causes It

What is restless legs syndrome?

Restless legs syndrome (RLS) is a neurological condition that causes an urge to move your legs, usually with uncomfortable sensations people describe as crawling, tingling, pulling or aching deep in the legs. Doctors diagnose it when all of the following are true:¹

• You have an urge to move your legs, usually with uncomfortable sensations
• It starts or gets worse when you are resting, sitting or lying down
• Moving, walking or stretching eases it, at least while you keep moving
• It is worse in the evening or at night than during the day
• It isn’t explained by something else, such as leg cramps, arthritis or habitual foot tapping

There is no blood test or scan for RLS. The diagnosis is made from this pattern.

How common is it?

In a survey of more than 15,000 adults, 7 per cent had RLS symptoms in the past year, and almost 3 per cent had symptoms at least twice a week that were moderately or severely distressing. Most of that group had mentioned it to a doctor, and very few had been given the diagnosis.²

How to stop restless legs immediately

These give short-term relief during an episode:^7,8,9

• Get up and walk around
• Stretch your calves and thighs
• Massage your legs
• Try a warm bath, or a heat pack or cool pack, whichever feels better
• Do something that occupies your mind, such as a puzzle or a conversation. Symptoms are often worse when you are bored and still

What causes restless legs?

• Low iron. The most important treatable cause. Iron stores in the brain can be low even when a standard blood count is normal⁴
• Family history. RLS that starts before middle age often runs in families
• Pregnancy. RLS is common in pregnancy, especially in the last three months, and usually settles after the birth⁶
• Kidney disease and nerve damage in the legs
• Some medicines, including certain medicines for allergies, nausea and mood. Alcohol, caffeine and untreated sleep apnoea can also make RLS worse³

Get your iron checked

Current guidelines recommend iron studies for everyone with significant RLS, ideally from a morning blood sample. Iron treatment is recommended at levels that would otherwise be considered normal: an international expert group advises treating when ferritin is 75 micrograms per litre or lower.^3,4

Don’t take iron without a test. Too much is harmful, and low iron needs a cause found.

Restless legs treatment

• Iron, as tablets or sometimes as an infusion, when levels are low⁴
• Reviewing triggers. Cutting back alcohol and caffeine, and checking whether a regular medicine could be contributing³
• Exercise. In a small randomised trial, 12 weeks of lower-body strength training and treadmill walking three times a week significantly improved symptoms⁵
• Good sleep habits. Being overtired makes RLS worse. See sleep hygiene
• Prescription medicines for people whose symptoms are frequent and still disruptive³

What changed in 2025

For many years, the first medicines prescribed for RLS were ones that act on dopamine. They work well at first. Over time, many people develop augmentation, where symptoms start earlier in the day, become more intense and spread to the arms.

Because of this, the American Academy of Sleep Medicine’s 2025 guideline no longer recommends those medicines as standard treatment, and gives stronger support to iron and to a different group of medicines.³ If you have taken an RLS medicine for years and your symptoms are getting worse, ask your doctor for a review. Don’t stop a medicine suddenly.

Restless legs or leg cramps?

RLS is an urge to move, relieved by moving. A cramp is a sudden, painful tightening of a muscle that you can feel as a hard knot. See leg cramps at night.

When to see a doctor

• Symptoms are disturbing your sleep or happening most evenings
• You are tired or sleepy during the day
• You are pregnant, or have heavy periods, and have restless legs
• Symptoms have changed or worsened on treatment

References

1. Allen RP, Picchietti DL, Garcia-Borreguero D, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria--history, rationale, description, and significance. Sleep Med. 2014;15(8):860-73.
2. Allen RP, Walters AS, Montplaisir J, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165(11):1286-92.
3. Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025;21(1):137-152.
4. Allen RP, Picchietti DL, Auerbach M, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Med. 2018;41:27-44.
5. Aukerman MM, Aukerman D, Bayard M, et al. Exercise and restless legs syndrome: a randomized controlled trial. J Am Board Fam Med. 2006;19(5):487-93.
6. Picchietti DL, Hensley JG, Bainbridge JL, et al. Consensus clinical practice guidelines for the diagnosis and treatment of restless legs syndrome/Willis-Ekbom disease during pregnancy and lactation. Sleep Med Rev. 2015;22:64-77.
7. healthdirect. Restless legs syndrome.
8. Sleep Health Foundation. Restless legs syndrome.
9. Better Health Channel (Victorian Government). Restless legs syndrome (RLS).