Diagnosing Restless Legs Syndrome

Do you have the urge to move your legs come bedtime? Is this sensation disrupting your sleep? Find out if it’s RLS.

Restless legs syndrome is a common problem, affecting some 12 million Americans in the United States. But research suggests that many people with the condition may go undiagnosed — largely because they either don’t recognize the symptoms or misattribute them to stress, aging, muscle cramps, or arthritis, according to the National Institutes of Health.

As bothersome as the strange symptoms of restless legs syndrome (RLS) can be, they can also help your doctor diagnose the problem because they’re so specific. “Restless legs syndrome is really a clinical diagnosis,” says Ritu Grewal, MD, a sleep physician and pulmonologist with the Jefferson Sleep Disorders Center in Philadelphia. “We really don’t have to run any tests to make the diagnosis.”

In other words, doctors don’t need to hook you up to sensors and watch you sleep overnight to figure out what’s interrupting your snoozing — something they typically do for other sleep disorders. However, since you’re probably going to be visiting your doctor during the day, when the condition isn’t a problem, it’s important for you or your sleeping partner to be able to observe your restless legs symptoms at night and describe them later.

Symptoms of Restless Legs Syndrome

Dr. Grewal says that when people have restless legs syndrome, they start complaining of odd sensations at night or in the evening hours — it may be pain, a tingling sensation, or just some discomfort. The condition is associated with an urge to move the legs, which is very characteristic. “Patients just can’t go to sleep; they have to keep moving around. Then they take a longer time to fall off to sleep, and the quantity of sleep gets shortened; that can lead to daytime sleepiness.”

According to the Restless Legs Syndrome Foundation, you need to exhibit the following symptoms to be diagnosed with RLS:

  • Restless legs. As the name of the condition implies, this urge can be accompanied by strange sensations in the legs. These sensations may be painful, and according to the foundation, patients have many different ways to describe these sensations. People may feel something similar to electric shocks, fizzy bubbles from a soft drink, crawling worms, or a deep itching or aching inside their legs.
  • Problems that arise while resting. RLS symptoms kick in or become worse while you’re relaxed, typically while you’re sitting or lying down. The longer you’re at rest, according to the foundation, the more likely you are to develop symptoms.
  • Movement relieves symptoms. If you have RLS, the odd sensations and the urge to move either go away completely or subside somewhat once you start moving your legs. Relief typically occurs quickly, after you move or rub your legs. However, you may have the sense that the symptoms will start up again as soon as you stop moving your legs.
  • Symptoms follow a time pattern. The sensations and urge to move your legs only occur once the sun sets, or they grow worse around this time. Other conditions can cause pain and uncomfortable sensations in your legs, like neuropathy (nerve damage) or muscle pain caused by poor blood flow, Grewal says. However, knowing that your symptoms are most troublesome at night and start when you’re at rest can help the doctor rule out other possible disorders, she says. Your doctor may order diagnostic tests, checking your blood for example, to see if you have an underlying condition that’s causing the RLS. Conditions and factors associated with restless legs syndrome include diabetes, kidney disease, and low iron levels.

Pay close attention to your body and sleeping habits — if the signs point to RLS, your doctor can help.

By Jennifer Acosta Scott – Medically reviewed by Pat F. Bass III, MD,