Restless legs

‘Restless legs’ is a very unpleasant feeling in the legs that is difficult to describe. You feel you must move them to get rid of the sensation. It is not pins-and-needles, but is more like a crawling, prickling and tingling irritation just under the skin (Sleep Medicine 2003;4:101–9).

Restless legs usually comes on when you have been sitting or lying still for a while, especially in bed just as you are getting off to sleep or when you wake in the night. It may also come on when you have to sit in a confined space, such as a cinema or plane.

It is very unusual to have it in one leg – usually both legs are affected, mainly the calves, but sometimes the thighs or feet. Some people also have it in their arms.

The only way to get rid of the feeling is to move your legs or get up and walk, which can be awkward if you are sitting at a public function, and annoying for your partner when you are in bed. If you try to keep still, the feeling becomes stronger and stronger, and more like a painful ache until you simply have to move.

Some people with restless legs also have repeated, jumping movements of their legs while they are asleep, which may wake them or their partner. Each of these movements may last several seconds.

Causes of restless legs

No one knows what causes restless legs, but researchers think it is probably due to a lack of availability of dopamine (a chemical transmitter) in a small area of the brain or spinal cord, rather than a problem in the legs themselves.

In about 40% of sufferers, the tendency to restless legs is inherited.
In a few people (usually elderly), it is due to a shortage of iron.
Some people have restless legs only when they are pregnant or find that pregnancy worsens it.
Sometimes a similar feeling occurs in people who have illnesses that affect small nerves in the skin (such as diabetes or rheumatoid arthritis).
Stress, fatigue, smoking, caffeine and alcohol can all make it worse.
Some medications can cause or worsen restless legs. If you are taking any of these medications, don't stop them, but talk to your doctor.

Medications that can make restless legs worse

(Information from Prescriber 2008;19(3):56–9)

Calcium channel blockers (for hypertension)
Some anti-nausea medications
Phenytoin (for epilepsy)
Some antihistamines (for allergies)
Some antidepressants
Some tranquillizers

What you can do

Stop smoking. Restless legs is another good reason for stopping smoking.

Consider reducing coffee, tea, alcohol. You may have to do some detective work to decide if these causes apply in your case. The caffeine in coffee and strong tea makes restless legs more likely, as well as interfering with sleep. Try cutting them out and see if the problem improves. Likewise, try to work out if alcohol might be a factor in your case.

Deal with stress. This is easier said than done but, if you have noticed that the problem is worse when you are tense, consult your public library for books or tapes on relaxation.

Distract yourself. Some people find that undertaking an interesting discussion or activity when sitting can help.

Do not nap during the day. This can make it more difficult to sleep at night.

Cool your legs. Some people find that cooling the legs helps to prevent attacks, or relieves the sensation. Make sure your bedroom is cool and airy. Try putting your feet in cold water for 5 minutes before going to bed, and avoid using a hot water bottle or electric blanket in the winter. During an attack, remove the bedclothes from your feet and legs to allow them to cool down.

Massaging the legs with a mint or herbal leg cream or gel can give some relief.

Try a painkiller. Some people find that a painkiller such as paracetamol (acetaminophen) or ibuprofen gets rid of the unpleasant feeling.

What your doctor can do

Check your iron stores. Your doctor can do a blood test to check your iron stores. If these are low, an iron supplement might help.

Check the medication you are taking. Your doctor can review any medication that you are taking, as some medications can worsen or cause restless legs.

Look for other causes. Your doctor can also decide whether you have ordinary restless legs, or whether it is due to some condition such as rheumatoid arthritis.

Discuss treatment. Some prescription drugs can help restless legs, but they all have some side effects. You will need to decide whether the discomfort in your legs and disturbance of your sleep is bad enough to warrant them.

If you are pregnant, or trying to become pregnant, you will just have to put up with the problem until after the pregnancy – you should not take any of the drugs used to treat restless legs. The problem will probably disappear within a few weeks after the birth of your baby.

Dopamine drugs are very important treatments for restless legs. They compensate for the lack of availability of dopamine in specific areas of the brain, and are about 90% effective (Journal of Postgraduate Medicine 2010;56:157–62).

One strange side effect of these dopamine drugs has been reported – a gambling compulsion (Neurology 2007;68:301–3). So if this happens to you while you are taking any of these drugs, tell your doctor.

Ropinirole (Ardartrel) is a dopamine drug that seems to be very effective for restless legs with minimal side effects, though headache, nausea and dizziness occasionally occur. It is taken as a single dose in the evening.
Pramipexole (Mirapexin) is another dopamine drug that is effective for restless legs. It also seems to be an effective drug. It can cause drowsiness in the day, and also nausea and headache.
Rotigotine is a newer dopamine drug that is applied as a patch. It is important to follow the instructions exactly about applying the patch. It is suitable for people with moderate-to-severe restless legs. It can cause drowsiness.
Pergolide is another dopamine drug. Researchers in America tested it in patients with restless legs and found that it was effective in relieving the problem. At present pergolide has been tried in only a small number of people with restless legs. Side effects include nausea, constipation and low blood pressure, so it is started at a low dose. There have been worries that, in rare cases, it could damage the valves of the heart.
Levodopa with carbidopa (the drugs are combined in one tablet) is a dopamine drug for Parkinson’s disease that has been used for severe cases of restless legs. The major drawback is that the symptoms initially improve, but tend to come back after a few months and are even worse than before. This occurs in about 80% of people. For this reason it is not used much.

Tranquillizers. Some tranquillizers can worsen restless legs, but clonazepam is a tranquillizer that has been used for many years as a reliever for restless legs. It can help if the problem is not too severe, but you may find you are drowsy in the day. If you are elderly, it is not a good choice, because you might become confused or have a fall.

Anti-epilepsy drugs, such as carbamazepine or gabapentin, are sometimes used to treat restless legs.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Wednesday, October 5th 2011

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Comments on this article

Posted by Optional on 11/05/2012 at 08:50

I wouldn't wish rls on my worst enemy(well,maybe):).But what I've always wondered is......are there any DOCTORS out there that have it? Seems to me the cause might be investigated more throughly if more doctors inherited it! And the info about being connected to spinal....alot of times it has seemed mine is connected to my lower back. Not most of the time, but occasionally. So that really interests me. The dopamine drugs made my legs feel very heavy and uncomfortable. The only thing working for me is Tramodol. I've had RLS since I was 19 and pregnant and the OB told me I was crazy and had me crying. I never told a soul about it until a story in Readers Digest appeared in the 1980's. You all can't know what a relief it was to know there were others out there like me. Thanks for letting me comment. I usually am more reserved and just read these things. Wendy

Posted by Jud on 25/04/2012 at 02:06

I have been dealing this restless legs for long time. Specially during pregnancy and after delivery makes it worse. Sometimes i don't want to be alive anymore because of this stupid restless legs. It seems like if i cut my leg lots of crawly germs will be moving around. Please please help me help me

Posted by david d. on 13/03/2012 at 06:21

RLS symptoms alleviated by performing the hurdlers' stretch and holding the stretch position for one entire minute, then stretch opposite side. Just touch wall for balance, DO NOT PUSH AGAINST WALL. Hurdlers' stretch: legs spread out, one foot forward with bent knee, back foot straight, both feet point forward. For balance merely touch a wall or stationary object. Shift weight to front (bent) leg, hold position and feel stretch in back of thigh & calves for 1+ minutes/side. My RLS brought on by sitting in a slouching position, particularly at low back area.

Posted by mario on 04/02/2012 at 04:25

try wearing light suport pantyhose like leggs sheer energy. works for me and i think it's worth a try.

Posted by Optional on 15/01/2012 at 06:20

have just developed RLS sice quititng smoking - so not necessarily the cure to it unfortunately! I have had it a little bit for a long time, but not enough for it to bother me and then as soon as I stopped smoking, BAM, twitchy legs, every night! It is causing depression and irritability and lots of other horrid symptoms that are making me worse. I have been told to try magnesium suppliments but the first lot I got were magnesium oxide which is not apparently 'bio-available', meaning the body does not absorb it well. today I bought magnesium phosphate, which is supposed to be easier for the body to absorb and I got some dead sea salts (but epsom salt is supposed to be better and I have some on order) to bathe in, skin absorbtion is supposedly the best way for the body to take magnesium in so will try that tonight and see what happens - here's hoping for a good nights sleep!

Posted by Optional on 19/11/2011 at 12:34

i do have a very very bad felling in my body,some times my body can jump.

Posted by Optional on 19/09/2011 at 01:28, United States

I was diagnosed with RLS when I had a sleep study done to see if I had sleep apnea. I have taken requip for many years it helps but I am tired all the time from the requip. I am very sensitive to medication. I quit taking it and was put on mirapex don't seem to help. My biggest problem is my legs (lower calves) hurt all the time if I get down on the floor I can't stand up without the help of furniture and sometimes it hurts sooo bad just trying to stand up from a setting position after I'm up for awhile the pain seems to go away but comes right back if I sit down in a chair or on the floor. Is the pain in my lower legs part of RLS or could it be something unrelated.

Posted by Optional on 11/09/2011 at 12:03, United Kingdom

driving me mad Iam so tired with being awake nights.

Posted by Chiara on 03/09/2011 at 09:35, United Kingdom

I'm nearly at the end of my 3rd pregnancy, and have been suffering from terrible insomnia and RLS at evening/night. After reading stuff you can do to help it, and stuff that causes it I learnt my iron levels were very low (as was in other two pregnancies) so after taking my tablets for two weeks and taking a couple of paracetemol each night it seems to have got better!

Posted by Sue on 07/08/2011 at 07:49, United Kingdom

I have suffered from RLS for many years, when will there be and answer to this problem as it is most debilitating as you loose so much sleep. I don't want to be taking paracetamol all the time, cold flannels on ankles and knees helps. (I am going to request a check on my iron levels with the doctor) Vitamin B complex is supposed to be the answer. Please, please can the medical profession find an answer !!

Posted by Optional on 22/06/2011 at 08:08, United States

why does it get worse after i eat lunch?

Posted by Optional on 06/03/2011 at 08:54, Canada

I find that if I take 4 Advil's at night when I get restless legs, after about an hour , I can finally sleep all night.

Posted by Louise on 05/03/2011 at 09:53, Canada

I have been afflicted with severe restless leg symptoms for about 35 years now. Just for context, each year, I might have 3 non sequential evenings per year where, for reasons unknown, I have no symptoms. In the past few years, the symptoms have gotten worse. I no longer suffer just evenings and nights, I am also woken up with them around 7 AM, and feel symptoms on and off throughout the day if I sit. I have never tried the medications (Requip etc..as the idea of lifelong medicating does not appeal to me.) 9 days ago, like usual, I was lying in bed twisting and bending my legs around trying to get momentary relief. For some reason, I ended up on my side in a tight fetal position. Strangely, I felt some immediate relief, so I held the position, thinking I would see how long it worked, (as you know, most movements give approximately 1 or 2 minutes of relief maximum). I really tightened up my knees to my chest and that stretched and curved the back also. I held the position for about 10 minutes and the symptoms stayed away, I was so happy with even that short relief, but got tired of keeping the position, so I relaxed and figured I would do it again after a few minutes. The miracle? When I relaxed, the relief continued, and incredibly, I fell asleep! It was only 11:45PM! I never fall asleep until the symptoms abate around 2 or 3 AM! Holding the position for approximately 2 minutes seems to give approximately 24 hours of relief! I have been doing it for 9 days, once each evening, and have eliminated the symptoms as soon as they reappear. I have no idea why this works, as it does not stretch or twist the lower leg area (the area affected for me). Please pass this information along to others to try. I am now telling anyone who will listen. I only wish I had discovered this while my father was alive. He also suffered so badly… I am so glad to have found long lasting relief. I am actually scared it might stop working in time, but for now, I CAN SLEEP!! I haven’t annoyed everyone walking around and doing deep knee bends all evening while trying to watch TV!

Posted by Shelley on 05/03/2011 at 12:21, United Kingdom

I'm having a promlem when I go to bed Its when I'm sleepy my feet Want to move when I try to stop them from moving. It's harder to stop them it's a really strange Feeling.

Posted by Kathleen on 06/02/2011 at 08:20, United Kingdom

I have RLS and Parkinson's but my lower legs and feet are often cold. There is a distinct pain with this, too. My doctors say it is not poor circulation. I take clonazepan as well as Parkinson drugs, which helps at night, particularly. Has anybody else these exact symptoms? Despite asking numerous other RLS sufferers and the health professionals I have found no one with exactly this problem. Would be very grteful for any advice.

Posted by Optional on 30/01/2011 at 03:57, United Kingdom

i have had hip replacement surgery two weeks ago and have not had a full nights sleep since because of restless leg in the operated leg does anyone know what could cause this please

Posted by Christine on 26/01/2011 at 05:55, United Kingdom

I first experienced this in my fifties. I thought it was circulatory problems. I was on no meds, etc. Living a very healthy life...runner, cyclist, working out. Drives me nuts. Every night, while sitting and watching TV or on the computer, my lower legs will both get really cold as if they were in a cold river. Then the RLS feeling starts....I heat up two towels in the dryer and wrap each leg...It starts relieving this really quick. I have to keep on doing this, because as soon as the towels cool down my legs start to get cold again. STRANGE HUH...Right before I get into bed, I reheat the towels, wrap my legs and get into bed and it pretty much stops....If my legs are not warm when I get into bed, the RLS just kicks in and I have to get up. I have had this for 9 years now and I AM SICK OF IT. I am not iron deficient, don't use alcohol, no caffeine, etc. I have no clue where this came from. No one else in the family is afflicted. I wish I could find Battery HEATED LEG WARMERS...Best wishes to all my FELLOW SUFFERERS....I am sorry for you....

Posted by Optional on 19/01/2011 at 08:03, United States

Why would my restless legs sydrome keep getting progressivley worse. I am on the medication and it is back and escalating.

Posted by Optional on 06/01/2011 at 01:58, United Kingdom

Its actually a good time of year for you twitchy legged folks I suffered for Years! with RLS tried all maner of lotions potions, eatting this not eatting that, raising,lowerin exercising, resting. Then, low and behold GONE!! How i hear you scream. Simple new years resolution, after 27 years I "Stopped Smoking" So if you are a smoker, my recomendation to you is visit your chemist start a program of nicotine patches and prepare to rest those legs lol HAPPY NEW YEAR X

Posted by Jane on 04/01/2011 at 12:04, United Kingdom

My husband has suffered from RLS for 6months now Dr said he is low in iron he is taking a course of iron tablets but has not made any diffrence He only moves about in his sleep sometimes just his legs but other times his whole body twitches I't driving me mad keeps me awake for hrs at a time I'm the tired one the next day not him Taking sleeping tablets myself for back pain but still he keeps me awake Pray the drs come up with something soon or it may be seperate bedrooms after a loving marriage of 45yrs also I worry that it's not just RLS and there is something worse that is happening to his body PS he also snores badly

Posted by Optional on 27/12/2010 at 11:37, Australia

I have had cold feet and legs for a year or so and now my legs at night hurt and very irritable in bed and sitting now. The best thing I found was pantyhose that helped keep me warm. Would wear them to bed also and now that at night time is getting worse I tried tights and I sleep alot better.

Posted by Optional on 25/12/2010 at 06:35, United States

alcohol definately makes my resless legs worse. i cannot sleep too much during the night when i have a few drinks. it is christmas morning about 1:30 and i have been up since 12 am. tossing and turning, now trying to sit up and write on computer. i took my medication and tonite it is not doing any good. very miserable.

Posted by Optional on 30/11/2010 at 09:16, United Kingdom

I have had restless legs since my teens but has got worse over the years. Losing weight help but since I've become inactive because of a back problem I've put on weight and the problem came back with avengence. I have Tramadol for my back which helps but I'm coming off it as it is such an adictive medication. I've come in to work following a night of just 45 minutes sleep and am exhausted. Has anybody tried magnetic therapy treatments? Keep posting suggestions as I will try anything.

Posted by Optional on 29/11/2010 at 02:43, United States

I had a seven hour surgery. When I came out of the anesthesia, I noticed something wrong with my legs. I wasn't able to fall asleep until around 4:00 a.m., when it would just ease away. I was only getting three hours of sleep a night for several weeks and was finally diagnosed with RLS. I have had restless legs severely since, more than 10 years. I took Mirapex until it quit working. I have taken Requip for several years now, and the side effects I have are nausea, sweating, fatigue, pain in my feet, short term memory loss, and confusion. I don't have any other alternative, because I have to be able to sleep. I am unable to take a nap during the day,, but can sleep at night. I have to take the Requip two to three hours before bed so that I can sleep when I go to bed. But there are times it doesn't work well, and I am awake until 1 or 2. I wish there was a cure.

Posted by Bob on 27/11/2010 at 08:32, United Kingdom

Had this for years. Pressure on thighs on seats meant to support thighs usually starts it off - like plane seats. Lying in recovery Position on a hard surface helps to alleviate symtoms. I find that the condition is brought on more quickly after a stodgy meal, when, presumably stomach acids are working hardest. Eating small light meals seems to keep condition at bay. I am type 2 diabetic, with low thyroid but in good physical shape. standing up and cooling feet and stretching leg muscles usually works through the night - now about twice or thrice nightly when I waken.

Posted by Optional on 13/11/2010 at 01:47, Canada

Every day and night my legs get so restlee.! I get a rash on my left leg and burns a lot!!My feet get cold very easily,and numbness and a lot of tingling

Posted by Optional on 05/11/2010 at 02:30, United Kingdom

I'm so glad that I am not alone as I was beginning to think that people thought I was mad. Reading what people do I will try a few of these things to see if it helps me !!!!

Posted by Optional on 05/11/2010 at 01:10, Canada

I go through restless legs and hot feet almost every night as well,I might get one day off a week once in a while and it's like what I imagine winning the lottery feels like, lol. I've found relief from massaging my lower spine right at the base where all the nerves are. Usually I massage quite firmly. I can feel the nerves react all the way to my feet sometimes--it's an awesome feeling and it will put me to sleep. I had been doing this for years and then recently read restless legs may be associated with a nerve thing in the lower spine...also I stick my feet out of the bedcovers and massage one foot with the other or massage my calfs,that feels great too but all this self-massage is a lot of work and I'm totally going to try the granny's dove soap, the surgical socks, yoga,magnesium and get a blood test for iron deficiency. I'd rather not resort to drugs but I'll try damn near anything that will get me a good night's sleep. Glad to know I'm not alone. Peace.

Posted by Optional on 03/11/2010 at 12:46, United States

I have had Restless Leg Syndrome my whole life. My mother, aunt, and maternal grandmother all have the same problem. I know this is going to sound completely weird and far-fetched, but this is what my grandmother does to ward off RLS, and I have tried it and it has worked, at least for me. She puts a bar of soap between the fitted sheets and the mattress down around her legs. That's it, although she swears only Dove soap will work. I know it sounds completely out there, and it may all be in our heads, but it seems to help. *shrug* If it helps someone else, cool. If not, it's an interesting read.

Posted by Optional on 20/10/2010 at 04:18, United States

I have this problem in my feet, and I go through the irritation every single night. I wake up repeatedly atleast 4 or 5 times a night because my feet feel like they've caught on fire, or need to move to relieve this itching pressure on them. It gets so bad that I have to go get a bag of ice to put on my feet, because of the friction when I rub them together to stop the tingly, itchy pressure. I haven't went to a doctor, or tried to take iron supplements, although I do take a trace mineral solution once in a while. I never bothered researching this before, until I was on this site looking at another problem. I hope this goes away eventually.

Posted by Optional on 17/10/2010 at 11:14, United Kingdom

simply no improvement despite trying ropinerole at present on pramipexole worked at beginning but now less so