How to recognise restless legs syndrome and what to do next
You lie down, and within minutes your legs feel like they're being pulled from the inside. There's a crawling, aching, restless sensation that no position relieves. The only thing that helps is getting up and pacing, but the moment you lie back down, it starts again. For many Adelaide residents, this is a nightly reality they've never had a proper name for. Restless legs syndrome, also known as Willis-Ekbom disease, affects an estimated 5, 15% of Australian adults, making it far more common than most people realise. It has clear diagnostic criteria, identifiable causes, and a range of effective treatments. The challenge is knowing what to ask for.
This article walks you through how to recognise the condition, which blood tests to specifically request, how RLS can overlap with sleep apnoea in ways that surprise people, and what the most current treatment guidance actually recommends. By the end of this article, you'll have a clear picture of your next steps, whether that means a GP visit, a sleep study, or both.
What restless legs syndrome actually feels like
RLS is diagnosed entirely from symptoms. There is no blood test, scan, or sleep study that confirms it, which is one reason it gets missed for so long. Current international diagnostic criteria (per the International Restless Legs Syndrome Study Group) require all five of the following features to be present: an urge to move the legs, usually with uncomfortable sensations; symptoms that start or worsen during rest or inactivity; symptoms that are at least partially relieved by movement; symptoms that are worse in the evening or at night; and symptoms that aren't better explained by another condition such as leg cramps, arthritis, or venous stasis.
The sensations people describe vary considerably from person to person. Some report crawling or pulling feelings deep in the muscle. Others describe aching, throbbing, burning, or a restlessness so hard to pin down that they struggle to explain it to a doctor. What ties these descriptions together is that lying still becomes almost impossible, and the urge to move the legs brings temporary relief but not a solution.
More than 90% of people with RLS also report insomnia, typically difficulty falling or staying asleep. Despite this, RLS is significantly underdiagnosed in Australia because many people attribute their symptoms to general poor sleep, anxiety, or just getting older. If the five-feature pattern above describes your nights, it's worth naming it correctly and having a direct conversation with your GP.
Restless legs syndrome causes and the tests worth requesting by name
Iron deficiency
Iron deficiency has the most consistent clinical and mechanistic evidence as a cause of RLS. Iron is essential for dopamine production in the brain, and low iron stores, even without full anaemia, can trigger or worsen symptoms significantly. When you see your GP, specifically request a ferritin level rather than a standard iron study panel alone. Current RLS guidelines recommend treating iron when ferritin is below 75 ng/mL, even if your GP would otherwise consider the result borderline normal. Also ask for transferrin saturation; a result below 20% alongside a low ferritin reading strengthens the case for iron therapy considerably.
Pregnancy-related RLS
Pregnancy affects 25, 40% of women and is one of the most common settings for restless legs syndrome to appear for the first time, though symptoms usually resolve after birth. The mechanism is thought to involve both the increased iron demand of pregnancy and hormonal changes affecting dopaminergic pathways. If you are pregnant and experiencing nocturnal leg restlessness, let your GP or obstetrician know early so that iron status can be assessed promptly.
Medications and other secondary causes
Chronic kidney disease, particularly in people on dialysis, carries a high RLS prevalence. Certain medications, including some antidepressants, antipsychotics, and antihistamines, can trigger or worsen nocturnal leg restlessness. Peripheral neuropathy is another recognised secondary cause. Telling your GP about every medication you're currently taking is essential before any RLS management plan is finalised.
For your first appointment, ask for: ferritin, transferrin saturation, a full blood count, and kidney function tests. These four investigations cover the most common reversible contributors to RLS and give your GP a solid foundation for the conversation about treatment.
When RLS and sleep apnoea overlap
RLS and obstructive sleep apnoea are both common sleep disorders that fragment sleep and produce excessive daytime fatigue. Because the daytime symptom picture is similar, patients, and sometimes clinicians, attribute everything to a single diagnosis when both conditions are actually present. Periodic limb movement disorder (PLMD) is a related but distinct condition where the legs jerk repeatedly during sleep in a stereotyped pattern. The person is usually unaware of these movements, and they are found in up to 80% of people who have RLS. Unlike RLS itself, PLMD occurs during sleep and requires a sleep study level 2 to detect and diagnose properly.
If you have daytime sleepiness, loud snoring, or a bed partner who has noticed pauses in your breathing, these are signs that sleep apnoea may be contributing alongside your leg symptoms. A sleep study can simultaneously detect obstructive sleep apnoea and periodic limb movements in a single overnight investigation, which addresses both diagnostic questions efficiently. CPAP Adelaide provides sleep studies for Adelaide residents, making this investigation accessible regardless of budget. For people ultimately diagnosed with both conditions, CPAP Adelaide also stocks a range of CPAP masks and accessories, including options well-suited to people who move frequently during the night.
Self-management strategies backed by evidence
Structured physical activity has the strongest clinical trial evidence among non-pharmacological approaches to restless legs syndrome. Regular aerobic exercise, including walking, cycling, and swimming, reduces symptom severity and improves sleep quality for many people. The key word is regular; sporadic or intense bursts of exercise can temporarily worsen symptoms rather than help them. Aim for moderate-intensity sessions of 30, 45 minutes on most days of the week, ideally finishing at least two hours before bedtime to avoid overstimulating the nervous system close to sleep.
Applying heat or cold to the legs before bed helps some people reduce the urge to move, with individual preference varying considerably. A warm bath or shower in the hour before bed can be effective for many. Leg massage has also shown measurable improvement in RLS severity and sleep outcomes in clinical trial data, making it a reasonable and low-risk addition to your evening routine. One small pilot randomised trial found massage produced clearer symptom relief than heat therapy alone, so if you're choosing between the two, massage is worth trying first.
Lifestyle adjustments also make a meaningful difference. Reducing caffeine and alcohol, particularly in the afternoon and evening, is consistently recommended because both are known to worsen RLS symptoms. Maintaining a consistent sleep and wake time helps stabilise the circadian pattern that makes symptoms worse at night. Mentally engaging activities during sedentary evening hours, such as reading, puzzles, or gentle stretching, can reduce symptom perception while you're sitting still, though this is based largely on patient experience rather than controlled trial data. These strategies don't replace medical treatment for moderate to severe RLS, but they form a solid foundation alongside whatever pharmacological approach you and your GP agree on.
Restless legs syndrome treatment options and what to know before you start
Current clinical guidelines, including those aligned with AASM and RLS Foundation recommendations, have moved clearly toward gabapentinoids (gabapentin, pregabalin) as the preferred first pharmacological treatment for most adults with persistent restless legs syndrome. This is a significant shift from older practice, and it matters if you've been managing your symptoms for a while without a formal review. Before any medication is considered, iron repletion is prioritised if ferritin is low or borderline. Oral iron supplementation is typically tried first. Intravenous iron may be considered in moderate-to-severe or refractory cases, typically when ferritin is in the 75, 100 ng/mL range or when oral iron is not tolerated, and should follow a guideline-based assessment by your GP or specialist. Your GP can refer you to a sleep physician or neurologist for iron infusion if oral supplementation isn't sufficient.
Dopamine agonists such as pramipexole and ropinirole were previously considered first-line treatments and are still widely prescribed, but current guidelines caution against using them as the starting option for most people. The reason is a phenomenon called augmentation. Over time, symptoms can begin earlier in the day, become more intense, and spread to other body parts, often requiring escalating doses just to maintain the same effect. If you're currently on a dopamine agonist and your symptoms seem to be worsening or spreading despite the medication, raise this explicitly with your GP or specialist. This pattern describes augmentation, not disease progression, and it requires a different management approach rather than simply increasing the dose.
In Australia, gabapentinoids are prescribed off-label for RLS and are not PBS-listed for this indication, so cost and access are worth discussing openly with your GP. This is also a conversation where a referral to a sleep physician can add significant value, particularly if you've already tried iron therapy without adequate relief.
Red flags and getting assessed in Adelaide
Most RLS is a chronic, manageable condition, but certain features warrant faster medical review. See your GP promptly if:
- your symptoms have suddenly become much worse
- you are losing significant sleep most nights
- you have kidney disease or signs of iron deficiency such as fatigue and pallor
- you are pregnant and experiencing severe nocturnal leg restlessness
- your symptoms are affecting your ability to function safely during the day
These situations call for blood tests and a structured management plan rather than a watch-and-wait approach.
Some symptoms need urgent same-day assessment and are not consistent with uncomplicated RLS. Seek immediate care if you notice new weakness or numbness in the legs, loss of bladder or bowel control, unilateral painful swelling or redness in one calf (which could indicate a clot), chest pain, or slurred speech. These features need to be excluded before any sleep-disorder-focused investigation proceeds.
For Adelaide residents ready to take the next step, start with your GP and ask specifically for ferritin, transferrin saturation, a full blood count, and kidney function tests. If a sleep study is warranted, CPAP Adelaide can help guide you through the process and discuss what options are available for your situation. If that study identifies sleep apnoea alongside your restless legs symptoms, CPAP Adelaide's team can assist with equipment selection and ongoing support. You're also welcome to contact CPAP Adelaide directly if you're unsure whether a sleep study is the right next step, or if you need guidance on referral pathways before your GP appointment.
The bottom line
Restless legs syndrome is a recognisable, diagnosable, and treatable condition. The first step is naming it correctly, knowing the five-symptom pattern that defines it, and understanding that iron deficiency is the single most important and reversible cause to rule out early. From there, self-management strategies, targeted blood tests, and an informed conversation with your GP can shift things considerably.
When sleep apnoea or periodic limb movement disorder is also in the picture, a sleep study opens up targeted treatment for multiple conditions at once. Adelaide residents have local resources for exactly this scenario, from sleep studies to CPAP equipment and knowledgeable support from CPAP Adelaide's team.
You don't have to keep pacing the hallway at midnight wondering what's wrong. With the right assessment and a clear management plan, most people with restless legs syndrome get their nights back.