Strange night-time leg sensations? Doctors warn it may be a disease: Check restless legs syndrome symptoms, causes and treatments

It usually starts subtly. You go to bed feeling tired, ready to fall asleep, but just as you begin to drift off, a strange discomfort develops in your legs, tingling, pulling, or even a crawling sensation deep inside. The only way to ease it is to move: stretch, shake your legs, or get up and walk. Many people dismiss this nightly disturbance as stress or a temporary sleep issue. However, doctors say it could point to a specific and surprisingly common condition: restless legs syndrome (RLS).

A clinical review published in JAMA suggests that nearly 8% of adults experience these symptoms annually, with close to 3% reporting moderate to severe episodes multiple times a week. In India, its prevalence is estimated to be around 6%.

What Is Restless Legs Syndrome?

Manjari Tripathi, head of neurology at All India Institute of Medical Sciences, noted that RLS is more commonly observed in individuals with anaemia, kidney failure, or those residing at high altitudes.


“Typically, symptoms begin in the evening when a person goes to bed to sleep but can’t because of an uncomfortable crawling or tingling sensation in the legs,” she explained. “It can occur daily and become chronic, or it may appear intermittently, especially during prolonged sitting, such as on long flights.”

She added that many patients find the sensation difficult to describe because it feels deep within the legs and is hard to pinpoint. This often delays seeking medical advice.

How RLS Differs from Ordinary Restlessness

According to Neha Kapoor, associate director and head of neurology at Asian Hospital, the defining feature of RLS is its pattern.

“Patients describe a strong urge to move legs that worsens at rest and improves with movement,” she said.

Because the symptoms are subjective, many people attribute them to anxiety, ageing, cramps, or circulation problems. “Unless someone asks the right questions, it can go unrecognised,” she said, highlighting that symptoms worsening in the evening is an important diagnostic sign.

The Role of Iron Deficiency

Iron deficiency is considered a major contributing factor. Even if haemoglobin levels are within normal limits, low iron stores can trigger or aggravate RLS symptoms.

Prof Tripathi emphasised the need for proper evaluation, including serum ferritin testing along with vitamin B12, vitamin D, calcium levels, kidney function, and blood sugar checks. “It is often misunderstood or mistaken for neuropathy or labelled psychological, leading to underdiagnosis. Yet it is relatively easy to diagnose and treat.”

Why Early Treatment Matters

PN Renjen, senior consultant of neurology at Indraprastha Apollo Hospitals, warned that untreated RLS can repeatedly disrupt sleep over long periods. This may result in persistent fatigue, difficulty concentrating, mood changes, irritability, and even depression. He noted that timely treatment can prevent years of unnecessary sleep disturbance.

Treatment and Lifestyle Changes

Treatment approaches have changed over time. Dopamine-based medications, once commonly prescribed, are now used more cautiously because prolonged use can sometimes worsen symptoms. Current medical guidelines increasingly recommend gabapentinoids.

Lifestyle modifications can also make a difference. Reducing caffeine intake particularly after the afternoon, avoiding alcohol, and maintaining consistent sleep routines may help manage symptoms.

Don’t Ignore Persistent Night-Time Restlessness

RLS often hides behind the assumption of “just poor sleep.” Doctors stress that ongoing night-time discomfort that consistently disrupts sleep is not normal and should be evaluated. Recognising the condition early can significantly improve quality of life and restore restful sleep.