The 11 Best Treatments for Restless Legs Syndrome

Key takeaways

• Usually, the initial approach to managing restless legs syndrome (RLS) is to determine any underlying cause. Frequent contributors include everyday behaviors, medication side effects, and coexisting medical problems.
• Treatment options for RLS range from iron supplementation and prescription drugs to lifestyle adjustments, like establishing consistent sleep habits.
• RLS can markedly reduce quality of life by disrupting sleep and daily activities, so timely treatment is important.

Restless legs syndrome (RLS), also called Willis-Ekbom disease, produces unpleasant sensations most commonly in the legs. People describe these sensations as tingling, crawling, or creeping feelings that create an intense need to move the affected limb.

RLS symptoms usually appear when a person is sitting, resting, or asleep, and they frequently occur at night. The associated movements are known as periodic limb movements of sleep (PLMS). Because of these involuntary movements, RLS can lead to substantial sleep disturbance.

Some individuals have primary RLS, which lacks an identifiable cause. Others experience secondary RLS, often linked to nerve disorders, pregnancy, iron deficiency, or advanced kidney disease.

Most people with RLS experience mild symptoms. However, when symptoms are moderate to severe, RLS can greatly affect daily life. It can prevent adequate sleep and cause problems with daytime concentration, work performance, and social engagement.

These consequences can contribute to anxiety and depression. Over time, symptoms may worsen and can even extend to other areas, like the arms (1).

Given the impact RLS can have, treating it matters. Treatments vary because the exact cause of RLS is uncertain. Some researchers point to abnormalities in the brain chemical dopamine; others suggest circulatory issues may play a role.

Below we outline effective treatments for RLS. Some you can try yourself; others should be discussed with your clinician, who can help design a treatment strategy to reduce your RLS symptoms.

1. Ruling out potential causes

The first move in tackling RLS is to determine whether a specific cause is present. While factors like genetics or pregnancy are often unavoidable, other triggers can be modified.

These triggers may include daily habits, medications you take, existing medical conditions, or other influences.

Habits

Consumption of caffeine, alcohol, and tobacco can aggravate RLS symptoms. Reducing or avoiding these substances may help lessen your symptoms (2).

Medications

Certain drugs can cause or worsen RLS. Examples include: (1, 2, 3).

• older antihistamines like diphenhydramine (Benadryl)
• anti-nausea agents such as metoclopramide (Reglan) or prochlorperazine (Compro)
• antipsychotics like haloperidol (Haldol) or olanzapine (Zyprexa)
• lithium (Lithobid)
• SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), or escitalopram (Lexapro)
• tricyclic antidepressants like amitriptyline (Elavil) or amoxapine (Asendin)
• tramadol (Ultram)
• levothyroxine (Levoxyl)

Tell your clinician about all medications and supplements you use, both prescription and over-the-counter. Discuss whether any of them could be worsening your RLS, particularly if they appear on the list above.

Health conditions

Certain medical conditions are associated with RLS. End-stage renal disease (ESRD) and diabetic neuropathy have links to RLS. Iron-deficiency anemia also shows a strong association (see iron below) (4, 5, 6).

Discuss with your healthcare provider how your medical history might influence your RLS, especially if you have any of these conditions.

Other triggers

Some people report that high sugar intake or tight clothing worsens their RLS. Although evidence is limited, you may want to experiment to see what seems to affect your own symptoms.

2. Healthy sleep habits

Good sleep hygiene is recommended for everyone, and it’s particularly important for people who have sleep problems like RLS.

While better sleep may not eliminate RLS symptoms, it can help offset the sleep loss caused by the disorder. Try these suggestions to make your rest more restorative.

• Go to bed and get up at the same times each day.
• Keep your bedroom cool, quiet, and dark.
• Minimize distractions like TV and phones in the bedroom.
• Avoid screens for two to three hours before bedtime. Blue light from these devices can disrupt your circadian rhythm and affect natural sleep patterns (7).

3. Iron and vitamin supplements

Iron deficiency is believed to be a major contributor to RLS. Multiple studies indicate that iron supplementation can reduce RLS symptoms (1, 3).

A simple blood test can detect iron deficiency, so if you suspect it, consult your doctor.

If iron deficiency is confirmed, your physician may recommend oral iron supplements available at pharmacies. In certain cases, intravenous iron may be necessary (1, 8).

Vitamin D deficiency may also be linked to RLS. A 2014 trial found that vitamin D supplementation improved symptoms in people with both RLS and vitamin D deficiency (9).

For patients on hemodialysis, vitamins C and E might help reduce RLS symptoms (4, 10).

4. Exercise

Physical activity can improve how you feel if you have RLS.

The National Institutes of Health notes that moderate exercise may alleviate mild RLS symptoms (3).

A 2006 trial of 23 people with RLS found that aerobic and lower-body resistance training three times weekly for 12 weeks significantly reduced symptoms (11).

Other studies also report exercise as beneficial for RLS, especially in those with ESRD (4, 12).

Given evidence that activity enhances sleep, exercise is a logical recommendation for RLS patients (13).

The Restless Legs Foundation advises exercising in moderation — avoid overexertion that leads to soreness, as that could aggravate RLS (14).

5. Yoga and stretching

Yoga and stretching, like other forms of exercise, have been shown to benefit people with RLS (12).

A small eight-week study in 2013 of 10 women found yoga reduced their RLS symptoms and improved mood and stress, potentially enhancing sleep. A 2012 study also reported improved sleep in 20 women with RLS after yoga practice (15, 16).

Another trial found stretching significantly improved RLS symptoms in hemodialysis patients (17).

Although the exact reasons why yoga and stretching help are unclear and more research is needed, incorporating calf and upper-leg stretches into daily routines may be worthwhile.

6. Massage

Massaging the leg muscles can reduce RLS symptoms. Major health bodies, including the NIH, recommend massage as a home therapy (3, 18).

Although large-scale research is limited, a 2007 case report documented benefits.

A 35-year-old woman received 45-minute leg massages twice weekly for three weeks and experienced improved RLS symptoms during treatment. Techniques included Swedish massage and direct pressure on leg muscles (20).

Her symptoms improved after two sessions and did not return until two weeks after the massage course ended (20).

The study’s author suggested massage might boost dopamine release or improve circulation as reasons for its effect. Massage also promotes relaxation, which may aid sleep (20, 21, 22).

7. Prescription medications

Drugs are an important option for moderate to severe RLS. Dopaminergic agents are often the first-line prescriptions. They can relieve symptoms but may cause side effects and other complications (1).

Other drug classes can also reduce RLS symptoms without the same issues.

Dopaminergic drugs

Dopaminergic medications boost dopamine activity in the brain, a neurotransmitter integral to normal movement (1).

They likely help because RLS is associated with disrupted dopamine function.

Three dopaminergic agents are FDA-approved for moderate to severe primary RLS:

• pramipexole (Mirapex) (23)
• ropinirole (Requip) (24)
• rotigotine (Neupro) (25)

Although effective, long-term dopaminergic therapy can worsen symptoms in a process called augmentation. To reduce this risk, physicians usually start at the lowest effective dose (1, 26).

These drugs may also lose effectiveness over time. To delay or avoid these issues, doctors might combine dopaminergic agents with other medications for RLS (1).

Gabapentin

Gabapentin (Horizant), an anticonvulsant, is another FDA-approved medication for RLS (27).

Its exact mechanism in RLS is unclear, but studies support its benefit (28).

In one trial, 24 RLS patients received gabapentin or placebo for six weeks; those on gabapentin achieved better sleep and fewer leg movements (28).

Another comparison between gabapentin and ropinirole found similar symptom relief with each drug in a small crossover study (29).

Benzodiazepines

Benzodiazepines, used for anxiety and insomnia, such as clonazepam (Klonopin), are sometimes prescribed alongside other RLS medications (30).

While they may not directly reduce RLS sensations, their sleep-promoting effects can be valuable for patients with disrupted sleep (30).

Opioids

Opioids, typically used for pain, can be an option when other treatments fail or augmentation occurs. They are used cautiously and at low doses (26, 8).

Extended-release oxycodone/naloxone (Targinact) has shown benefit for RLS and sleep improvement (4), but due to tighter guidelines for opioid use, it should be a last-resort choice.

As with all opioids, careful medical supervision is required because of risks of dependence and misuse.

8. Foot wrap (restiffic)

A specialized foot wrap has been found to reduce RLS symptoms.

Known as Restiffic, the wrap applies pressure to specific points on the sole. This pressure sends signals to the brain that help the affected muscles relax, easing RLS symptoms (31).

A 2013 trial of 30 participants using the foot wrap for eight weeks reported significant improvements in RLS symptoms and sleep quality (32).

Restiffic is prescription-only and, according to the manufacturer, costs around $200. Insurance coverage may vary (31).

9. Pneumatic compression

If you’ve stayed overnight in a hospital, you may have seen pneumatic compression devices (PCDs). These use an inflatable sleeve that rhythmically squeezes and releases the leg.

PCDs are commonly used in hospitals to boost circulation and reduce clot risk. Improved blood flow could explain why pneumatic compression has helped some people with RLS (33).

Some researchers propose that low oxygen levels in the limbs might trigger RLS, and increased circulation through muscle contractions could be a compensatory response (33).

Research shows mixed results: a 2009 study of 35 people using a PCD for at least an hour daily for a month reported marked improvements in symptoms, sleep, and daytime function, though not all studies have replicated these findings (33, 34).

Some PCDs are rented, others are purchased OTC or by prescription. Insurance coverage may be easier to obtain for patients who cannot tolerate RLS medications (33, 35).

10. Tonic motor activation (TOMAC)

Tonic motor activation (TOMAC) stimulates the peroneal nerves that serve movement and sensation in the lower legs. The FDA approved the NTX100 TOMAC System in 2023 (36).

A 2023 randomized clinical trial of 133 participants found TOMAC effective for medication-resistant RLS, with no serious adverse events aside from mild local irritation (37).

TOMAC is a noninvasive clinician-applied device using two treatment units and electrode patches placed externally just below the knee over the head of the fibula (36).

11. Near-infrared spectroscopy (NIRS)

A noninvasive approach not yet widely used may help reduce RLS symptoms.

Near-infrared spectroscopy (NIRS) employs long-wavelength light that penetrates the skin and dilates blood vessels, increasing circulation (33).

One hypothesis suggests RLS stems from low oxygen levels in affected limbs; increasing blood flow with NIRS may raise oxygenation and reduce symptoms (33).

Several studies report positive outcomes. One treated 21 patients three times weekly for four weeks and observed notable improvements in circulation and symptoms (38).

Another trial delivering twelve 30-minute NIRS sessions over four weeks found symptoms significantly reduced, with benefits lasting up to four weeks post-treatment (39).

NIRS devices are available for purchase online, ranging from several hundred to over $1,000 (33).

Treatments with less scientific backup

The treatments above have some evidence supporting them. The following options have less robust data but might still benefit certain people with RLS.

Hot and cold treatments

Although research is limited, many health organizations, including the Restless Legs Syndrome Foundation, recommend heat or cold therapies (40).

Suggestions include taking a warm or cold bath before bedtime or applying hot/cold packs to the legs (18).

Some people’s symptoms worsen in cold, others in heat, which may explain why these treatments help some individuals.

Repetitive transcranial magnetic stimulation (rTMS)

rTMS, a noninvasive procedure commonly used for depression, may alleviate RLS symptoms. Research is preliminary but promising (4, 41, 42).

rTMS applies magnetic pulses to brain regions. One idea is that these pulses increase dopamine release; another proposes they reduce hyperactivity in brain areas linked to RLS (43).

In a 2015 study, 14 RLS patients received 14 rTMS sessions over 18 days, which significantly improved symptoms and sleep, with effects lasting at least two months post-treatment (44).

Transcutaneous electrical nerve stimulation (TENS)

TENS delivers small electrical currents to the body to ease pain.

Evidence for TENS in RLS is limited, but it may help by providing counterstimulation similar to vibrating pads. One report described complete symptom relief in a man using regular TENS combined with vibration therapy (33, 45).

Acupuncture

Acupuncture can benefit various conditions and may help RLS.

A 2015 trial of 38 RLS patients treated with acupuncture for six weeks showed a marked reduction in abnormal leg activity (46).

Further research is needed to confirm acupuncture’s reliability for RLS.

Surgery for varicose veins

For some individuals with circulatory disorders, surgery may be the most effective RLS treatment (12).

Varicose veins are enlarged leg veins that can lead to superficial venous insufficiency (SVI), where blood pools instead of circulating properly.

In a 2008 study, 35 people with SVI and RLS underwent endovenous laser ablation for varicose veins; 84 percent experienced significant improvement or complete resolution of RLS symptoms after surgery (47).

As with other options, more research is necessary to validate this surgical approach for RLS.

The takeaway

RLS can cause significant discomfort, sleep disruption, and impaired daily functioning, so addressing it should be a priority. Start by trying the at-home remedies listed here, and consult your physician if they don’t provide sufficient relief.

Your doctor can explain these treatments further and recommend which approach — or combination of approaches — might suit you best.

Remember that responses vary: what helps one person may not help another, and you may need to try multiple medications or therapies. Keep working with your clinician until you find a plan that effectively manages your RLS (48).