Restless legs syndrome

Also called RLS, Willis-Ekbom disease

An irresistible urge to move the legs, worse at rest and at night. Often caused by low iron, and rarely checked for.

What it is

Restless legs syndrome affects around one in twenty adults. It causes an uncomfortable, hard-to-describe sensation in the legs with an overwhelming urge to move them, and it is worse in the evening and at rest.

It is a genuine neurological condition, related to dopamine signalling and to iron levels in the brain.

Here is the practical point that gets missed constantly: low iron stores are one of the commonest treatable causes, and the threshold that matters is higher than the one used for anaemia. A ferritin below 75 is often enough to cause or worsen RLS, and most people are never tested.

Several common medications also cause it, including some antidepressants, antihistamines and anti-sickness drugs.

Signs you might notice

An urge to move the legs, usually with an unpleasant sensation described as crawling, fizzing or aching.

Worse at rest, worse in the evening and at night, relieved by movement.

Difficulty falling asleep, and involuntary leg jerks during sleep.

Daytime exhaustion from chronically broken sleep.

In people who cannot describe it, restlessness in the evening, pacing, and distress at bedtime.

How it can affect day-to-day life

Chronic sleep deprivation is the real cost, and it drives low mood, poor concentration and reduced function.

Long journeys, cinemas, flights and meetings all become difficult, and people avoid them.

Dopamine agonists, once the standard treatment, can cause augmentation, where symptoms become worse and start earlier in the day. Prescribing has shifted away from them for that reason, and anybody on one long-term should have it reviewed.

Supporting someone well

Get ferritin checked, and ask for the number rather than being told it is normal. Below 75 usually warrants iron supplementation for RLS.

Review medication with a pharmacist for drugs that cause it.

Reduce caffeine and alcohol in the evening.

Keep a regular sleep schedule, and use movement, stretching or a warm bath at the point of symptoms.

If on a dopamine agonist and symptoms are worsening or starting earlier, ask about augmentation specifically.

In care settings, recognise evening restlessness as a possible physical cause rather than agitation to be sedated.

Where to get help

A GP can test iron and review medication. Ask for referral to a sleep clinic or neurologist if symptoms are severe.

RLS-UK provide patient information and a list of specialists.

Sudden severe restlessness after starting a new medication, particularly an antipsychotic, may be akathisia and needs urgent review.