It's become a pattern. Just when you crawl into bed and begin to fall asleep, your legs begin to twitch and jerk. You may feel burning or a crawling sensation deep inside your calves that seem to go away when you move your legs. These same sensations often return whenever you sit down and relax. If these symptoms sound familiar, you may have restless legs syndrome (RLS). 

RLS can cause significant disruption to your sleep cycle and can worsen if left untreated. It can also mimic other conditions and therefore should be diagnosed by a neurologist or sleep specialist to ensure appropriate diagnosis and treatment, says Diego Torres-Russotto, MD, Nebraska Medicine neurologist who specializes in movement disorders. 

Risk factors

Approximately 5% to 15% of the population suffers from RLS, a neurological condition that can be associated with a variety of factors including:

• Genetics
• Low iron levels
• Kidney disease or diabetes
• Neuropathy
• Spinal cord disease
• Multiple sclerosis

The condition occurs more frequently in women than men and becomes more common with age. You have a 3 to 6 times higher risk for RLS if you have a first-degree relative with the condition such as parents, siblings or children, Dr. Torres-Russotto says. 

Symptoms of restless legs syndrome

The condition is associated with these symptoms: 

• Unpleasant leg crawling sensations or urges to move the legs, particularly during periods of rest or inactivity
• Relief from these symptoms by leg movement such as stretching or walking
• Worsening symptoms in the evening or night
• Twitching or kicking of the legs throughout the night while sleeping

About 80% of people with restless legs will experience periodic leg movements during sleep. This includes jerk-like leg movements that occur throughout the night, often causing partial awakenings that disrupt sleep and may cause daytime sleepiness. Some people may not even be aware of these movements and it is often the bed partner that observes the leg movements and complains, notes Dr. Torres-Russotto. Although most patients start having symptoms in the evenings, some might have symptoms during periods of inactivity during the day as well. 

Managing restless legs syndrome

RLS tends to be a lifelong condition that can be managed with lifestyle changes, medications and treatment of symptoms if caused by underlying disorders. If the underlying cause is iron or folic acid deficiency, supplements alone may be sufficient to relieve your symptoms.

Lifestyle changes include:

• Refrain from caffeine 
• Avoid alcohol consumption
• Practice good sleep habits
• Exercise regularly
• Take warm or cool baths
• Leg massages
• Avoidance of antidepressants, antihistamines and anti-nausea agents that can trigger or worsen restless legs

"Medications are extremely helpful and many people have no symptoms at all with occasional adjustments to meds," says Dr. Torres-Russotto.

If not treated appropriately, RLS can worsen and can affect other parts of the body such as the arms. Overuse of certain medications can also lead to RLS augmentation which is associated with a progressive escalation of symptoms by increased medication dosages, explains Dr. Torres-Russotto. This can make the condition more difficult to treat, prompting the need for management by a specialist.

"Restless legs syndrome can be very disruptive to your lifestyle," says Dr. Torres-Russotto. "Don't dismiss your symptoms. Make sure that you talk to your doctor or see a specialist who can help."