What Is Restless Leg Syndrome? A Guide to the Science, Symptoms, and Solutions

You are finally in bed. The house is quiet, the lights are off, and your body is ready to call it a day. Then, just as you start to settle in, your legs stage a full-blown revolt. Not painful exactly, but weird – tingling, crawling, twitching, buzzing. Unpleasant enough to ruin the moment and persistent enough to send you pacing down the hallway at 11:48 p.m., wondering if you are losing your mind. If this sounds familiar, you may have had a brush with Restless Leg Syndrome, a condition that shows up uninvited and makes itself comfortable exactly when you are trying to be still.

Restless Leg Syndrome, or RLS, is one of those conditions that feels difficult to describe until you have lived it. It is classified as a neurological sensorimotor disorder, which is a fancy way of saying that your brain and nerves are misfiring in a way that creates movement urges in the legs. The hallmark symptom is an irresistible need to move, usually the legs and sometimes the arms, especially in the evening and at night. Moving around can temporarily relieve it, but the moment you sit or lie down again, the discomfort creeps right back. Some people describe it as ants under the skin. Others call it a deep itch, an electric sensation, or just something that feels so wrong it makes staying still impossible.

The science behind RLS is still evolving, which is a polite way of saying we are figuring it out as we go. That said, we do know that dopamine, the neurotransmitter responsible for regulating movement, plays a major role. When dopamine signaling in the brain goes out of balance, it can lead to all kinds of motor mischief. There is also a well-documented connection to iron levels. Iron is essential for dopamine synthesis, and even people with “normal” blood iron can have low iron in the brain. That is why clinicians will often check ferritin levels, a marker of iron storage, when evaluating someone with RLS. Low ferritin is a known trigger, and replenishing iron stores can sometimes work wonders.

Restless Leg Syndrome does not always travel alone. It frequently tags along with other medical conditions including diabetes, kidney disease, peripheral neuropathy, and pregnancy. In fact, pregnant individuals often develop RLS in the third trimester only to have it disappear after delivery. There is also a strong genetic component, and some people begin experiencing symptoms early in life without any clear cause at all. Regardless of where it comes from, the result is predictably the same: disrupted sleep, elevated stress, and an increasing dread of bedtime.

Diagnosis is primarily based on clinical history. There is no magic lab test or scan. What matters is the pattern: symptoms that get worse with rest, improve with movement, are more severe in the evening, and create a strong and often unbearable need to move. In certain cases, a sleep study may be ordered to evaluate for periodic limb movement disorder, a related condition that causes rhythmic leg jerks during sleep and often coexists with RLS.

Once the diagnosis is made, the first step is to identify contributing factors. If ferritin is low, iron supplementation becomes a priority. Oral iron is the usual starting point, but intravenous iron may be considered if absorption is an issue. When symptoms are moderate to severe, medications can help. Dopamine agonists like pramipexole and ropinirole increase dopamine activity and have been approved for RLS. Medications like gabapentin and pregabalin can calm nerve overactivity and reduce the sensory discomfort. In rare and more severe cases, opioids or benzodiazepines are prescribed, although these are generally last-resort options when others have failed.

Lifestyle changes are equally important. Sleep hygiene matters. Maintaining a consistent bedtime, minimizing screen time in the evening, and creating a calming bedtime routine can help reset your brain’s internal rhythm. Moderate exercise during the day helps too, but overstimulation at night can make things worse. Alcohol and caffeine are frequent culprits, so reducing or eliminating them is usually a smart move. For some people, relief comes in the form of warm baths, Epsom salt soaks, compression wraps, or even a good old-fashioned leg massage. Weighted blankets or heating pads can provide a kind of sensory distraction that makes the symptoms less noticeable, if not entirely gone.

There is also increasing curiosity about whether ketamine therapy could play a role in alleviating Restless Leg Syndrome. Although there is no large-scale clinical trial yet focused solely on RLS, ketamine’s known effects on NMDA receptor modulation and glutamatergic signaling suggest it may have potential in reducing central sensitization and abnormal sensory processing. A few case reports and small studies have hinted that ketamine may help with neuropathic symptoms and movement-related discomfort, which opens the door to future research. For now, while ketamine therapy is not considered a first-line treatment for RLS, it remains an area of great interest, particularly for individuals whose symptoms overlap with chronic pain or severe sensory disturbances.

There is no universal fix for RLS, but that does not mean there is no relief. For some, the answer is as straightforward as iron supplementation. For others, it is a balance of medication, routine, and some trial and error. And for many, it starts with being heard, with someone taking the time to understand what bedtime has become for them. The good news is that RLS is manageable. The path forward may not be linear, but it exists.

At Kalea Wellness, we believe that rest is not a luxury. It is medicine. If your legs are stealing your sleep and the nights are getting longer than they should be, we are here to help you find stillness again, in whatever form that takes.There is a path to stillness. You just have to take the first step.