Understand Restless Legs Syndrome (RLS): Causes, Symptoms & Treatments

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restless legs in bed

Restless legs syndrome, or Willis-Ekbom disease, often causes difficulties in initiating or maintaining sleep. A Hong Kong study found that the prevalence of restless legs syndrome symptoms was 2.8% in Chinese adolescents. The symptoms typically become more frequent and last longer with age. Globally, restless legs syndrome is thought to affect between 4 and 29% of adults, but is thought to be less common in Asians than in Europeans. 


In this article, you will learn more about the symptoms, causes and treatments of restless legs syndrome and understand how to manage the condition in Hong Kong.


What is Restless Legs Syndrome?

Restless legs syndrome causes an irresistible urge to move the legs, usually due to uncomfortable sensations in the legs. The symptoms typically develop or worsen during periods of inactivity, and are particularly prevalent in the evening or at night. Restless legs syndrome is considered a sleep-related movement disorder and most patients have characteristic leg movements even while sleeping.

Signs & symptoms of Restless Legs Syndrome

People with restless legs syndrome may experience the following signs or symptoms:

  1. Uncomfortable feelings in their legs, and sometimes arms. These sensations are hard to define but are usually described as itching, crawling, aching, throbbing, or pins and needles.
  2. These uncomfortable feelings result in an overwhelming urge to move one’s legs. Though less likely, the sensations may also affect the arms. They can occur on one side of the body or both sides, alternately or concurrently. The symptom intensity can vary from uncomfortable to irritating to painful.
  3. Keeping the legs in motion helps temporarily relieve the discomfort. As a result, people with restless legs syndrome often walk back and forth or move their legs while sitting and resting in bed.
  4. The distinct symptom-occurring period is a hallmark feature of restless legs syndrome. People with restless legs syndrome often experience worsened symptoms at night and a symptom-free period in the morning, whereas deprivation of sleep time and quality may exacerbate the symptoms.

Remissions may sometimes occur during the early stages of the disorder, in which people with restless legs syndrome may experience spontaneous disappearance of the symptoms before they emerge again, even more severely.

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Causes and risk factors of Restless Legs Syndrome

The causes of idiopathic or primary restless legs syndrome are still under study. However, the role of genetic factors in the onset of symptoms before age 40 has been confirmed. Evidence also suggests that a low level of iron content in the brain may give rise to restless legs syndrome. 


Various studies suggest that dysfunction in the basal ganglia may be associated with restless legs syndrome. Dopamine, stored in the basal ganglia, is required to produce purposeful muscle behavior and movements. Disruptions of the basal ganglia pathways, hence, may be responsible for involuntary leg movements. People with Parkinson’s disease have an increased chance of developing restless legs syndrome due to a deficit in dopamine. 


Secondary restless legs syndrome may be caused by certain long-term medical conditions, especially iron deficiency anemia or kidney failure. In addition, the last three months of pregnancy are associated with increased occurrence of restless legs syndrome. The symptoms usually cease within a month after delivery.

Treatments of Restless Legs Syndrome

Restless legs syndrome is a lifelong condition with no cure. However, there are treatments that can effectively relieve the symptoms. 


Iron supplementation can often provide significant relief of the symptoms of restless legs syndrome. 


Depending on the severity of the syndrome, clinicians may offer different treatment options:


Mild to moderate

  • Lifestyle changes: Regular exercise, maintaining good sleep hygiene, and avoiding caffeine, tobacco and alcohol — you probably already knew this!— are instrumental in relieving the symptoms.
  • Relaxation: Leg massages or stretching, warm baths, using heating pads or ice packs can soothe the intensity of the urge to move the limb.


  • Medications
  1. Iron supplementation: Iron supplements are usually recommended as the first treatment for people with iron deficiency anemia.
  2. Anti-seizure drugs: Gabapentin and other anti-seizure drugs may be prescribed for people with restless legs syndrome. They are as effective as dopaminergic drugs but cause less augmentation (progressive worsening) of symptoms.
  3. Dopaminergic agonists: These drugs include ropinirole, pramipexole and rotigotine and can improve the levels and effectiveness of the chemical messenger dopamine. While their original use lies in treating Parkinson’s disease, they have also proven effective in treating moderate to severe restless legs syndrome. Chronic use of dopaminergic agents should be administered with care because continuous use may aggravate the symptoms both intensity- and frequency-wise.
  4. Opioids: Drugs containing codeine or methadone can be prescribed to individuals with more severe symptoms who do not respond well to other possible remedies.
  5. Benzodiazepines: A type of sedative that can help individuals with their sleep, with a side effect of having daytime drowsiness. Due to their addictive nature, they are usually prescribed only if all other drugs fail.

Before receiving medications, patients should consult their healthcare provider to understand the possible risks and side effects of the drugs. Please also note that some of the listed medications are not available over-the-counter and require prescription by a qualified medical professional.


What causes restless legs at night in bed?

Research is still underway to establish the causes of (idiopathic or primary) restless legs syndrome. However, the role of genetic factors in the onset of symptoms before age 40 has been confirmed.

What is your body lacking when you have restless legs?
What is prescribed for restless legs syndrome?
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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Sarah Borwein
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