Restless Legs Syndrome at Night: How to Get Relief

What exactly is restless legs syndrome?

RLS (also called Willis-Ekbom disease) is a neurological sensorimotor condition defined by four core features 1Ref 1Allen RP, Picchietti DL, Garcia-Borreguero D, et al. (2014).Restless Legs Syndrome/Willis-Ekbom Disease Diagnostic Criteria: Updated International Restless Legs Syndrome Study Group (IRLSSG) Consensus Criteria.The four diagnostic criteria for RLS (urge to move, worsened by rest, relieved by movement, worse at night) used in the article:

1. An urge to move the legs, usually accompanied by uncomfortable sensations 2. The urge starts or worsens during rest or inactivity 3. The urge is partially or fully relieved by movement 4. The urge is worse in the evening or at night than during the day

The sensations are typically in the legs, but can extend to the arms. People describe them as crawling, creeping, pulling, aching, itching, or electric — rarely painful in the way a cramp is, but intensely uncomfortable and disruptive to sleep. RLS is distinguished from leg cramps by the absence of true muscle cramping and the fact that movement (rather than stretching the cramped muscle) brings relief.

RLS affects roughly 5–10% of adults in Western populations, is more common in women and with increasing age, and has a strong genetic component. Many people with RLS also have periodic limb movements during sleep (PLMS) — repetitive leg twitches that may or may not disturb sleep.

What can I do right now to stop restless legs at night?

Several approaches provide temporary relief in the moment:

• Walk or move: Even a brief walk around the room can quiet the urge for a period. Many people with RLS spend time walking at night for this reason.
• Leg stretches and massage: Calf stretches, thigh stretches, and vigorous leg massage can reduce the sensation temporarily.
• Temperature changes: Some people find relief with a cool shower or cool pack on the legs; others prefer warmth. Trial and error helps identify which works for you.
• Distraction: Engaging activities — a conversation, a puzzle, a hand-held game — can reduce the severity of mild symptoms, though this works less well as symptoms intensify.
• Avoid triggering positions: Sitting with legs still for long periods (on flights, in theaters) commonly provokes symptoms; standing or walking periodically helps.

In terms of substances to avoid in the evenings: - Caffeine after mid-afternoon may worsen RLS in some people - Alcohol can initially seem calming but disrupts sleep architecture and often worsens RLS later in the night - Antihistamines (common in OTC sleep aids like diphenhydramine) and some antidepressants can significantly worsen RLS — review your medications with your clinician

What causes restless legs syndrome?

RLS can be primary (no identifiable cause, strong genetic basis) or secondary (caused by or worsened by an underlying condition or medication).

Secondary causes to look for include:

• Iron deficiency: Low serum ferritin is one of the most important and treatable contributors to RLS. Even if hemoglobin is normal, low iron stores in the brain can worsen RLS. A ferritin level is a standard part of RLS evaluation — if it is below a clinician-recommended threshold, iron supplementation can meaningfully reduce symptoms 2Ref 2Winkelman JW, Armstrong MJ, Allen RP, et al. (2016).Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Evidence-based treatment recommendations for RLS including iron supplementation and pharmacotherapy options; cautious prescribing of dopamine agonists3Ref 3Winkelman JW, Berkowski JA, DelRosso LM, et al. (2025).Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline.Current AASM clinical practice guideline for RLS and PLMD treatment, including iron therapy recommendations.
• Pregnancy: RLS commonly develops or worsens during pregnancy, particularly the third trimester. It usually resolves after delivery.
• Kidney disease: Chronic kidney disease, particularly in people on dialysis, is associated with high rates of RLS.
• Peripheral neuropathy
• Medications: Antidepressants (especially SSRIs and SNRIs), antipsychotics, antihistamines, and some anti-nausea drugs can trigger or worsen RLS. Do not stop any prescribed medication without speaking to your clinician, but do let them know about this connection.

A blood test panel from your clinician can identify iron deficiency and kidney dysfunction as contributors.

When should I see a doctor, and what treatments are available?

See a primary care clinician if: - RLS is happening several nights a week and disrupting your sleep - It is occurring during the day - Symptoms are worsening over time - Lifestyle measures are not enough

Your clinician should check iron levels (serum ferritin and iron saturation), kidney function, and review your medications.

Treating iron deficiency is a priority — oral iron supplements can improve RLS in people with low ferritin, and for some this alone is sufficient 2Ref 2Winkelman JW, Armstrong MJ, Allen RP, et al. (2016).Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Evidence-based treatment recommendations for RLS including iron supplementation and pharmacotherapy options; cautious prescribing of dopamine agonists3Ref 3Winkelman JW, Berkowski JA, DelRosso LM, et al. (2025).Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline.Current AASM clinical practice guideline for RLS and PLMD treatment, including iron therapy recommendations.

Prescription medications exist specifically for RLS, and the AAN guideline provides evidence-based recommendations for their use 2Ref 2Winkelman JW, Armstrong MJ, Allen RP, et al. (2016).Practice guideline summary: Treatment of restless legs syndrome in adults: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology.Evidence-based treatment recommendations for RLS including iron supplementation and pharmacotherapy options; cautious prescribing of dopamine agonists. Dopamine agonists were widely used but are now prescribed more cautiously because of a side effect called augmentation — where symptoms gradually worsen, occur earlier in the day, and spread to other body parts over time. Newer alternatives have a better long-term profile for many patients. Any medication decision should be individualized with your clinician or a neurologist.

For people with significant sleep disruption, a referral to a sleep specialist or neurologist with RLS expertise may be helpful.