When RLS Symptoms Occur
RLS symptoms follow a predictable circadian pattern, worsening in the evening and at night, and are triggered or worsened during periods of rest or inactivity such as sitting or lying down. 1
Temporal Pattern (Circadian Rhythm)
- Evening and nighttime worsening is a defining feature of RLS, with symptom intensity becoming worse at night and improving toward morning 1
- This circadian pattern is so characteristic that it must be present (or must have been previously present in very severe cases) to meet diagnostic criteria 1
- Symptoms typically occur or are worse in the evening or night compared to daytime 1
Rest-Induced Symptom Onset
- Symptoms begin or worsen during periods of rest or inactivity, such as sitting or lying down 1
- The urge to move and accompanying unpleasant sensations are provoked by immobility 2
- This rest-induction is a core diagnostic criterion that distinguishes RLS from other conditions 1
Movement-Related Relief Pattern
- Symptoms are partially or totally relieved by movement such as walking, rubbing, or stretching, at least as long as the activity continues 1
- Relief occurs while moving, and symptoms return when movement stops 2
- In very severe cases, relief by activity may not be noticeable anymore but must have been previously present 1
Clinical Pitfall to Avoid
When symptoms are very severe, the evening/night worsening pattern may no longer be apparent, but this circadian pattern must have been present earlier in the disease course to confirm the diagnosis 1. Do not dismiss RLS simply because a patient with severe symptoms reports constant discomfort throughout the day—ask specifically about the historical pattern 1.
The combination of these three temporal features—circadian worsening, rest-provocation, and movement-relief—creates the characteristic symptom pattern that defines RLS and separates it from mimicking conditions like arthritis, leg cramps, or peripheral neuropathy 1.