Restless Legs Syndrome (RLS): What to Know and What to Do

Waking up at night because your legs feel twitchy, crawling, or unbearably restless? That’s classic restless legs syndrome, or RLS. It’s more than an annoyance — it can wreck sleep, make you tired during the day, and affect your mood. Good news: there are simple steps that often help right away and medical options when you need them.

What causes RLS?

Sometimes there’s no clear reason — that’s called primary RLS and it often runs in families. Other times RLS is secondary to something else. Common causes include low iron stores (doctors check ferritin), kidney disease, neuropathy, diabetes, and pregnancy. Certain medicines can make RLS worse: over-the-counter sleep antihistamines (like diphenhydramine), some antidepressants and antipsychotics, and anti-nausea drugs such as metoclopramide.

RLS symptoms usually show up when you’re resting or lying down and get better with movement. You might also have periodic limb movements during sleep (brief jerks every 20–40 seconds) which can fragment sleep even if you don’t fully wake up.

How to get relief tonight and long-term

Immediate tricks: get up and walk for a few minutes, stretch your calves and hamstrings, or try a quick leg massage. Many people find hot or cold packs help. Compression socks or vibration devices can reduce sensations for some folks.

Adjust habits that trigger symptoms. Cut back on caffeine, nicotine, and heavy alcohol, especially in the evening. Regular moderate exercise helps, but avoid intense workouts right before bed. Keep a consistent sleep schedule and make your bedroom cool and dark — good sleep hygiene lowers RLS severity for many.

Check iron. Low iron stores are a treatable cause. If your doctor finds ferritin is low (many clinicians use a cutoff like <50 µg/L), iron supplements may help. Don’t start high-dose iron on your own — discuss dose and follow-up testing with your healthcare provider.

When lifestyle changes aren’t enough, medicines can help. Options include gabapentin or pregabalin for nerve-like sensations, and low-dose dopamine agonists (pramipexole, ropinirole) in selected patients. Dopamine drugs can sometimes cause ‘augmentation’ — symptoms return earlier or worse — so they need careful monitoring. In severe, refractory cases, doctors may consider other drug classes, but those come with risks and need specialist input.

Pregnancy-related RLS often clears after delivery, but if symptoms are bad, talk with your OB. If RLS starts suddenly, gets much worse, or leaves you extremely sleepy during the day, get evaluated — that could mean a need for different treatment or testing for an underlying condition.

Bottom line: small changes often bring real relief, and testing for iron and reviewing your medications is a smart first step. If those don’t work, there are effective prescription options — ask your doctor what fits your situation.