If you keep getting the urge to move your legs when you are trying to sleep, or are bothered by a crawling, itching sensation in your legs when driving long distances in your car or flying long-haul, you may have a condition called Willis-Ekborn disease. That term sounds alarming, but the sensations you are feeling are commonly referred to as restless legs syndrome.
Neurologist Winona Tse, MD, says it is important to get diagnosed and treated for restless legs, especially if it is disturbing your sleep. “Not sleeping well at night puts you at risk of daytime drowsiness that may contribute to falls and car accidents,” she explains. “Restless legs syndrome also may contribute to depression and anxiety.”
What Causes Restless Legs Syndrome?
It isn’t clear what causes restless legs syndrome, or RLS, but Dr. Tse says some research has linked it to an imbalance in dopamine, a brain chemical that plays a role in muscle movement. This is one reason why people with Parkinson’s disease—which also is characterized by dopamine disruption—are at greater risk of developing restless legs syndrome. “Diet may play a role, too,” Dr. Tse notes. “For example, having an iron deficiency raises the risk of restless legs syndrome because iron plays a role in the production of dopamine in the brain.”
Other health conditions that raise the risk of restless legs syndrome include kidney failure (which often results in low iron levels) and, in younger adults, pregnancy. Conditions that have a weaker association with RLS include rheumatoid arthritis, diabetes, and peripheral neuropathy (nerve damage in the limbs that often results from diabetes).
Restless legs syndrome also may have genetic causes, since the condition often runs in families. In these cases, restless legs syndrome symptoms typically start before age 40.
Diagnosing Restless Legs
Restless legs syndrome usually is diagnosed based on symptom description, rather than a physical evaluation, which isn’t likely to be conclusive. Your doctor also may order blood tests to check your iron levels and rule out any possible underlying conditions that may be contributing to RLS.
Restless Legs Linked to Periodic Limb Movement Disorder
The majority of people with restless legs syndrome also experience periodic limb movement disorder, a condition in which the legs or arms move during sleep. “Episodes typically recur every 20 to 40 seconds,” says Dr. Tse. “The movements can range from slight twitching to more violent jerking of the muscles and may be very brief or last five seconds or more.”
Restless Legs Syndrome Treatment
Treating restless legs syndrome successfully depends on avoiding any possible triggers and following lifestyle strategies that have been shown to help reduce the urge to move and kick your legs. Your doctor may prescribe medications to help alleviate RLS symptoms, and there also is a new treatment option called tonic motor activation (TOMAC). If you have any health conditions that may raise the risk of restless legs syndrome, be sure to closely follow your doctor’s advice for controlling them.
RLS symptoms may be triggered by caffeine, alcohol, and smoking, so try to cut down your intake of the first two and quit smoking if you engage in the habit. Lifestyle strategies that may provide relief include getting plenty of exercise.
“Take the precaution of scheduling exercise for early in the day, since there is evidence that exercising later on in the day may exacerbate the symptoms of restless legs syndrome,” Dr. Tse advises. She adds that some medications—including antidepressants, and anti-nausea and allergy medications—may trigger RLS. “Check the information leaflets for any drugs you take, and tell your doctor if you think a drug may be contributing to your restless legs,” she advises. “It is possible that lowering the dose or substituting a different drug may help.”
A warm bath in the evening can help relax your leg muscles, and gentle massage and stretching have the same effect. Crawling, itching sensations may be relieved by alternating cold and heat packs. Lastly, establish good sleep hygiene so that the sleep you do get is as restful as possible.
“Your bedroom should be dark, cool, and quiet. If you live in a noisy neighborhood, wear ear plugs or use a white noise machine to drown out external noise from traffic,” Dr. Tse advises. “Also, go to bed and get at the same times each day.” She adds that getting checked for iron deficiency can be helpful, as people with restless legs syndrome and iron deficiency often respond to iron supplementation. However, you shouldn’t self-prescribe iron supplements without asking your doctor if they are appropriate.
According to recent American Academy of Sleep Medicine (AASM) 2025 guidelines, gabapentin (Neurontin), gabapentin enacarbil (Horizant) and pregabalin (Lyrica) are options for restless legs syndrome treatment. However, drugs known as dopamine agonists—including pramipexole (Mirapex), ropinirole (Requip) and rotigotine (Neupro)—used to treat Parkinson’s disease, are no longer recommended as an initial treatment modality.
“While doctors often used to prescribe Parkinson’s drugs to help manage restless legs syndrome, the AASM now recommends against using these drugs as a first-line treatment option, since studies have suggested they may worsen symptoms over the long term,” Dr. Tse notes. The AASM’s guidelines (Journal of Clinical Sleep Medicine, January 2025) recommend reserving these drugs for people who place more importance on relieving their RLS symptoms and less importance on the risk of worsening symptoms later on. “If you are considering using Parkinson’s drugs to relieve restless legs syndrome, be sure you fully understand the risks,” Dr. Tse cautions.
New Device Expands Treatment Options
In September 2024, the U.S. Food & Drug Administration granted approval to Nidra, a TONAC-based wearable device that may help moderate-to-severe RLS symptoms that are not controlled by lifestyle measures and medications. Nidra consists of two strap-on devices worn just below the knees. The devices deliver a mild electrical current to nerves in the lower legs, activating the muscles in a way that reduces the symptoms of restless legs syndrome. Nidra must be prescribed by a doctor, and it is covered by Medicare.
Don’t Panic About Restless Legs Syndrome
Above all, try not to panic if you develop restless legs syndrome. “It doesn’t in any way indicate that you are vulnerable to more serious neurologic conditions, such as Parkinson’s disease,” Dr. Tse notes. “Moreover, many people with restless legs syndrome go into periods of remission that can bring relief for weeks, months or even years.”
