Restless Leg Syndrome

Getting a diagnosis

New treatments for RLS

Self-care for RLS

When to see your doctor

Table of Contents

Restless Legs Syndrome: Why Your Legs Won’t Stay Still

RLS affects up to 1 in 10 adults over age 65. Learn about the new guidelines for treating and managing the symptoms

9-minute read

Sarah Gleim,

AARP

Published October 31, 2025

AARP (Getty Images, 2)

Key takeaways

RLS is a disorder that causes you to move one or both legs, usually at night.
Symptoms of RLS improve when you’re walking or stretching your legs.
Genetics is a common cause of RLS, but a brain iron deficiency can also play a role.
There’s no medical test for RLS, which means it’s often misdiagnosed.
New guidelines for treating RLS were released in early 2025.

Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is a neurological sleep disorder that causes an overwhelming urge to move your legs. It also triggers sensations in your legs that can be uncomfortable and difficult to describe.

Both typically get worse when you’re resting or inactive, so the symptoms of RLS are particularly bad when you’re trying to sleep. Although it’s often misdiagnosed, RLS affects up to 10 percent of adults over age 65, and new guidelines released in early 2025 are reshaping how doctors treat it.

What is restless legs syndrome?

“RLS is a neurological disorder that affects sleep,” says Dr. John Winkelman, an RLS specialist and chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital. He uses the URGE acronym when describing RLS:

U = Urge to move your legs, associated with an uncomfortable feeling in your legs.
R = Resting , whether sleeping or just sitting down, is when RLS symptoms are the worst.
G = Gets better with movement, like walking or stretching, but the discomfort reappears when you rest again.
E = Evenings are when you need to move your legs the most.

RLS can show up at any age, though it’s more common as you get older.

In a 2024 survey on sleep disorders by the American Academy of Sleep Medicine, 13 percent of respondents between 55 and 64 said they’d been diagnosed with RLS, while 6 percent over age 65 reported having an RLS diagnosis. Women are more likely to have RLS than men.

Symptoms of RLS

The main symptom of RLS is the need to move your legs. But it also causes feelings inside your legs, not on your skin. “So it’s not joint pain. It’s really a difficult to describe sensation,” says Dr. Rachel Salas, assistant medical director at the Johns Hopkins Center for Sleep and Wellness.

“Sometimes people will say, ‘It feels like bugs are crawling in my legs or on my legs.’ They’ll say, like, maybe it feels like soda or soda pop, or something is fizzing in their blood vessels,” Salas says.

People also to describe this feeling as:

Crawling
Creeping
Throbbing
Aching
Itching
Electric
Bubbling

You may notice that these symptoms get better and then worse again. They might even go away entirely, only to come back.

Insomnia is a major symptom of RLS. “What makes it a sleep disorder is that it has a circadian component, meaning that the symptoms either only come on in the evening or at bedtime,” Salas says. Walking or moving can make the sensations subside, but they come back as soon as you try to go back asleep again.

If you do get to sleep, RLS can wake you up. That’s how RLS can cause insomnia, Salas says.

This cycle of lack of sleep and discomfort in your legs may cause you to experience:

Mood swings
Fatigue or exhaustion
Difficulty concentrating
Problems with memory
Depression and anxiety

What causes RLS?

Researchers and doctors don’t know the exact cause of RLS, but they do have a better understanding today than they did before.

There are two types of RLS: primary and secondary restless legs syndrome.

Primary (idiopathic) RLS: This is the most common form. Primary RLS typically has a genetic component and runs in families. Numerous studies suggest that abnormalities in the central nervous system play a role, as well as a dysfunctional dopamine system.

A 2024 study published in the journal Nature Genetics discovered 164 genetic markers (up from just 22) in our DNA linked to RLS, including some that affect brain signaling.

“There’s a strong genetic influence, and genes have about a 20 percent role in who gets it,” Winkelman says. “But that still leaves the other 80 percent due to other things.” Those are considered secondary RLS.

Secondary RLS: These cases are usually linked to other factors, including:

Medications: Winkelman says common medications — like the antidepressants called selective serotonin reuptake inhibitors, antihistamines and some anti-nausea meds — can cause RLS symptoms or make them worse.
Iron deficiency: RLS is thought to be, in part, due to a brain iron deficiency.

Other health issues can lead to secondary RLS, including:

End-stage kidney disease
Diabetes
Peripheral neuropathy
Musculoskeletal diseases
Venous insufficiency
Folate or magnesium deficiency
Pregnancy

Other possible triggers of RLS are alcohol, smoking and caffeine.

How is RLS diagnosed?

There’s no test to determine if you have RLS, which means it’s often misdiagnosed. Many patients don’t get a clear diagnosis until 10 or even 20 years after they have their first symptoms, according to the Odyssey II survey , which was commissioned by the Restless Legs Syndrome Foundation.

Instead, your doctor has to use a clinical diagnosis.

“A clinical diagnosis means that the patient has to have certain criteria, and they have to meet all of the criteria for us to give them the diagnosis of restless leg syndrome,” Salas says.

These are set by the International Restless Legs Syndrome Study Group and involve five specific signs:

You have an urge to move your legs, and it usually occurs with uncomfortable sensations in your legs.
Your symptoms start or get worse when you’re resting.
Your symptoms get better as long as you’re moving.
Your urge to move is usually worse at night than it is during the day.
Your symptoms aren’t related to another medical or behavioral condition.

Salas says she also asks her patients if they’re having consequences from their symptoms. “Even if somebody met all those criteria … if it’s not causing any problems for them, we wouldn’t treat them with medication,” she says.

Your doctor will likely:

Get your medical history, including family history, other health conditions, medications you take and details about your RLS symptoms.
Perform a physical and neurological exam.
Order blood tests to check your iron levels and to rule out any other possible health conditions.

How is RLS treated?

Dopamine agonists like pramipexole (brand name Mirapex) and ropinirole (brand name Requip) were the first-line treatments for RLS for nearly 20 years. But studies have shown that taking them long term can cause RLS symptoms to get worse, which is known as augmentation. This causes the symptoms to start earlier in the day and can affect other body parts, like the arms.

“[Augmentation] happens, our data suggests, in about 8 percent of people taking these medications, every year that they’ve been on them,” Winkelman says. “Now, if somebody starts these medicines when they’re 60 and they’re going to stay alive until they’re 90, the odds are high that they’re going to have this augmentation develop eventually.”

Winkelman says he slowly detoxes his patients off dopamine agonists with the help of gabapentinoids or a low-dose opioid, usually over six months or longer, because even a small reduction in dose can cause a big flare-up of symptoms.

Augmentation is a big reason why the American Academy of Sleep Medicine established new recommendations in January 2025 that advise against dopamine agonists to treat RLS.

Winkelman was part of the committee that wrote the new guidelines for adults with RLS. They now recommend:

Iron supplements: If your iron falls in the bottom half of normal, Winkelman says, you may benefit from iron supplementation, though you may not absorb an oral iron supplement. “So for many people, we use intravenous iron, which is readily available, very, very well tolerated and effective for restless legs.”
Alpha 2 delta ligands: Gabapentin, gabapentin enacarbil and pregabalin are now considered first-line medicines for RLS and work by calming the central nervous system. They can have side effects, including sleepiness, unsteadiness, weight gain and brain fog. Winkelman says he starts his patients on a low dose and gradually increases it.
Opioids: Low-dose opioids are also used to manage RLS. The most common is methadone—about one-tenth of the dosage that’s prescribed for chronic pain, Winkelman says. “The good news is that it appears to be stable long term,” he says, “so many of us have had patients on these low-dose opioids for many years with very little change in dose.”
Bilateral high-frequency peroneal nerve stimulation: In 2023, the Food and Drug Administration approved the Nidra Tonic Motor Activation (TOMAC) System to treat moderate to severe RLS symptoms. You wear the devices on your legs, and they electrically stimulate the peroneal nerves to trick your body into thinking you’re walking. Winkelman says he’s had success with Nidra with some of his patients but not all, and none have been able to stop taking their medications.

“It’s more to manage symptoms that develop in people who are on medications and not fully controlled,” he says. “You put it on maybe before bed if you’re having symptoms … and then hopefully it’s helpful and allows you to fall asleep.”

Self-care strategies for RLS

Some other things you can do that might help with your RLS symptoms include:

Regular exercise: Low-impact exercises like walking, stretching and swimming may be helpful, but avoid them close to bedtime.
Proper sleep hygiene: Follow good sleep habits , like going to bed and waking up at the same times daily and keeping your bedroom cool and dark.
Avoid RLS triggers: Don’t drink caffeine or alcohol, and if you smoke, quit.
Leg massage: Massaging your legs at night may be beneficial.
Warm baths: A warm bath before bedtime may calm your RLS symptoms.

When to see your doctor

If you think you have RLS, talk to your doctor, especially if your symptoms are affecting or disrupting your sleep. If you’ve already been diagnosed with RLS, call your doctor if: • Your symptoms get worse• You have side effects from your medications• Your treatment isn’t helping

Conclusion

Restless legs syndrome is a neurological disorder that causes an uncontrollable urge to move the legs, especially at night. It disrupts your sleep and can lead to fatigue and other problems, like depression and anxiety.

Doctors don’t know the exact cause, but it can be linked to genetics, a brain iron deficiency, certain medications and other health conditions. Treatments include iron supplementation, medications like gabapentin, low-dose opioids and lifestyle changes.

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Sarah Gleim is a contributing writer at AARP based in Atlanta. She has also written for WebMD, Forbes, Time Inc., Discovery Communications, HowStuffWorks.com, Atlanta magazine, CNN and more.