RLS Diagnosis and Treatment

Diagnosing restless legs syndrome (RLS)

Your health care provider will review your medical history and ask you about your symptoms. They will want to know what the symptoms feel like, how often you have them and anything that makes them better or worse.

They may also ask about your sleep habits, medical history, medications and any family history of RLS or other neurological disorders.

They may perform a physical exam to rule out other conditions that could cause your symptoms. That can include checking your neurological function and looking for signs of peripheral neuropathy and conditions such as iron deficiency or kidney disease.

Your provider may also see if you respond to medication that increases your dopamine levels and whether you have limb movements when you’re sleeping (periodic limb movement disorder).

Sometimes, your provider will order other tests to rule out other possible causes of your symptoms:

• Blood tests can check for iron deficiency, kidney function and other abnormalities.
• Sleep studies can evaluate your sleep patterns and detect other sleep disorders, such as sleep apnea or periodic limb movement disorder.
• Neurological testing such as nerve conduction studies or electromyography (EMG) can check for peripheral neuropathy or other neurological conditions.

Treating restless legs syndrome (RLS)

A combination of lifestyle changes, medication and alternative therapies may help reduce the symptoms of RLS. Your provider may recommend trying these steps first:

• Getting regular exercise, such as walking, jogging or swimming, to help your circulation and reduce stress. Avoid intense exercise close to bedtime, which could make symptoms worse.
• Keeping to a regular sleep schedule with set bedtimes and wake times.
• Writing down what makes symptoms better or worse in a sleep diary. You can share this information with your provider.
• Avoiding caffeine, nicotine and alcohol.
• Allowing yourself to move when you feel the urge. Trying to fight it can make symptoms worse.
• Practicing relaxation techniques such as deep breathing, progressive muscle relaxation and mindfulness meditation.
• Stress management techniques such as journaling, meditation or spending time with loved ones, in nature or on hobbies.
• Making sure your bedroom is comfortable, cool, dark and quiet. If you can, invest in a comfortable mattress and pillows and consider using white noise machines or earplugs to block out disturbances.
• Limiting exposure to electronic screens before bed since the light can disrupt your sleep.
• Relaxing before bedtime by reading, taking a warm bath or practicing relaxation techniques.
• Staying hydrated since dehydration can make your symptoms worse. 
• Taking regular breaks from sitting to stand up, stretch and move around.
• Distracting yourself from symptoms by listening to music, reading a book or doing puzzles. Keeping your mind occupied can help keep the symptoms milder and more manageable.

If those steps don’t bring relief, your provider may recommend medications such as: 

• Iron supplements or an iron infusion.
• Ropinirole (Requip), pramipexole (Mirapex ER) or rotigotine (Neupro), which increase dopamine levels in the brain.
• Alpha-2-Delta ligands, such as gabapentin (Neurontin, Gralise), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), which act on calcium channels in the brain.
• Benzodiazepines, such as clonazepam (Klonopin) and lorazepam (Ativan), which can help you sleep better.
• Opioids, in severe cases where other treatments don’t work. Opioids include codeine, oxycodone (Oxycontin, Roxicodone), hydrocodone (Hysingla ER) and tramadol (ConZip, Qdolo). But with opioids there’s a risk of dependence and tolerance, so they need to be used cautiously under close medical supervision.

Alternative and complementary therapies that may also help include:

• Gentle massage and myofascial release to help reduce muscle tension and promote relaxation
• Acupuncture
• Gentle stretching or yoga poses that target the legs and lower body
• Apply heat or cold packs to the legs
• Foot wraps designed for RLS
• Use a pad that vibrates on your legs

Connecting with support

Living with RLS can be stressful and frustrating, and it’s often a condition you’ll deal with for life. These strategies may help:

Connect with in-person or online support groups. Others who understand what you’re going through can give you emotional support, advice and a sense of community. You may also want to join online forums or discussion boards.

Ask your health care providers for reliable sources of information about RLS, such as websites, books and educational materials.

Consider seeking mental health support if your symptoms are causing distress or impacting your emotional well-being. A counselor can provide coping strategies and emotional support.

Final thoughts

Restless legs syndrome (RLS) is a neurological condition where it feels like your legs are tingling or burning or something is crawling inside them. Symptoms are usually worse when you’re still and ease up when you move your legs. 

RLS can interrupt your sleep and interfere with your quality of life. Talk to your health care provider if you have symptoms since treatment can help.