When your legs refuse to rest: The hidden struggle of Restless Leg Syndrome

Often dismissed as simple restlessness, Restless Leg Syndrome can disrupt sleep, affect mental health and raise heart risks. Experts explain symptoms, causes and treatment

Lying down after a long day is meant to be comforting, yet some people experience a strange crawling or pulling sensation deep inside their legs that makes staying still almost impossible. This is not anxiety or simple restlessness, but Restless Leg Syndrome, a condition that often goes undiagnosed, leading many sufferers to endure symptoms for years before seeking help.

 

What is Restless Leg Syndrome and why does it happen?

 

RLS is a neurological movement disorder characterised by:

 

• an uncomfortable sensation deep within the legs, often described as crawling, tingling, pulling, or aching
• a compelling urge to move the legs, especially when at rest
• temporary symptom relief upon movement
• worsening of symptoms in the evening or at night when trying to relax or sleep

 

According to Dr Puneet Agarwal, vice-chairman – neurology at Max Healthcare, people with RLS often feel “an uncomfortable crawling, itching, or pulling sensation deep inside their legs”, which becomes stronger at night when the body is still and quiet.

 

"It is often linked to imbalances in brain chemicals that regulate movement, particularly dopamine," he adds.

 

These sensations are not caused by a visible problem with the muscles or skin, but rather by disordered neurological signalling, which can be influenced by iron levels, nerve health, genetics, and other underlying factors.

 

Who is more at risk of developing RLS?

 

RLS can occur at any age but is more common in middle-aged and older adults. It also occurs more frequently in people with:

 

• Iron deficiency or anaemia, even if haemoglobin levels are normal
• Chronic kidney disease or renal failure
• Certain neurological conditions
• Family history of RLS
• Pregnancy, particularly in the third trimester
• Other underlying health issues such as diabetes and nerve disorders

 

How does RLS affect health beyond sleep?

 

The impact of Restless Leg Syndrome does not end when morning arrives, because broken sleep often carries over into every aspect of daily life. What begins as an uncomfortable urge to move at bedtime can gradually translate into persistent fatigue, poor concentration and reduced productivity.

 

Chronic sleep disruption has been linked to wider health concerns, and clinical evidence suggests that the burden of RLS extends far beyond disturbed nights. A clinical review published in JAMA recently highlights the broader impact:

 

• Patients with RLS report a significantly impaired quality of life, largely driven by ongoing sleep loss and exhaustion
• Nearly 29.6 per cent have co-existing cardiovascular disease, including coronary artery disease, stroke, or heart failure
• Around 30.4 per cent experience depression, underlining the strong link between sleep disorders and mental health
• There was also significant risk of suicidal thoughts or self-harm among some RLS patients

 

Experts suggest that when RLS remains untreated, repeated sleep deprivation may compound physical and psychological stress. Early recognition and management are therefore crucial not only for better sleep but also for long-term health.

 

When should you see a doctor for RLS symptoms?

 

Occasional leg discomfort after a long day may not be a cause for concern, yet persistent or worsening symptoms should not be ignored. Early evaluation can prevent years of disturbed sleep and unnecessary distress. You should consider consulting a doctor if:

 

• The urge to move your legs occurs several times a week, especially in the evening or at night
• Symptoms are interfering with your sleep and leaving you fatigued during the day
• The sensations feel intense, painful, or progressively worsening
• You have iron deficiency, kidney disease, diabetes, or a neurological condition alongside these symptoms
• There is a family history of Restless Leg Syndrome and you are noticing similar patterns
• Lifestyle measures such as reducing caffeine and improving sleep habits are not providing relief

 

Doctors can assess underlying causes through clinical evaluation and blood tests, particularly to check iron levels and other deficiencies, and they can recommend appropriate treatment options to improve both sleep and quality of life.

 

How is Restless Leg Syndrome diagnosed and treated?

 

Diagnosis generally depends on clinical criteria, including timing, symptom patterns, and relief with movement, rather than a specific blood test. Doctors may also test for:

 

• Iron stores (serum ferritin)
• Vitamin B12 and vitamin D levels
• Kidney function and blood sugar levels to identify contributing factors

 

Treatment typically combines lifestyle changes with medical therapy.

 

Lifestyle measures include:

 

• Reducing caffeine after the afternoon
• Avoiding alcohol
• Maintaining consistent sleep routines
• Regular physical activity and leg stretching

 

"Some people find relief from compression socks, leg massagers, or pneumatic devices designed to improve circulation," shares Dr Agarwal. Relaxation therapies like warm baths, stretching, and gentle massage can also be effective as part of a home routine.

 

Medical treatment options:

 

While dopamine-based drugs were used more commonly in the past, modern guidelines often favour gabapentinoids for long-term use, as dopamine stimulants may worsen symptoms over time. In certain cases, doctors may prescribe pain relief, anti-seizure medications, or iron supplements, particularly if symptoms are severe or linked to underlying deficiencies.

 

Monitoring and follow-up help tailor therapy to individual needs and mitigate side effects.   

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This report is for informational purposes only and is not a substitute for professional medical advice.