What restless legs syndrome is
It is a sleep-related neurological movement disorder. It is characterised by a compelling urge to move the legs, almost always accompanied by unpleasant sensations described as tingling, pins and needles, tension, heat or a deep discomfort that is hard to name.
It follows a very characteristic pattern: it appears or worsens at rest, eases with movement and gets worse in the evening and at night. Precisely because it worsens at bedtime, it is a frequent cause of sleep-onset insomnia.
Many people live with this for years without knowing it has a name and a treatment — being told it is "nerves" or "poor circulation".
How it shows up
- An irresistible urge to move the legs, sometimes also the arms
- Unpleasant sensations inside the legs, not on the skin
- Appears or worsens at rest — sitting in the evening, at the cinema, on a flight
- Eases while walking, stretching or massaging the legs
- Worse at night than in the morning
- Difficulty falling asleep and fragmented sleep
- Daytime fatigue, irritability and difficulty concentrating
- Periodic leg movements during sleep, noticed by the bed partner
Causes and risk factors
There is a primary form, often with a family history, related to dopamine function and brain iron metabolism. And there are secondary forms, associated with treatable conditions — hence the importance of investigating.
- Iron deficiency, even without anaemia (low ferritin)
- Family history of restless legs
- Pregnancy, especially in the third trimester
- Chronic kidney disease
- Peripheral neuropathy and diabetes
- Some antidepressants, antipsychotics and antihistamines
- Caffeine, alcohol and nicotine
- Sleep deprivation, which worsens symptoms
How it is diagnosed
Diagnosis is clinical: it rests on the history and on that typical symptom pattern. There is no single test that makes the diagnosis.
We usually request blood tests to assess iron — ferritin and transferrin saturation — and to rule out secondary causes such as kidney disease or thyroid problems. We also review all medication, because some common drugs significantly worsen symptoms.
A sleep study can be useful when periodic limb movements during sleep or another associated disorder are suspected.
Treatment options
Correcting iron
If ferritin is low, supervised iron supplementation can improve or resolve symptoms. It is one of the interventions with the best ratio of simplicity to result — but it must always be guided and monitored.
Reviewing medication
Some antidepressants and antihistamines clearly worsen the syndrome. It is often possible to switch to alternatives with the same therapeutic effect and without this side effect.
Behavioural measures
Regular schedules, moderate exercise, cutting caffeine, alcohol and nicotine, stretching and warm baths in the evening. In mild forms these may be enough.
Pharmacological treatment
In moderate to severe forms there are effective drugs, chosen case by case and with regular follow-up. Drug choice and dose adjustment are clinical decisions that require monitoring.
When to seek help
If these sensations appear several times a week, or stop you falling asleep or sitting quietly in the evening, seek an assessment. It is a treatable condition and frequently misidentified.
Frequently asked questions
No. Although it is often mistaken for poor circulation or cramps, restless legs syndrome is neurological in origin. It is distinguished by the pattern: relief with movement and worsening in the evening.
In most cases symptoms improve significantly after delivery. During pregnancy, assessing iron levels is particularly important, and treatment should always be discussed with the team following you.
Educational information reviewed by our clinical team. It does not replace an individual medical consultation.