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Restless legs syndrome is characterized by a build up of abnormal feelings (paresthesia) in the legs at rest that results in an unremitting urge the individual to move ones legs for relief. The movement of the legs is involuntary while the choice of which activity or movement to do is voluntary. Symptoms typically develop within a few minutes of rest, such as sitting down or lying down and they worsen the longer one remains inactive. Symptoms are worse at night and usually peak between the hours of midnight and 4 AM. The activity that patients choose in order to relieve the restlessness is often repetitive, such as pacing the floor, or continuous stretching. Sometimes movements are stereotypical and are used each time to relieve the urge to move and some people vary the activity each time.

Activities which individuals with restless legs syndrome engage in to alleviate the restlessness include:

• Pacing
• Stretching
• Rocking
• Bending
• Massaging
• Walking
• Shaking the affected limb
• Using hot compresses
• Using cold packs
• Relaxation techniques

Restlessness of the legs is more disruptive at night than in the day because the need to move interferes with falling asleep and staying asleep. Many patients report that throughout the night, they sleep very lightly. From 6 AM to noon, the patient usually experiences the most restful period during which the symptoms either disappear or are very mild. Symptoms are typically bilateral (affect both legs) but can also be unilateral (affect only one leg) or can alternate between both sides. It is reported that up to 50% of individuals with idiopathic or primary restless legs syndrome also experience symptoms in their upper body.

Associated with the restlessness is paresthesia, feelings of abnormal sensation or discomfort deep in the legs, typically in the calves. It is hard for people to articulate precisely the feeling, but all agree that it is deep and not superficial, and is not felt in the foot. The sensations have been described as "creeping, crawling, burning, cramps, tingling, soda in the veins" and much more. Typically, patients do not complain of pain. The feet are rarely affected and the sensations are typically felt deep within the calf of the leg. Movement relieves these abnormal sensations.

Periodic limb movement of sleep occurs in approximately 80% of individuals with restless legs syndrome. However, they are not diagnostic of restless legs syndrome as they can occur with other medical conditions as well and even in individuals with no other illnesses. When restless legs syndrome is accompanied by PLMS, the greatest concentration of movements is in the first third of the sleep period. The number of limb movements generally increases with the severity of restless legs syndrome but PLMS on its own does not typically increase in severity over time. In many individuals, PLMS may cause brief arousals (a few seconds) which results in poor sleep quality due to repeated interruption of sleep. Insomnia is a common complaint and patients typically complain of daytime fatigue more than sleepiness. Movements usually occur during a period of light sleep (non REM or dream sleep).