Evidence and service information checked, October 2026.
An urge to move your legs at night is not always a cramp, poor circulation or a magnesium deficiency. Restless legs syndrome has a recognisable pattern, and identifying it can change what helps. A useful assessment looks at the timing of symptoms, medicines, iron status and sleep, rather than handing you a supplement list.
Why do my legs feel restless at night?
Restless legs syndrome, also called Willis-Ekbom disease, causes an urge to move the legs, usually with an uncomfortable crawling, pulling, aching or electric feeling. It starts or becomes worse at rest, improves temporarily with movement, and is usually worse in the evening or at night. Another condition must not better explain the symptoms.
That combination matters. One symptom alone does not diagnose restless legs. Walking around because a calf has seized into a painful knot is different from an irresistible need to keep moving otherwise relaxed legs.
The short answer
- Restless legs is usually diagnosed from the story, not a scan or a single blood result.
- Iron deficiency can contribute even without obvious anaemia. Ferritin needs interpreting with other iron tests and your clinical history.
- Some medicines and untreated sleep apnoea can make symptoms worse.
- Treatment has moved away from routinely starting dopamine medicines because they can worsen the condition over time.
- Do not start high-dose iron or stop a prescribed medicine without a plan.
If symptoms repeatedly interrupt your sleep, ask The Online GP about an assessment. Tell the team that the problem is an urge to move your legs at rest, not simply difficulty sleeping.
Is it restless legs, cramps or something else?
Restless legs: an urge to move, often deep in both legs, brought on by sitting or lying still. Movement helps while you are doing it; symptoms can return when you settle down.
Night cramps: a sudden painful muscle contraction, often in a calf or foot. The muscle may feel hard. Stretching can help, but this is not the same pattern as an ongoing urge to move.
Nerve symptoms: persistent burning, numbness, weakness or altered sensation can suggest a different problem. These deserve assessment rather than being labelled restless legs from a questionnaire alone.
Medicine-related restlessness: a whole-body feeling of being unable to sit still, especially after a medicine change, may be akathisia or another adverse effect.
A swollen, hot, red or painful leg, particularly on one side, is not something to manage as routine restless legs. Seek urgent medical advice. If this is accompanied by chest pain or breathlessness, call 999.
Which tests are worth discussing?
A clinician may examine your circulation and nervous system and review your medicines. Blood tests can look for contributing problems, particularly iron deficiency. Depending on the history, kidney function and other tests may be appropriate. A large untargeted panel is not automatically better.
Ferritin reflects stored iron, but it can rise with inflammation. A full blood count and transferrin saturation can add context. A result inside a laboratory's usual range does not, on its own, settle whether iron treatment is appropriate for someone with restless legs.
The American Academy of Sleep Medicine's 2025 guideline uses RLS-specific iron thresholds that differ from general anaemia thresholds. These are clinician treatment criteria, partly based on consensus, not permission to take iron until you reach a self-selected number. Too much iron can be harmful, and the reason for deficiency matters. Heavy periods, blood donation or bleeding from the gut may need separate attention.
A sleep study is not usually needed to diagnose RLS. It may help if another sleep disorder, such as sleep apnoea, is suspected. A wearable's sleep score cannot make the diagnosis.
What can I do tonight without buying a treatment?
Try a warm bath, gentle massage or a warm or cool pack. Brief walking or stretching can ease symptoms. Keep exercise regular and moderate rather than suddenly adding a hard late-evening workout.
For the next couple of weeks, note whether reducing caffeine or alcohol helps. Keep a regular sleep and waking time. A sleep diary is more useful if it records the leg symptoms as well as hours in bed.
Review non-prescription products with a pharmacist. Some sedating antihistamines, cold remedies and other medicines can aggravate restless legs. Prescribed antidepressants, anti-nausea medicines and antipsychotic medicines can also be relevant. Do not abruptly stop them; the solution may be a review or a different balance of treatment.
If you are pregnant, have kidney disease or already take an RLS medicine, ask for individual advice before using supplements or another person's prescription.
Which treatments have the best evidence?
Treating a contributing problem, including confirmed iron deficiency, may help. Oral or intravenous iron is a clinical decision based on results, tolerance and the wider picture. An IV infusion is not automatically the premium or more effective choice for every patient.
For persistent symptoms, medicines such as gabapentin or pregabalin may be considered after assessment. They can cause dizziness, sedation and other adverse effects, and are not suitable for everyone. UK prescribing, licensing and monitoring need discussing with the prescriber rather than copying a US treatment list.
The AASM's updated guideline recommends against standard use of medicines such as pramipexole and ropinirole for adults with RLS because of augmentation. This means the treatment can gradually make symptoms begin earlier, become more intense or spread beyond the legs. These medicines can still have a place in selected cases, but require a clear discussion and follow-up.
If you already take one, do not stop suddenly. Rebound symptoms can be severe. Earlier daytime symptoms or a need for rising doses should prompt a review, not automatic dose escalation.
When should I book a review?
Arrange an assessment if symptoms keep returning, disturb sleep, affect driving or concentration, or are not responding to sensible self-care. Bring a list of all medicines and supplements, previous blood results and a one-week symptom diary.
Useful details include: when symptoms start, whether moving helps, whether both legs are affected, any pregnancy, kidney problems, heavy periods, family history, snoring and daytime sleepiness.
Request a private GP appointment if you want a structured review rather than another sleep supplement trial. Video can start the history and test planning; a physical or neurological examination may still be needed.
What does a private assessment cost?
As checked in October 2026, The Online GP lists a video GP consultation from £150 for up to 30 minutes. A same-day in-person appointment is listed at £220. Availability, the suitable format, tests and any additional fees are confirmed before booking.
The value is a coherent plan: establish whether this is RLS, identify reversible factors, choose treatment with its risks in view and decide how to review progress. It is not a guarantee of a prescription or an instant cure.
Questions people often ask
Does magnesium cure restless legs?
It is not a substitute for diagnosis or the guideline-supported assessment of iron status and other contributors. Do not assume a night-time leg symptom proves a magnesium deficiency.
Can I have restless legs with a normal blood count?
Yes. A normal haemoglobin does not exclude RLS or settle iron status. The clinical pattern and appropriate iron tests matter.
Does everyone need a specialist?
No. A GP can begin the assessment. Severe, uncertain or treatment-resistant symptoms, or problems with augmentation, may need sleep or neurology expertise.
Can an online GP diagnose it?
The history is central, so a remote consultation can be useful. Examination or testing may still be needed before a safe conclusion or treatment plan.
Ask our team for the next suitable appointment, or email team@thewellnesslondon.com. For emergencies, call 999 rather than waiting for a clinic reply.
Sources
- Mayo Clinic: Restless legs syndrome, symptoms and causes.
- Mayo Clinic: Restless legs syndrome, diagnosis and treatment.
- AASM: Treatment of restless legs syndrome and periodic limb movement disorder, clinical practice guideline, 2025.
- AASM: Explanation of the updated treatment recommendations.
This article gives general information, not an individual diagnosis or prescription. Do not change prescribed treatment without speaking to your clinician.