Restless Legs Syndrome

Treatment & Sleep Health Solutions

Understanding Restless Leg Syndrome (Willis-Ekbom Disease)

Restless Leg Syndrome (RLS), also known as Willis-Ekbom Disease, is a neurological disorder causing an irresistible urge to move the legs, accompanied by uncomfortable sensations described as crawling, creeping, pulling, tingling, or burning deep within the leg muscles. These symptoms worsen during rest, improve with movement, and peak in the evening and nighttime hours, creating a paradox where legs demand activity just when the body needs to wind down for sleep.

Key Characteristics:

  • Overwhelming urge to move legs during rest

  • Uncomfortable sensations that worsen at night

  • Relief with movement or stretching

  • Often accompanied by periodic limb movements during sleep (PLMS)

  • Can include periodic limb movements that fragment sleep even when unnoticed

Root Causes & Mechanics

Iron Deficiency and Brain Function

Iron deficiency, particularly in the brain, is a primary factor in RLS development. Iron is crucial for dopamine production and function—a neurotransmitter that regulates movement and muscle control. Brain iron deficiency can occur even when blood iron levels appear normal, explaining why specialized testing and iron therapy can be effective even with "normal" blood tests.

Dopamine System Dysfunction

Impaired dopamine function, whether from iron deficiency, medications, or other factors, leads to the characteristic restless sensations and movement urges. This explains why dopamine-blocking medications worsen RLS while dopamine-enhancing drugs can provide relief (though with potential complications).

Genetic and Environmental Factors

RLS often runs in families, with genetic variants increasing susceptibility. Environmental triggers include certain medications, pregnancy, kidney disease, and sleep deprivation.

Health Consequences of Untreated RLS

Cardiovascular Impact

  • Increased blood pressure: Periodic limb movements cause repeated blood pressure spikes during sleep

  • Heart rhythm disorders: Higher rates of atrial fibrillation and other rhythm problems

  • Cardiovascular disease risk: Chronic sleep disruption contributes to heart disease and stroke risk

Sleep and Cognitive Effects

  • Sleep fragmentation: Limb movements cause brief awakenings that prevent restorative deep sleep

  • Daytime fatigue: Poor sleep quality leads to exhaustion and reduced performance

  • Mental health impact: Increased rates of depression and anxiety related to chronic sleep disruption

  • Cognitive impairment: Problems with concentration, memory, and decision-making

Systemic Health Effects

  • Immune dysfunction: Chronic sleep disruption suppresses immune function

  • Inflammatory processes: Poor sleep promotes systemic inflammation

Worsening of other conditions: RLS can exacerbate sleep apnea, particularly at higher altitudes

The Rebis Comprehensive Treatment Approach

Advanced Diagnostic Assessment

Our team uses the Five Finger Approach to evaluate all potential contributors to RLS symptoms, ensuring comprehensive identification of underlying factors.

Specialized Iron Testing

  • Ferritin levels: Many RLS patients have "normal" but low ferritin levels

  • Transferrin saturation: Low levels (under 17%) indicate iron deficiency

  • Complete iron panel: Comprehensive evaluation of iron metabolism

Sleep and Movement Analysis

  • Sleep study evaluation to document limb movements and their impact on sleep quality

  • Assessment of sleep patterns and environmental factors affecting symptoms

Medication and Lifestyle Review

  • Identification of medications that may worsen RLS (antidepressants, antihistamines, anti-nausea drugs)

  • Evaluation of caffeine, alcohol, and other substances affecting symptoms

Iron Replacement Therapy

Oral Iron Supplementation

  • For patients with low ferritin levels (typically below 30-50 ng/mL), oral iron can be highly effective. Treatment includes optimization strategies for absorption and monitoring for progress.

Intravenous Iron Therapy (coordinate but do not provide)

  • When ferritin levels are higher but functional iron deficiency exists, IV iron may be necessary. About 50% of patients experience significant improvement, often within days, with effects lasting approximately one year.

Medication Management (When Appropriate)

While addressing underlying causes is preferred, some patients benefit from medications with careful monitoring to avoid complications like "augmentation" (worsening symptoms over time with dopaminergic drugs).


Alternative Medications

  • Alpha-2-delta ligands (gabapentin, pregabalin) that don't carry augmentation risk

  • Other options selected based on individual patient factors and response

Integrative Health Approaches

Nutritional Support

  • B-vitamin optimization: Deficiencies in folate, B12, and other B vitamins can contribute to symptoms

  • Magnesium: Important for muscle and nerve function

  • Anti-inflammatory nutrition: Dietary approaches to reduce inflammatory burden

Sleep and Lifestyle Optimization

  • Sleep hygiene strategies tailored for RLS patients

  • Circadian rhythm support and stress management

  • Evening movement strategies and exercise timing

Physical Approaches

  • Specific stretching and movement techniques for symptom relief

  • Physical therapy approaches for muscle and nerve function

  • Timing strategies for activity and rest

Connection to Other Health Conditions

RLS and Sleep Apnea

RLS can worsen sleep apnea through increased sympathetic nervous system activation and sleep fragmentation. Conversely, sleep apnea can worsen RLS symptoms, creating a complex bidirectional relationship requiring coordinated treatment.

RLS and Cardiovascular Disease

The chronic inflammation and stress responses associated with RLS contribute to long-term cardiovascular risk beyond the immediate effects of limb movements.

RLS and Hormonal Changes

Hormonal fluctuations, particularly estrogen and progesterone changes during pregnancy and menopause, significantly affect RLS symptoms. Hormone replacement therapy can sometimes worsen the condition.

Treatment Expectations and Outcomes

Timeline for Improvement

  • Iron deficiency correction: Improvement often occurs within days to weeks of appropriate iron therapy

  • Medication effects: When necessary, symptom improvement typically occurs within days to weeks

  • Lifestyle approaches: Gradual improvement over weeks to months as underlying factors are addressed

Long-term Management

Successful RLS management requires ongoing attention to contributing factors, including periodic iron status monitoring, continued sleep hygiene, and regular follow-up to ensure sustained symptom control.

Frequently Asked Questions: Restless Leg Syndrome

  • RLS has specific characteristics: an urge to move accompanied by uncomfortable sensations, symptoms that worsen during rest, improvement with movement, and evening/nighttime worsening pattern.

  • Yes, brain iron deficiency can occur with normal blood levels. Specialized testing and sometimes trial iron therapy can determine if iron deficiency contributes to your symptoms.

  • Many patients with iron-deficiency-related RLS achieve long-term control with iron replacement. Others may need ongoing medication, but the goal is using the lowest effective doses while addressing root causes.

  • RLS increases cardiovascular disease risk, including high blood pressure and heart rhythm disorders. Sleep disruption also affects immune function, mental health, and cognitive performance.

  • RLS can worsen due to progressive iron deficiency, medication effects (particularly augmentation from dopaminergic drugs), worsening of other health conditions, or hormonal changes.

  • RLS often runs in families, with genetic factors playing important roles. Having family members with RLS increases risk, but environmental factors like iron status also contribute significantly.


  • RLS commonly develops or worsens during pregnancy, particularly in the third trimester, likely related to iron deficiency and hormonal changes. Symptoms often improve after delivery but may persist if underlying factors aren't addressed.

  • Our multidisciplinary team uses the Five Finger Approach to examine all potential contributors, focusing on identifying and treating root causes like iron deficiency rather than just managing symptoms, leading to more comprehensive and lasting improvements.