Restless Legs Syndrome

People with RLS may experience:
• A strong, uncontrollable urge to move the legs, often accompanied by unpleasant sensations.⁵
• Symptoms that start or worsen during rest (sitting or lying down).¹
• Partial or total relief with movement (walking, stretching).⁵
• Symptoms that are worse in the evening or at night.¹
• In some cases, involuntary jerking movements during sleep, known as periodic limb movements of sleep (PLMS).¹

These symptoms can disrupt sleep, leading to fatigue, irritability, and reduced quality of life.

RLS doesn’t always have a clear cause, but research points to two main factors:

1. Iron deficiency — especially low ferritin levels — which can impair the brain’s ability to produce dopamine.³
2. Dopamine dysfunction — dopamine is a brain chemical that helps control movement; dysregulation may underlie RLS.⁴

Other risk factors include:

• Family history of RLS.²
• Pregnancy (especially in the third trimester).⁷
• Chronic kidney disease (particularly on dialysis).³
• Certain medications (some antidepressants, antipsychotics, older antihistamines).⁵
• Secondary to other health conditions such as diabetes, venous insufficiency, folate or magnesium deficiency, fibromyalgia

There is no single test for RLS. Diagnosis is based on your symptoms and medical history, often alongside:

• A physical examination including assessment of circulation and neurological systems, to exclude secondary causes of RLS.¹
• Blood tests, as determined by the physical examination, could include: iron status (e.g., ferritin, transferrin saturation), micronutrient, glucose, electrolyte, and hormonal disturbances.¹
  • Tests to exclude neurological, muscular and other conditions that might mimic RLS.¹

In some cases, a sleep specialist may order a sleep study, especially if other sleep disorders are suspected.¹

• Exercise moderately during the day (e.g., walking, stretching).¹
  • Establish a regular sleep routine: go to bed and wake up at the same times daily.¹
  • Create a restful bedroom: dark, quiet, and comfortable.
  • Use warmth or cold on your legs: warm baths, heat pads, or ice packs.¹
  • Massage or stretch your legs before bed.²
  • Walk, stretch, or distract yourself (reading, puzzles) when symptoms occur.

Avoid:

• Caffeine (coffee, tea, energy drinks) in the afternoon/evening.¹
• Alcohol too close to bedtime.¹
• Heavy meals or strenuous exercise late at night.
• Using screens (smartphones, tablets) right before bed.
• Daytime naps, especially long ones.

If lifestyle changes are not enough, your doctor may recommend medication:

• Iron therapy: for those with low iron stores (especially low ferritin).²
  • Calcium-channel ligands: gabapentin or pregabalin are first-line for many patients.¹
  • Dopamine agonists: pramipexole, ropinirole or rotigotine may help, though long-term use can cause “augmentation” (where symptoms start earlier in the day or become more intense).²
  • Opioids: low doses may be prescribed for severe cases unresponsive to other treatments.¹

Because RLS often persists long-term, it may take time to find the right treatment plan.

This brochure is for educational purposes only and is not intended to provide a diagnosis or treatment or replace the advice of your doctor, pharmacist, primary health care nurse or other health care provider. You are advised to discuss any questions or concerns you have with your health care provider.