Restless leg syndrome (RLS), also known as Willis-Ekbom disease, causes sensations in people’s legs and sometimes arms that make it difficult for them to relax and stay still. The symptoms most often happen when people are lying down—particularly when trying to fall asleep—or while they’re sitting still for a long time, such as on a long drive, during a plane ride or at the movies.

“The descriptions people give of their symptoms are very diverse,” said neurologist Echo Tan, MD, director of the Cedars-Sinai Movement Disorders Fellowship Program. “Some people describe it as a numbness or a burning or aching feeling, and others say it’s a tingling, gnawing sensation—just an irresistible urge to move their legs and an inability to sit or lie still.”

Up to 10% of Americans experience some symptoms of RLS, and about 3% have severe symptoms. The rate is higher among women than men. Symptoms often develop in middle age and increase in severity as people age. Older adults report the highest incidence and the most severe symptoms of RLS.

The first medical description of RLS was provided in 1685 by Sir Thomas Willis. But it’s only in the past few decades that RLS has been taken seriously as a neurological disease and that research into the underlying cause of the disease has increased and more effective treatments have become available. Despite those efforts, doctors still don’t fully understand what causes RLS.

RLS can’t be diagnosed or measured using blood tests or imaging, but an experienced neurologist or sleep expert can diagnose the condition based on a physical exam, medical history and reported symptoms.

“I think at first, a lot of restless leg patients get misdiagnosed as having some sort of muscle cramp or spasm,” said Tan. “Or some doctors think they have a nerve issue, or neuropathy, before they get accurately diagnosed by a specialist with experience in this disorder.”

“RLS is less common and harder to diagnose in children. It is often misidentified as growing pains or ADHD,” she noted.

As part of the diagnostic process, doctors may recommend tests that can rule out other possible conditions, including neuropathy or Parkinson’s disease. A sleep test may also be suggested, especially if sleep apnea is suspected, though it is not needed for diagnosis.

Read: How to Get Better Sleep

The underlying cause of RLS has not been identified, but an imbalance of dopamine is thought to be involved. Dopamine is a neurotransmitter, a chemical that helps regulate how the body moves. Neurological damage—damage to brain cells—from injuries or diseases such as neuropathy and Parkinson’s disease can affect dopamine and contribute to RLS symptoms.

Other factors thought to contribute to RLS symptoms:

• Genetics: RLS often runs in families
• Anemia, or low iron levels
• Certain medications, including antihistamines, antidepressants, and anti-anxiety and anti-nausea drugs
• Pregnancy 
• Kidney disease

Many patients do not have an identifiable cause for their RLS. This is called idiopathic RLS. For these patients, genetics may play an important role.

People with RLS often have a hard time getting to sleep. Some of the worst side effects of the disease are due to poor sleep, including:

• Fatigue and lack of energy
• Daytime sleepiness
• Inability to concentrate
• Memory issues
• Depression and mood swings

“People who come to see us are being hit with these symptoms most often at night when they go to bed,” said pulmonologist Oragun Rojanapairat, MD, who directs the Cedars-Sinai Sleep Health program. “They’re trying to fall asleep, but the sensations in their legs—that tingling and just itching to move—make it really difficult.”

“RLS is very common in our sleep health patients,” said Jiyeon Seo, MD, a pulmonologist who works with the Cedars-Sinai Sleep Health program. “People don’t usually bring it up as their chief complaint, but when we go through a full sleep and medical history, it comes up a lot.”

A lack of sleep can affect the body’s dopamine regulation. As a result, people with RLS may be caught in a vicious cycle: A dopamine imbalance contributes to RLS symptoms, RLS symptoms cause a lack of sleep and a lack of sleep makes the dopamine imbalance worse.

Read: At-Home Sleep Tests: What to Know

There is no cure for RLS, but there are treatments that can help reduce symptoms.

Your doctor will likely begin by testing your iron levels and looking over a list of any medications you’re taking. If your iron level is low, increasing it through diet and/or supplements may relieve your symptoms. Some patients find relief with simple over-the-counter supplements, such as multivitamins, vitamin D and magnesium.

If any medications you’re taking are known contributors to RLS symptoms, you and your doctor can discuss possible substitutes.

Light exercise and/or stretching before bed have been found to reduce symptoms, as well as massage.

“Also, relaxation techniques, such as meditation or yoga, have been shown to help—and warm or hot baths, too,” said Seo. “We always like to start with these treatments that don’t require taking medications, especially for mild and intermittent cases of restless leg.”

Good sleep hygiene can also help. This includes establishing a consistent bedtime, cutting out screen time at night and reducing food intake before bed, as well as avoiding stimulants such as caffeine, tobacco and alcohol in the evening.

Activating muscles with electrical stimulation using a transcutaneous electrical nerve stimulation, or TENS, machine can also provide relief.

If these remedies don’t work, you and your doctor can consider medications. There are several drugs that have been shown to effectively improve RLS symptoms. These include antiseizure medications such as gabapentin and pregabalin.

Medications that increase dopamine or mimic its effects in the brain, such as ropinirole, pramipexole and rotigotine, have also been shown to effectively reduce symptoms. Unfortunately, some people experience their symptoms coming back and getting worse over time when using these drugs—even spreading to their arms.

Low doses of opioids, such as oxycodone, hydrocodone and buprenorphine, also are used in treating RLS. Addiction is rare if doses are kept low.

If your sleep and overall quality of life are being affected by restless leg syndrome, there’s no need to suffer in silence. Reach out to Cedars-Sinai’s Movement Disorders or Sleep Health programs. Our doctors are experienced in treating this disease, and they can identify the cause of your RLS and help you begin your journey to recovery.