Restless legs syndrome: why your legs won't let you rest at night
You are almost asleep. And suddenly — an unpleasant itching, tingling or pulling sensation in your legs. You change position. It eases for a moment. And then again. Hour after hour, night after night. If this sounds familiar — you are not alone. And this is not just "tired legs" or nervousness. It is a medical condition with a name, causes and solutions.
What is restless legs syndrome
Restless legs syndrome (RLS), medically known as Willis-Ekbom disease, is a neurological disorder characterised by an irresistible urge to move the legs — often accompanied by unpleasant sensations: tingling, itching, pulling, burning or something resembling "insects crawling under the skin".
These sensations occur at rest — when sitting or lying down, worsen in the evening and at night, temporarily subside with movement or leg massage and return when movement stops.
The last point is the most important diagnostic feature — relief with movement is what distinguishes RLS from other leg problems.
How many people suffer from RLS
RLS is significantly more common than most people think. Studies show that around 5–15% of the adult population is affected. Women suffer more often than men — approximately twice as often. The condition can occur at any age but is most commonly diagnosed in middle-aged and older individuals.
Important to know: many people have a mild form of RLS and never seek medical help, assuming it is normal. However, moderate to severe RLS can dramatically worsen sleep quality and overall quality of life.
Causes of RLS
Primary form
Around 40–60% of RLS cases are the so-called primary or idiopathic form — meaning there is no clear medical cause. In this group, genetics plays an important role: if one parent had RLS, the probability of inheriting it is around 50%.
Secondary form — other conditions
The remainder of RLS cases are associated with other medical conditions.
Iron deficiency is the most documented and most common cause among secondary forms. Even when haemoglobin levels are normal, low ferritin levels can cause RLS symptoms. Dopamine — a neurotransmitter that regulates movement — requires iron for its production, and its deficiency directly affects motor control at night.
Pregnancy, particularly the third trimester, is thought to be linked to iron and folic acid deficiency as well as hormonal changes. Symptoms usually resolve after delivery.
Chronic kidney failure makes RLS very common in patients undergoing dialysis.
Peripheral neuropathy and nerve damage due to diabetes or other causes may also underlie the condition.
Certain medications — antidepressants (particularly SSRIs and tricyclics), antihistamines, metoclopramide and antipsychotics — can trigger or worsen RLS.
How to recognise RLS
The RLS diagnosis is based on four main criteria confirmed in 2012 by the International Restless Legs Syndrome Study Group.
The first criterion is an irresistible urge to move the legs, usually accompanied by unpleasant sensations. The sensations can be very varied — tingling, itching, pulling, burning, pain, "electric shock" feeling, "insects under the skin". Important: there does not always have to be pain, and there are not always clearly defined sensations — sometimes it is simply an irresistible urge to move.
The second criterion is that symptoms appear or worsen at rest — when sitting or lying down.
The third criterion is that symptoms temporarily disappear or diminish with movement — walking, stretching the muscles, massaging the legs.
The fourth criterion is that symptoms are more pronounced in the evening and at night than during the day.
If all four criteria match — this is a strong sign of RLS that should be discussed with a doctor.
RLS and sleep — a connection that changes everything
RLS is one of the most common causes of chronic insomnia, which is rarely spoken about. And that is understandable — when the legs won't rest at night, falling asleep simply becomes impossible.
But RLS affects sleep not only through difficulty falling asleep. Many RLS patients also have periodic limb movements during sleep — uncontrolled leg jerks every 20–40 seconds during the deep sleep phase. The person often does not know their legs are jerking, but these movements cause micro-arousals that fragment sleep.
The result: one wakes up in the morning unrefreshed, feels tired during the day, struggles to concentrate, and over time chronic sleep deprivation can develop with all its health consequences.
What helps — treatment and self-help
Medical solutions
Iron supplements can, if ferritin levels are low — typically recommended to be above 75 µg/l in the RLS context — significantly reduce or completely eliminate symptoms. This is the first step that many neurologists recommend.
Dopaminergic medications — pramipexole, ropinirole and rotigotine — are approved for RLS treatment. They act on the dopamine system and effectively reduce symptoms. However, they have side effects and long-term use problems — particularly the so-called "augmentation" phenomenon where symptoms worsen over time.
Alpha-2-delta ligands — gabapentin and pregabalin — are increasingly used as first-line treatment, especially when RLS is accompanied by pain or sleep disturbance.
Opioids are used in severe cases when other methods do not work.
Non-medical methods
Regular moderate-intensity physical activity is one of the best-documented non-medical treatment methods for RLS. Important: excessively intense exercise can worsen symptoms, so balance is recommended.
Alternating cold and warm compresses — many people find it helpful to massage their legs with cold water or use a combination of warm and cold before bed.
Sleep hygiene with a regular sleep schedule, dark and cool bedroom environment and breathable bedding. Since RLS symptoms worsen when temperature rises, cool, breathable bedding can reduce discomfort. Savashome percale, linen or Tencel bedding helps maintain optimal body temperature during the night — particularly important for people with RLS, for whom even slight overheating amplifies the unpleasant sensations.
Avoiding caffeine, alcohol and nicotine is important as all three are known factors that provoke RLS symptoms, particularly in the evening.
Mental stimulation is interestingly effective: mental activity — games, puzzles, conversation — can temporarily reduce RLS symptoms. This explains why many people feel relief when watching television or reading — but this is not a solution, only temporary relief.
RLS in children
RLS can occur in children too — and is often misdiagnosed as "growing pains" or behavioural problems. Children with RLS often cannot lie still, complain of unpleasant leg sensations and have significant sleep problems.
If your child regularly complains of leg discomfort at night and cannot sleep peacefully — it is worth consulting a doctor and mentioning the possibility that it might be RLS.
When to see a doctor
See a doctor if symptoms occur more than twice a week, RLS disturbs sleep so much that you feel exhausted during the day, symptoms worsen, symptoms occur in a child or you have started new medications and symptoms have appeared or worsened.
The doctor may recommend blood tests — ferritin, haemoglobin, vitamin B12, glucose — and may also refer to a neurologist or sleep specialist.
In summary
Restless legs syndrome is not an imaginary condition or a sign of nervousness. It is a real neurological disorder with clear causes, criteria and treatment options. Millions of people worldwide suffer from this condition at night — and many of them do not know that a solution exists.
If your legs won't let you rest at night — it is worth discussing with a doctor. It may turn out that the solution is simpler than you think: sometimes iron supplements, changes to the sleep environment or a few lifestyle adjustments are enough to make nights peaceful again.