Restless Legs Syndrome: Why Your Legs Won't Stay Still at Night

You finally lie down after a long day, and just as your body starts to relax, your legs start to complain. There's a crawling, pulling, jittery feeling deep inside them, and the only thing that helps is moving. If this happens most nights, you're not imagining it and you're not alone. It has a name: restless legs syndrome.

Restless legs syndrome (also called Willis-Ekbom disease) is a common, treatable neurological condition. Understanding what's actually happening in your body is the first step toward quieter nights and better sleep.

What is restless legs syndrome?

Restless legs syndrome (RLS) is a chronic neurological movement disorder defined by an irresistible urge to move your legs, usually paired with uncomfortable sensations deep inside them. People describe the feeling as crawling, creeping, pulling, tingling, itching, electric, burning, or aching. Importantly, the sensation sits in the deep structures of the leg, not on the skin, which is part of what sets it apart from an ordinary itch or cramp.

RLS is far more common than many people realize, though exact estimates vary depending on how the condition is defined and measured. A 2024 systematic review estimated global prevalence at 7.12% among adults aged 20 to 79, which works out to roughly 356 million people worldwide. NINDS describes RLS as affecting an estimated 7 to 10% of people in the United States, with moderate to severe symptoms in a smaller share, around 2 to 3%. Different studies use different diagnostic criteria, so you'll see a range of figures, but the takeaway is consistent: many people live with this, and most are never diagnosed.

What does restless legs syndrome feel like?

The hallmark of RLS is a pattern, not just a sensation. The urge to move appears when you're at rest and eases the moment you start moving. Telltale signs that point to RLS rather than something else include:

• An uncomfortable urge to move the legs, often with deep crawling, jittery, tingling, or aching sensations
• Symptoms that begin or worsen during rest or inactivity, like sitting or lying down
• Relief that comes with movement, such as walking, stretching, or pacing
• A diurnal pattern: symptoms are worse in the evening and peak at night
• Occasionally, similar sensations spreading to the arms

What causes restless legs syndrome?

In many people, RLS runs in families, pointing to a genetic predisposition. The underlying biology is thought to involve dysfunction in the brain's dopamine signaling, the same system that helps control movement.

RLS can also be secondary to another condition. Common contributors include iron deficiency, pregnancy, and chronic kidney (renal) disease. Iron matters a great deal here, because iron is involved in the brain's dopamine pathways. This is why doctors often check your iron status when you're evaluated for restless legs, and why treating low iron can meaningfully improve symptoms.

How is restless legs syndrome treated?

The first step is often correcting iron deficiency. Recent American Academy of Sleep Medicine (AASM) guidance supports checking iron stores and supplementing when they are low, with treatment guided by your bloodwork. Never start iron supplements on your own, though, because too much iron is harmful. Your clinician should check your ferritin and transferrin saturation first and set the right target for you.

When medication is needed, the treatment landscape has shifted in recent years. Alpha-2-delta ligands such as gabapentin, gabapentin enacarbil, and pregabalin are now favored as first-line drugs. Dopamine agonists like pramipexole and ropinirole, once standard, have been moved down the list. The reason is a problem called augmentation, where the medication paradoxically makes RLS worse over time, with symptoms starting earlier in the day and spreading. Because of this risk, dopamine agonists are no longer recommended as the default starting treatment. Simple lifestyle steps like regular movement, good sleep habits, and limiting caffeine and alcohol can also help.

When should you see a doctor?

See a clinician if leg discomfort is disrupting your sleep, affecting your mood or daytime focus, or simply wearing you down. RLS is diagnosed clinically, based on your history and these tell-tale symptoms, so a thorough conversation about what you feel and when is genuinely useful.

It's especially worth getting checked if you're pregnant, have kidney disease, or have a history of anemia or low iron, since these are treatable contributors. And if you're already on a dopamine agonist and notice symptoms creeping earlier into the day or getting worse, tell your doctor promptly, because that can be a sign of augmentation that needs a change in plan. Seek urgent care if leg symptoms come on suddenly with weakness, numbness, swelling, or severe pain, since those point to something other than RLS that needs prompt evaluation.