How Is Restless Legs Syndrome Diagnosed?

Reviewed by: HU Medical Review Board | Last reviewed: June 2020 | Last updated: May 2020

Restless legs syndrome (RLS) is one of the most common sleep disorders. It causes unpleasant sensations in the legs. People describe these sensations as aching, throbbing, itching, pulling, or tingling. Twitching, jerking, and the irresistible urge to move the legs also happens.1-2

Most RLS is diagnosed by a doctor’s physical exam and medical history. There is no blood test or scan that will diagnose RLS. A sleep study in a lab may help determine if you also have periodic limb movement disorder (PLMD).

Physical exam and medical history

To diagnose restless legs syndrome, your doctor checks your overall health and asks you a series of questions. The physical exam will help rule out other health conditions that may cause RLS. These conditions include:1-3

  • Iron deficiency anemia
  • Kidney failure
  • Pregnancy
  • Spinal cord injury
  • Fibromyalgia
  • Rheumatoid arthritis
  • Multiple sclerosis
  • Parkinson’s disease
  • Peripheral neuropathy

Your doctor may ask you about a family history of RLS since the condition does run in families. Your doctor may also ask if your bed partner complains of you kicking, thrashing, or twitching in your sleep. Finally, you will also be asked about any medications you are taking. Some medicines cause RLS or make it worse.

5 criteria for an RLS diagnosis

There are 5 basic criteria used to diagnose restless legs syndrome. These are:1-2

  • A strong need to move the legs caused by unpleasant or uncomfortable sensations
  • The urge to move the legs starts or gets worse while sitting still or resting
  • Moving the legs temporarily or totally relieves the discomfort
  • These symptoms start or get worse late in the day or at night
  • None of these symptoms are explained by another health condition

Your doctor may order blood tests to rule out kidney disease or anemia.

Rating how bad your symptoms are

Because RLS symptoms are often very individual, your doctor may ask you to rate your symptoms using the International RLS Rating Scale. This rating system helps doctors decide what type of treatment might be best for your RLS. Reviewing this scale before talking with your doctor can also help you discuss your symptoms.4

Sleep diary

Your doctor may ask you to keep a sleep diary for 1 to 2 weeks. This will help your doctor understand how often you have trouble sleeping because of RLS. A sleep diary is a detailed record of your sleep that includes:5

  • When you get into bed and how long it takes you to fall asleep
  • The number of times you wake up and when
  • What causes you to wake up at night
  • How long you are asleep each time
  • When you wake up and get out of bed
  • How sleepy or tired you are during the day
  • Nap times and how long you nap
  • How much caffeine you consume
  • If you use a sleep aid
  • How much alcohol you consume

Sleep study

Your doctor may order polysomnography, which is an overnight sleep study in a sleep clinic. However, sleep studies are usually not ordered for RLS but for PLMD, which 80 percent of people with RLS have. These tests record many functions of sleep, including brain waves, breathing, heart rate, and leg movements. A sleep study can also tell your doctor if your lack of good quality sleep is caused by another sleep disorder such as sleep apnea.1,3

Diagnosing RLS in children

Restless legs syndrome can be hard to diagnose in children unless they are old enough to describe their symptoms. Because of this, children with RLS may be diagnosed with growing pains or attention deficit disorder rather than RLS.1

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