Restless legs syndrome

Restless legs syndrome is an uncomfortable or unpleasant feeling in your legs and an irresistible urge to move them. It is common in people with chronic kidney disease (CKD). This page gives more information about the condition and the different treatment options you can discuss with your doctor.

Why might I have restless legs syndrome?

Restless legs syndrome affects around 1 in 10 people. It is more common in people with chronic kidney disease (CKD), especially if you are on haemodialysis, and during pregnancy.

Restless legs syndrome can be caused by another underlying health condition such as anaemia (low red blood cell count), iron deficiency (low iron stores in the body), or high calcium levels in the blood. These conditions are all common in people with kidney disease.

Triggers which can make restless legs syndrome worse:

Stimulants such as caffeine, chocolate, alcohol and nicotine
Medications, including antidepressants, antipsychotics and antihistamines (allergy tablets)
Sleep deprivation and other sleep conditions (sleep apnoea)

What are the symptoms of restless legs syndrome?

Restless legs syndrome affects people in different ways. You may just find it slightly annoying, or it may be severely distressing and painful.

You may feel an irresistible urge to move, along with uncomfortable feelings in your legs. These feelings are temporarily relieved when you move the affected limbs but it can also cause pain. It can be difficult to describe the feeling, but it may be aching, creeping, crawling or itching.

You may get similar feelings in other areas of your body like your arms, chest or head. You may get the feelings in just one side of your body or both at the same time.

As restless legs syndrome usually occurs in the evenings, it can lead to disturbed sleep as you toss and turn in bed to ease the symptoms. It usually improves in the early hours of the morning, but this disturbance can make you tired and affect your mood the next day.

A similar condition called periodic limb movement disorder is very common in people with restless legs syndrome, affecting around 8 out of 10 people. It causes involuntary jerks of the arms or legs, usually just before falling asleep, or can wake you up during the night.

How will restless legs syndrome affect my life?

Restless legs syndrome affects people in different ways. It may only affect you once or twice a week, but in more severe cases, it can occur every day.

Severe restless legs syndrome can also affect your relationships, family life and social activities. For example, you may find eating out, going to the cinema or long-haul flights very difficult due to the urge to move your legs. However, many people with restless legs syndrome do find effective treatment that reduces or relieves their symptoms.

It is important for your healthcare team to understand how restless legs syndrome affects you so they can help plan the best form of treatment.

You may find it helpful to keep a symptom diary to track the severity of your restless legs syndrome and to help identify any triggers.

How is restless legs syndrome diagnosed?

There are no specific tests to diagnose restless legs syndrome. Your healthcare team will usually make the diagnosis after asking a series of questions and examining both you and your medication history.

You may be asked to have a nerve conduction study which is a test to see how well your nerves pass on electrical impulses. This can be used to rule out a condition called peripheral neuropathy, which has similar symptoms to restless legs syndrome but needs different treatment.

Blood tests to check your iron levels (ferritin) and kidney function tests may help to identify any other medical conditions that may be causing your restless legs syndrome. You may also be referred to a neurologist (a doctor specialising in the nervous system) or a sleep expert if the diagnosis is not certain, or if treatment for restless legs syndrome does not work.

Diagnostic criteria for restless legs syndrome

An overwhelming need or urge to move the legs, usually associated with an abnormal, uncomfortable or unpleasant sensation.
The urge or need to move starts, or gets worse, when resting.
The urge to move is at least temporarily and partially relieved by moving.
The urge to move starts or is worse in the evening or at night.
These sensations are not due to any other condition.

How is restless legs syndrome treated?

Treatment aims to help you manage the symptoms of restless legs syndrome. You may need to try different treatments before you find one that works for you.

Your healthcare team will work with you to try to identify triggers for your restless legs syndrome, which can then be avoided or adjusted. This might include cutting down on caffeine and/or alcohol, stopping smoking and changing some of your medications.

You may find that light exercise like walking and stretching helps. Relaxation techniques such as having a bath before going to bed can also make a difference. Trying to establish a regular sleep pattern, with a calming nighttime routine, can also help.

Most people will experience some relief in the severity of their restless legs syndrome symptoms with these techniques.

If your symptoms do not improve, your healthcare team may prescribe medication to help. Iron supplements can be given if blood tests have shown that your restless legs syndrome is caused by iron deficiency.

Or, you may be given specific medications to suppress restless legs syndrome. These include painkillers, sleeping tablets (sedatives) and medications commonly prescribed for neurological conditions.

You should always follow your healthcare team’s advice regarding medications.

Where can I find out more information?

Talk to your healthcare team about any symptoms that you are experiencing. It is particularly important that you consult them before changing or starting medications.

Other sources of information include: