®Walking during the day
Walk at a comfortable or moderate pace, fast enough that you can talk but find it a little harder. Don’t leave strenuous exercise until late at night.
20–30 minutes a day2024The American Academy of Sleep Medicine’s updated treatment guideline: iron assessment first
7–10% a yearHow often symptoms gradually worsen (augmentation) with dopamine medicines
35–50%The proportion of patients who may develop augmentation on these medicines within 5 years
12 weeksLength of the randomised trial in which exercise three days a week reduced symptoms
Symptoms
- An urge to move the legs
- An uncomfortable feeling such as tingling, throbbing, itching or aching
- Worse at rest, especially in the evening and at night
- Eases with walking or stretching
- Difficulty falling asleep and waking during the night
- Sometimes a similar feeling in the arms
What causes it?
Often there is no clear cause; it is thought to be linked to iron and dopamine levels in the brain. A family history raises the risk.
- Iron deficiencyA cause that can be corrected; it is linked to iron deficiency anaemia.
- PregnancyCommon, and usually goes away after birth.
- Kidney diseaseEspecially in advanced kidney failure.
- Some medicinesCan trigger or worsen symptoms; your doctor can review your medicines.
What can you do yourself?
1
Move during the day
Exercise regularly during the day. Don’t leave strenuous exercise or large meals until late at night.
2
When symptoms start
Walk, stretch or massage your legs. Do something that takes your mind off them, such as reading or a puzzle.
3
Sleep routine
Go to bed and get up at the same time every day, and avoid daytime naps. Try a warm bath or heat on your legs before bed.
4
Caffeine, alcohol, smoking
Avoid caffeinated drinks after midday and alcohol in the 2 hours before bed, and stop smoking.
To regulate your sleep, see For a good night’s sleep; to unwind in the evening, see Muscle relaxation.
Treatment: what does the 2024 guideline say?
The American Academy of Sleep Medicine’s 2024 guideline made an important change: dopamine medicines, the first choice for many years, are no longer recommended for routine use in most patients.
- Iron assessmentEveryone’s iron levels should be measured, and supplements given according to the results. Iron into a vein (ferric carboxymaltose) receives a strong recommendation, iron by mouth a conditional one.
- Gabapentin and pregabalinMedicines with a strong recommendation.
- Dopamine medicinesPramipexole, ropinirole, rotigotine and levodopa are not recommended for routine use in most patients. With these medicines, symptoms can over time start earlier and spread to other parts of the body (augmentation); this happens in 7–10% of people a year.
- Other optionsCareful use of opioids and high-frequency stimulation of the peroneal nerve in both legs also receive conditional recommendations.
Don’t stop your medicine or change its dose on your own; plan any change with your doctor. If symptoms get worse despite your medicine, ask your doctor about augmentation rather than increasing the dose.
Does exercise help?
In a randomised trial in the US, people with restless legs syndrome did aerobic exercise and leg strengthening three days a week for 12 weeks. In the exercise group, symptom severity fell markedly compared with the group that did not exercise.
- 41 people were enrolled and 23 completed the study; a small study.
- Exercise is also good for sleep and general health.
- The NHS also recommends regular exercise during the day, and walking, stretching and massage when symptoms start.
Exercises at home
Six movements for restless legs
Do the walking and leg strengthening movements during the day, on at least 3 days a week. Use the stretches in the evening and when symptoms start. Don’t leave strenuous exercise until just before bed.
Sit-to-stand from a chair
Sit towards the front of a sturdy chair. Lean forward slightly and stand up without using your arms, then sit down slowly.
10 repetitions, 2 sets, 3 days a weekHeel raises
Hold the back of a chair. Slowly lift both heels off the floor, pause briefly and lower them slowly.
12–15 repetitions, 2 setsBridge
Lie on your back with your knees bent. Squeeze your buttocks and lift your hips, hold for 3 seconds and lower slowly.
10–12 repetitions, 2 setsCalf stretch
Stand facing a wall and step one leg back; keep the back heel on the floor and the knee straight. Bend your front knee and lean forward until you feel a stretch in your calf.
30 seconds on each leg, twice; in the evening and when symptoms startLower calf stretch
Stand as for the calf stretch, but this time bend the back knee slightly too; you will feel the stretch just above the Achilles tendon.
30 seconds on each leg, twiceFrequently asked questions
Can restless legs happen in pregnancy?
Yes, it is common in pregnancy and usually goes away after birth. Tell your doctor, as iron deficiency may be involved; don’t take medicines or supplements in pregnancy without talking to your doctor.
Can I start iron tablets myself?
Your blood levels need to be checked first. The American Academy of Sleep Medicine’s 2024 guideline recommends measuring iron levels in everyone with restless legs syndrome and giving supplements according to the results. Taking iron you don’t need can be harmful.
Do coffee and alcohol make a difference?
They can make symptoms worse. The NHS recommends avoiding caffeine after midday and alcohol in the 2 hours before bed, and stopping smoking.
How is it different from cramp?
A cramp is a painful, involuntary tightening of a muscle and is usually short-lived. In restless legs, there is an urge to move the legs and an uncomfortable feeling; it starts at rest and eases with movement. Nerve damage (neuropathy) can cause similar symptoms; a doctor can tell them apart.
When should you see a doctor?
- If symptoms are stopping you sleeping
- If they are affecting your mood or your daytime life
- If self-help measures haven’t helped
- If symptoms start earlier or spread despite your medicine
- If you have persistent numbness or weakness in the legs, or swelling and pain in one leg
Sources
- NHS. Restless legs syndrome. Page last reviewed 22 September 2025.
- Winkelman JW, Berkowski JA, DelRosso LM, et al. Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2024. doi:10.5664/jcsm.11390. Summary: AASM, Summary of new clinical practice guideline for RLS and PLMD, 13 November 2024.
- HCPLive. AASM updates clinical guidelines for restless legs syndrome. 22 November 2024.
- Aukerman MM, Aukerman D, Bayard M, Tudiver F, Thorp L, Bailey B. Exercise and restless legs syndrome: a randomized controlled trial. J Am Board Fam Med. 2006;19(5):487–493.