New Delhi: It often begins quietly. You lie down to sleep, exhausted, but just as you begin to drift off, an uncomfortable sensation creeps into your legs: tingling, pulling or a crawling feeling deep inside. The only relief is to move — stretch, shake or walk around. For many, this nightly disturbance is dismissed as stress or a passing sleep problem. But doctors say it may be something more specific and far more common: restless legs syndrome (RLS).A clinical review published in JAMA estimates that about 8% of adults experience these symptoms each year and nearly 3% have moderate to severe symptoms multiple times a week. In India, the prevalence is around 6%.Prof Manjari Tripathi, head of neurology at AIIMS, said the condition was more frequently seen in people with anaemia, renal failure and those living 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.” Some patients describe the sensation as deep-seated and difficult to localise, which makes it harder to explain and often delays consultation, she added.What distinguishes RLS from ordinary restlessness is its cycle. “Patients describe a strong urge to move legs that worsens at rest and improves with movement,” said Dr Neha Kapoor, associate director and head of neurology at Asian Hospital. Because the sensations are subjective, many people assume it is anxiety, ageing, muscle cramps or poor circulation. “Unless someone asks the right questions, it can go unrecognised,” she said, noting that the evening-worsening pattern is a key diagnostic clue.Iron deficiency plays a central role. Even when haemoglobin levels are normal, low iron stores can trigger or worsen symptoms. Prof Tripathi stressed that evaluation should include serum ferritin, along with vitamin B12, vitamin D, calcium, kidney function and blood sugar levels. “It is often misunderstood or mistaken for neuropathy or labelled psychological, leading to underdiagnosis. Yet it is relatively easy to diagnose and treat.” Dr PN Renjen, senior consultant of neurology at Indraprastha Apollo Hospitals, noted that untreated RLS could fragment sleep night after night, leading to fatigue, poor concentration, irritability and even depression. Early treatment can prevent years of avoidable sleep disruption, he said.Treatment has evolved in recent years. Dopamine-based drugs, once widely prescribed, are now used cautiously because long-term use may worsen symptoms. Current guidelines favour gabapentinoids. Reducing caffeine intake, especially after the afternoon, avoiding alcohol and maintaining regular sleep habits can help.RLS often remains hidden behind the label of “just poor sleep”. Doctors say persistent night-time restlessness that repeatedly disrupts sleep is not normal and should not be ignored.
