Throughout the day the patient may feel compelled to move his or her legs in order to relieve the symptoms. At night these unpleasant sensations and the resulting uncontrollable urge to move the legs can often disturb sleep. About 80% of patients with RLS also experience periodic limb movement disorder, also called PLMD, in which the leg muscles involuntarily contract every 20 to 40 seconds during sleep, occasionally arousing the patient, who, however, is usually unaware of the cause of the interruption. Symptoms of PLMD and RLS are usually worse at night right after midnight and at their lowest level between 9:00 and 11:00 AM ..

The primary cause of restless legs syndrome is not known. Leg restlessness at bedtime occurs in more than 15% of adults. It is more common in women than in men, and its prevalence increases with age. Up to half the people with restless legs syndrome have a family history of the disorder. In about 40% of patients, it begins in adolescence. RLS and periodic limb movement disorder are thought by some experts to be strongly associated with attention-deficit hyperactivity disorder (ADHD) in some children.

As many as 25% of pregnant women experience restless legs. People with many medical conditions are at risk for restless legs or periodic limb movement disorder; such disorders include diabetes, iron or folic acid deficiency, rheumatoid arthritis, anemia, kidney failure, emphysema, chronic alcoholism, and many muscle and nerve disorders.

In one study, half of patients with systemic lupus erythematosus had abnormalities in the periodic limb movement index. Smoking, caffeine, stress, fatigue, and prolonged exposure to cold can exacerbate symptoms. Drugs that worsen or provoke the condition include many antidepressants, antipsychotic drugs, beta blockers, antihistamines, oral decongestants, diuretics, asthma drugs, and the antidepressants selective serotonin reuptake inhibitors (SSRIs).

Restless legs syndrome and benign nocturnal leg cramps rarely have any serious consequences. In some cases, however, severe and persistent symptoms can cause chronic insomnia and considerable mental distress. Insomnia, itself, if persistent, can be serious. Insomnia can lead to reduced concentration, decreased memory, and impaired task performance.

A physician should first try to treat any underlying medical condition that may be causing restless legs. In the elderly, iron deficiency is often a cause and in such cases iron supplements can produce a significant reduction in symptoms. If the cause cannot be determined, it is best to try sleep hygiene and relaxation methods first. Hot baths or cold compresses may help. These therapies can provide added benefits, even if drug therapy is required.

Some patients report that symptoms do not occur if they sleep late in the morning, so if it is professionally feasible, changing sleep patterns may be helpful. If medications being taken for other medical conditions worsen RLS, a physician may be able to prescribe alternatives.

The term sleep hygiene is used to describe a holistic approach to sleeping that encompasses many behaviors. Everyone should practice good sleep hygiene to prevent or relieve insomnia, or simply to safeguard sleep, making it more restful and pleasurable. Consider the following:

• 1. Establish a regular time for going to bed and getting up in the morning and stick to it even on weekends and during vacations.
• 2. Use the bed for sleep and sexual relations only, not for reading, watching television, or working; excessive time in bed seems to fragment sleep.
• 3. Avoid naps, especially in the evening.
• 4. Exercise before dinner. A low point in energy occurs a few hours after exercise; sleep will then come more easily. Exercising close to bedtime, however, may increase alertness.
• 5. Take a hot bath about an hour and a half before bedtime. The body temperature then begins dropping rapidly, which may help sleep after that time. (Taking a bath shortly before bed increases alertness.)
• 6. Do something relaxing in the half-hour before bedtime. Reading , meditation, and a leisurely walk are all appropriate activities.
• 7. Keep the bedroom relatively cool and well ventilated.
• 8. Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
• 9. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
• 10. Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
• 11. Avoid caffeine in the hours before sleep.
• 12. Quitting smoking not only brings many health benefits to any smoker, it eliminates the effects of nicotine that contribute to sleep loss.
• 13. Patients who cannot sleep after 15 or 20 minutes should get up and go into another room, read or do a quiet activity using dim lighting until they are sleepy again. (Don't watch television, which emits too bright a light.)
• 14. One study showed that sleeping alone is more restful than sleeping with another person. If a person with insomnia is distracted by a sleeping bed partner, moving to the couch for a couple of nights might be useful.

Exercise may be one of the best ways to achieve healthy sleep. A recent study found that people with minor sleep disturbances improved after four months of brisk walking 30 minutes four times a week. Another recent study also reported that sleep improved in a group of elderly people who exercised regularly. Regular, moderate exercise may help prevent RLS (and is, in any case, healthful). Some patients report that either bursts of excessive energy or long sedentary periods worsen symptoms.

The American Academy of Sleep Medicine recommends medications only for persons who fulfill the diagnostic criteria and who experience excessive sleepiness that occurs secondary to RLS or periodic limb movement disorder. Your physician will help you decide which is best for you.

Before taking stronger medications, people should try over-the-counter pain relievers, such as acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs), which include ibuprofen (Advil, Motrin, Rufen), naproxen (Anaprox, Naprosyn, Aleve), and ketoprofen (Orudis KT, Aktron). Some people report that vitamin E (800 to 1200 IU per day) and calcium supplements may help.