Restless legs syndrome (RLS) is more than an occasional urge to move your legs at night—it is a neurological sensorimotor disorder that can quietly erode sleep quality, mood, and daytime function for millions of people worldwide. For years, researchers have identified two nutrients as central players in symptom management: iron and magnesium. Understanding how these nutrients interact with dopamine signaling, nerve excitability, and muscle relaxation can help you have a more informed conversation with your healthcare provider. This guide reviews the current evidence on iron and magnesium for restless legs syndrome, explores ferritin targets, compares supplement forms, and outlines practical, scientifically grounded steps you can discuss with a clinician.
Understanding Restless Legs Syndrome (RLS): Symptoms, Causes, and Types
Restless legs syndrome is a chronic condition characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations that are often described as crawling, creeping, tingling, pulling, or aching. Symptoms typically begin or worsen during periods of rest or inactivity—most commonly in the evening or at night—and are partially or completely relieved by movement such as walking, stretching, or shaking the legs. This circadian pattern is one of the defining features of the disorder and explains why sleep disruption is so common.
RLS affects an estimated 5–10% of adults in Western populations, with women affected roughly twice as often as men. Prevalence increases with age, though symptoms can begin in childhood. Despite its frequency, RLS remains underdiagnosed and frequently dismissed, leaving many people to manage symptoms on their own without appropriate support.
Diagnostic Criteria for RLS
Clinical diagnosis relies on five essential criteria established by the International Restless Legs Syndrome Study Group (IRLSSG):
- An urge to move the legs, typically accompanied by uncomfortable sensations.
- Symptoms begin or worsen during rest or inactivity.
- Symptoms are partially or totally relieved by movement.
- Symptoms worsen in the evening or night.
- The condition is not better explained by another medical or behavioral condition.
These criteria are clinical—meaning there is no single blood test that confirms RLS. However, laboratory testing is essential to identify underlying causes that might be treatable, particularly iron deficiency.
Primary vs. Secondary RLS
Primary RLS (also called idiopathic RLS) has no identifiable underlying medical cause and often runs in families. Genetic studies have linked variants in several genes, including MEIS1 and BTBD9, to an increased risk. Primary RLS tends to begin earlier in life and progress slowly.
Secondary RLS arises from an identifiable underlying condition or trigger. Common contributors include:
- Iron deficiency (with or without anemia)
- Pregnancy, especially in the third trimester
- Chronic kidney disease and dialysis
- Peripheral neuropathy (e.g., from diabetes)
- Certain medications, including some antidepressants and antihistamines
- Rheumatoid arthritis and other inflammatory conditions
Identifying and addressing a secondary cause—such as low iron stores—can meaningfully reduce symptom burden. This is one reason thorough evaluation, rather than self-treatment with supplements, is so important.
Common Triggers and Aggravating Factors
Beyond the underlying cause, several lifestyle factors are known to aggravate RLS symptoms in susceptible individuals, including caffeine, alcohol, nicotine, sleep deprivation, and certain medications. Recognizing these patterns can help you and your clinician build a more effective management plan.
The Iron-RLS Connection: How Iron Deficiency Affects Your Brain
Iron is the most extensively studied nutritional factor in RLS, and for good reason. The brain requires iron for the synthesis of dopamine, a neurotransmitter central to movement control and reward signaling. When brain iron is low, dopamine production and receptor activity can be altered, contributing to the sensorimotor symptoms that define RLS.
Iron, Dopamine, and Brain Function
Iron serves as a cofactor for tyrosine hydroxylase, the rate-limiting enzyme in dopamine synthesis. It also supports the function of dopamine receptors and the myelination of nerve fibers that carry motor signals. Research using cerebrospinal fluid analysis, MRI brain imaging, and postmortem studies has shown that people with RLS often have lower brain iron concentrations, even when their blood iron levels appear normal.
This phenomenon—sometimes referred to as a "brain iron deficiency"—helps explain a key clinical observation: many people with RLS have low or low-normal ferritin (the primary storage form of iron) without meeting the criteria for iron-deficiency anemia. The brain can be iron-deficient even when standard blood tests look acceptable.
What the Evidence Shows
Multiple studies have found an association between low serum ferritin levels and increased RLS severity. A landmark study by Earley and colleagues demonstrated that cerebrospinal fluid ferritin and transferrin levels were significantly reduced in RLS patients compared with controls. Autopsy and neuroimaging studies have further supported a regional iron deficiency in the substantia nigra and other basal ganglia structures.
Importantly, the relationship between iron status and RLS symptoms is not perfectly linear. Some individuals with low ferritin have mild symptoms, while others with normal ferritin have severe symptoms. This variability underscores that RLS is multifactorial and that iron is one important factor among many.
Iron Deficiency Without Anemia
A common misconception is that iron deficiency only matters if you have anemia. In reality, iron deficiency without anemia—sometimes called "latent iron deficiency"—is the stage at which ferritin drops but hemoglobin remains normal. In the context of RLS, this stage can be clinically meaningful. Many patients experience symptom improvement after iron repletion even when their hemoglobin was never low.
Diagnosing Iron Deficiency: The Ferritin Test and What Your Numbers Mean
If you suspect iron might be contributing to your RLS symptoms, the first step is a blood test—not a supplement. The most important marker for RLS is serum ferritin, which reflects the body's iron stores. Additional markers help build a complete picture.
Recommended Blood Tests
- Serum ferritin — iron storage status
- Complete blood count (CBC) — anemia assessment
- Serum iron and total iron-binding capacity (TIBC) — circulating iron availability
- Transferrin saturation — percentage of transferrin carrying iron
- High-sensitivity C-reactive protein (hs-CRP) — ferritin is an acute-phase reactant and can rise with inflammation, potentially masking a deficiency
Ferritin Targets for RLS
The International Restless Legs Syndrome Study Group (IRLSSG) and the RLS Foundation recommend aiming for a serum ferritin level of at least 75–100 ng/mL in people with RLS. This is higher than the typical reference range lower limit used for general screening (often around 15–30 ng/mL), reflecting the brain's relatively high iron demand.
| Ferritin Level (ng/mL) | Interpretation for RLS | General Approach |
|---|---|---|
| < 15 | Iron deficiency with or without anemia | Clinical evaluation; iron therapy typically indicated |
| 15–30 | Low iron stores | Evaluation for supplementation |
| 30–75 | Suboptimal for RLS | Discuss iron status with clinician |
| 75–100 | Target range for RLS | Monitor and maintain |
| > 100 | Generally adequate | Iron unlikely to be primary driver |
Interpreting Results in Context
Ferritin does not exist in isolation. It can be elevated by inflammation, infection, liver disease, and certain cancers. A ferritin level of 90 ng/mL in a person with systemic inflammation may actually reflect genuine iron deficiency. This is why transferrin saturation and hs-CRP are important companion tests.
Conversely, ferritin can be normal in the presence of brain iron deficiency—a phenomenon well documented in RLS research. For this reason, clinical judgment and symptom response matter, not just numbers.
Summary: Ferritin is the most useful single marker for iron status in RLS, with a target of at least 75–100 ng/mL. However, results must be interpreted alongside other iron markers and clinical context, ideally by a clinician familiar with RLS.
Iron Supplementation for RLS: Dosage, Types, and What Actually Works
Iron supplementation is the most evidence-based nutritional intervention for RLS when iron deficiency or low ferritin is present. That said, it is not a "one-size-fits-all" therapy, and improper use can cause side effects or delayed diagnosis of other conditions.
Oral Iron vs. Intravenous Iron
Clinicians generally start with oral iron when ferritin is low and the person tolerates it. Intravenous (IV) iron is considered when oral iron is poorly tolerated, absorption is compromised (e.g., in chronic kidney disease, inflammatory bowel disease, or post-bariatric surgery), or symptoms are severe and rapid repletion is needed. IV iron should only be given in a medically supervised setting.
Oral Iron Dosing and Timing
Clinical guidelines commonly cite a regimen of ferrous sulfate 325 mg every other day, which provides roughly 65 mg of elemental iron per dose. Alternate-day dosing takes advantage of hepcidin physiology—hepcidin, a hormone that blocks iron absorption, rises after a dose and stays elevated for about 24 hours. Taking iron every other day may improve absorption compared with daily dosing.
Practical tips for improving absorption and tolerability:
- Take with vitamin C (for example, a glass of orange juice or a vitamin C supplement) to enhance absorption.
- Take on an empty stomach if tolerated—about one hour before meals or two hours after.
- Avoid tea, coffee, calcium, and antacids within two hours of a dose.
- If gastrointestinal side effects occur, take with food (accepting somewhat lower absorption).
Common Iron Forms Compared
| Form | Elemental Iron Content | Tolerability | Notes |
|---|---|---|---|
| Ferrous sulfate | ~20% | Moderate—can cause constipation, nausea | Most studied and widely used |
| Ferrous fumarate | ~33% | Moderate | Higher elemental iron per tablet |
| Ferrous gluconate | ~12% | Better tolerated by some | Lower elemental iron per tablet |
| Iron bisglycinate | ~20% | Often better tolerated | Chelated form; slower absorption but gentler |
| Polysaccharide iron complex | Varies | Generally well tolerated | Non-ionic; less food interaction |
Side Effects and Safety
Oral iron commonly causes constipation, dark stools, nausea, and abdominal discomfort. These effects can usually be managed with dose adjustment, alternate-day dosing, or switching formulations. Iron overdose is dangerous—particularly in children—so all supplements should be stored securely.
Iron supplementation should not be initiated based on symptoms alone. Excess iron can be harmful, particularly in people with undiagnosed hemochromatosis or other iron-loading disorders. Regular monitoring of ferritin during supplementation is important to prevent overshoot.
How Long Until Symptoms Improve?
Some patients notice improvement in RLS symptoms within 4–6 weeks of adequate iron repletion, while others require several months. Ferritin repletion typically lags behind symptom improvement, so periodic monitoring is needed. Response is variable—some individuals experience meaningful benefit, others minimal—which is why iron should be part of a broader evaluation.
Magnesium for Restless Legs: Mechanisms, Benefits, and Limitations
Magnesium is an essential mineral involved in more than 300 enzymatic reactions, including muscle contraction and relaxation, nerve transmission, and energy metabolism. It is widely promoted as a natural remedy for restless legs, but the evidence base is more limited than that of iron.
How Magnesium Might Help
Magnesium acts as a natural antagonist of calcium at the neuromuscular junction and helps regulate the release of neurotransmitters. In theory, this could reduce nerve hyperexcitability and muscle cramping—two features that overlap with RLS symptoms. Magnesium is also involved in dopamine signaling indirectly through its role in NMDA receptor modulation.
What the Research Says
Research on magnesium specifically in RLS is modest. Small studies and case reports have reported symptom improvement in some patients, particularly those with low magnesium intake or deficiency. A randomized controlled trial in older adults with insomnia found that magnesium supplementation improved sleep quality and reduced markers of insomnia severity, but it was not specific to RLS.
A 2019 review noted that while magnesium has biological plausibility for helping RLS and related conditions such as leg cramps, high-quality trials are lacking. The overall evidence is best characterized as promising but insufficient to support magnesium as a primary treatment for RLS.
Who May Benefit Most
People most likely to benefit from magnesium for restless legs include those with low dietary intake, those taking medications that deplete magnesium (such as proton pump inhibitors or diuretics), older adults, and people with diabetes or alcohol use disorder. In these groups, correcting a deficiency may provide symptom relief.
Potential Limitations
Not everyone with RLS responds to magnesium. Some individuals experience no benefit, and others may experience digestive side effects. Magnesium can also interact with certain medications, including some antibiotics, bisphosphonates, and thyroid medications. People with kidney disease should be particularly cautious, as impaired magnesium clearance can lead to accumulation.
If you are considering magnesium, a well-formulated magnesium supplement is one option—but the right form and dose matter, which brings us to the next section.
Choosing the Right Magnesium: Types, Doses, and Patient Experiences
Walk into any pharmacy or scroll through any supplement aisle and you will find a bewildering array of magnesium products. They are not interchangeable. The "type" of magnesium refers to the compound it is bound to—and this determines absorption, tolerability, and where it is best targeted.
Common Forms of Magnesium Compared
| Form | Absorption | Common Uses | Notes |
|---|---|---|---|
| Magnesium oxide | Low (~4%) | Constipation relief | Cheap; not ideal for systemic repletion |
| Magnesium citrate | Moderate–high | General supplementation; constipation | May have mild laxative effect |
| Magnesium glycinate | High | Calm and sleep support | Well tolerated; gentle on digestion |
| Magnesium malate | Moderate–high | Energy and muscle support | Sometimes chosen for fatigue |
| Magnesium taurate | High | Cardiovascular support | Popular in some cardiovascular protocols |
| Magnesium threonate | High (brain) | Cognitive support | Emerging evidence; higher cost |
Magnesium Glycinate vs. Magnesium Citrate for RLS
Among people who try magnesium for restless legs, magnesium glycinate and magnesium citrate are the two most commonly discussed options. Magnesium glycinate is often preferred for its gentle tolerability and calming effect, as glycine itself is an inhibitory neurotransmitter. Magnesium citrate is well absorbed but more likely to cause loose stools at higher doses, which some people find beneficial and others find irritating.
There is no strong head-to-head evidence showing that one form is superior for RLS. Personal tolerance and goals—sleep support, constipation relief, general repletion—should guide the choice.
Typical Magnesium Dosing
The recommended dietary allowance for magnesium is about 310–420 mg per day for adults depending on age and sex. Supplemental doses above that level can be used short-term under supervision, but very high doses can cause diarrhea and, rarely, more serious effects. A common approach is 200–400 mg of elemental magnesium in the evening for sleep-related symptoms, taken with food.
It is worth reading labels carefully: "500 mg magnesium oxide" does not equal 500 mg of elemental magnesium. Look for the elemental content, not the compound weight.
Patient Experiences and Realistic Expectations
Some individuals report noticeable improvement in nighttime leg symptoms within a few days to a few weeks of consistent magnesium use. Others notice no change. Because symptom relief is subjective and RLS is naturally variable, careful tracking—ideally with a simple symptom diary—can help you and your clinician determine whether magnesium is helping.
Beyond Iron and Magnesium: Other Supplements and Natural Remedies for RLS
Iron and magnesium receive the most attention, but other nutrients and natural approaches may play supporting roles in some individuals. The key word is "some"—evidence remains limited, and these should be considered complementary to thorough clinical care rather than replacements.
Vitamin D
Vitamin D deficiency has been associated with increased risk of RLS in observational studies, and some research suggests symptom improvement with correction of deficiency. Vitamin D plays a role in neuromuscular function and inflammation regulation. Testing 25-hydroxyvitamin D and correcting a deficiency if present is reasonable—and a vitamin D supplement is a common way to do that.
B Vitamins and Folate
Vitamin B12 deficiency can cause peripheral neuropathy, which can mimic or worsen RLS. Folate (vitamin B9) deficiency has been reported in some RLS cases, particularly during pregnancy. B6 (pyridoxine) is involved in neurotransmitter synthesis. However, high-dose B6 has itself been associated with neuropathy, so more is not necessarily better. A standard multivitamin can help cover baseline needs without excessive dosing of any single nutrient.
Zinc and Copper
Zinc and copper interact with iron metabolism and are essential for neurological function. Deficiencies are uncommon in well-nourished populations but can occur with restrictive diets or malabsorption. These are rarely first-line considerations for RLS but are worth checking if deficiencies are suspected.
Other Natural Remedies
A variety of other natural remedies have been anecdotally reported to help with RLS symptoms, including:
- Warm baths or heating pads before bed
- Gentle stretching and massage
- Relaxation techniques such as deep breathing or progressive muscle relaxation
- Regular moderate exercise (but not too close to bedtime)
- Establishing a consistent sleep schedule
None of these are proven treatments, but they are low-risk and may support overall symptom management.
Lifestyle and Dietary Strategies That Complement Supplementation
Supplements are most effective when paired with supportive lifestyle strategies. For RLS, several evidence-informed adjustments can reduce symptom burden and improve sleep quality.
Dietary Considerations
- Iron-rich foods: Red meat, poultry, fish, lentils, beans, fortified cereals, and dark leafy greens.
- Pair plant iron with vitamin C: Enhances absorption of non-heme iron.
- Avoid excessive tea and coffee with meals: Tannins inhibit iron absorption.
- Consider overall dietary pattern: A balanced, Mediterranean-style diet supports neurological and metabolic health.
Caffeine, Alcohol, and Nicotine
These are common RLS triggers in susceptible individuals. Reducing or eliminating caffeine after midday, moderating alcohol, and avoiding nicotine can meaningfully reduce nighttime symptoms for some people.
Exercise
Regular moderate exercise has been associated with reduced RLS symptom severity in several studies. However, intense exercise late in the evening may aggravate symptoms in some individuals. Morning or afternoon activity tends to be better tolerated.
Sleep Hygiene
Good sleep hygiene supports RLS management by reducing the secondary insomnia that so often accompanies it. Consistent bed and wake times, a cool dark bedroom, and a relaxing wind-down routine are foundational. A warm bath about 90 minutes before bed can help with both relaxation and the core body temperature drop that promotes sleep onset.
When to See a Doctor: Diagnosis, Treatment Options, and Safety Considerations
RLS is a clinical diagnosis, and self-treatment with supplements is not a substitute for proper evaluation. You should speak with a healthcare provider if:
- Symptoms interfere with sleep or daily functioning
- Symptoms are new or worsening
- You suspect iron deficiency or have risk factors for it
- You are pregnant or planning pregnancy
- You have chronic kidney disease, diabetes, or peripheral neuropathy
- You are taking medication that may be triggering symptoms
Standard Medical Treatments
When lifestyle and nutritional approaches are insufficient, clinicians may use prescription medications. These include:
- Dopamine agonists such as ropinirole and pramipexole. These can be effective short-term but have risks of augmentation—where symptoms worsen and spread over time—so they are now used more cautiously and often at lower doses.
- Alpha-2-delta ligands such as gabapentin and pregabalin. These are often favored for patients with significant sleep disruption or pain, and they have a lower risk of augmentation than dopamine agonists.
- Intravenous iron for individuals with documented iron deficiency who do not respond to or tolerate oral iron.
- Benzodiazepines and opioids in selected, carefully monitored cases—rarely used first-line due to dependency risks.
Special Populations
Pregnancy: RLS is common in pregnancy, particularly in the third trimester. Iron deficiency is a frequent contributor, and low-dose iron is often recommended if ferritin is low. Medication choices in pregnancy require particular care and should always be supervised.
Older adults: RLS in older adults is often complicated by polypharmacy, chronic conditions, and altered nutrient absorption. Medication review and nutritional assessment are especially important.
Chronic kidney disease: Iron deficiency and RLS are both common in CKD, and IV iron is often used. Nephrology involvement is essential.
Safety Considerations for Supplements
Supplements are regulated differently from medications and vary in purity and content. Choose products from reputable manufacturers that use third-party testing. Report all supplements to your clinician, particularly if you take prescription medications, as interactions are possible.
Key Takeaways
- Restless legs syndrome is a common neurological disorder with a strong genetic and biological basis.
- Iron is the most evidence-supported nutritional factor in RLS, with brain iron deficiency documented even when blood tests appear normal.
- Serum ferritin is the key marker to check; the target for RLS is generally 75–100 ng/mL, higher than standard reference ranges.
- Oral iron is often the first step, with alternate-day dosing (e.g., 325 mg ferrous sulfate) favored for absorption; IV iron may be needed in some cases.
- Magnesium has biological plausibility and some supporting evidence, but quality trials are limited; it is best viewed as a complementary option.
- Magnesium glycinate and magnesium citrate are the most commonly recommended forms, but response is highly individual.
- Vitamin D, B12, folate, and other micronutrients may matter in specific subgroups—testing rather than guessing is preferable.
- Lifestyle factors including caffeine, alcohol, exercise, and sleep hygiene meaningfully shape RLS symptoms.
- RLS should be medically evaluated; symptoms alone cannot reliably distinguish iron deficiency from other causes.
- Personally tailored care—combining nutrition, lifestyle, and when needed prescription treatment—tends to work best.
Frequently Asked Questions About Iron, Magnesium, and RLS
Do iron supplements help with restless leg syndrome?
Yes, iron supplements can help, especially when iron deficiency or low ferritin levels are present. Clinical guidelines suggest aiming for a ferritin level of at least 75–100 ng/mL. However, iron should only be taken after blood testing and with medical guidance, since excess iron can be harmful.
What is the best form of magnesium for restless legs?
Magnesium glycinate and magnesium citrate are commonly discussed because they are well absorbed and generally well tolerated. Glycinate is often chosen for its calming effect, while citrate may also support regularity and sleep. There is no strong evidence that one is clearly superior for RLS.
How much iron should I take for restless legs syndrome?
Dosing depends on your iron status and health background. Clinical guidelines often mention 325 mg of ferrous sulfate taken every other day to improve absorption, but your clinician should determine the right dose based on ferritin and other markers.
Can low iron cause restless legs syndrome?
Yes, low iron is a well-established contributor to RLS. Iron deficiency can affect dopamine pathways in the brain, contributing to the sensorimotor symptoms of RLS. Correcting iron deficiency often improves symptoms, sometimes substantially.
What is the ideal ferritin level for restless leg syndrome?
The International Restless Legs Syndrome Study Group recommends a ferritin level of at least 75–100 ng/mL for people with RLS. Below this range, iron supplementation may be considered, typically under medical supervision.
Does magnesium help with restless legs immediately?
Magnesium is unlikely to provide immediate relief. Some people notice benefits after days to weeks of consistent use, particularly for muscle relaxation and sleep quality. Evidence is mixed, and individual response varies.
Can I take iron and magnesium together for restless legs?
Yes, but they are best taken at different times because magnesium can interfere with iron absorption. A common approach is iron in the morning with vitamin C and magnesium in the evening before bed. Always follow your clinician's guidance.
What are the best supplements for restless legs syndrome?
Iron is the most evidence-supported supplement when deficiency is present. Magnesium, vitamin D, and B vitamins may help in specific cases, especially where deficiencies exist. Testing rather than guessing is the most reliable way to determine what may benefit you.
Can iron supplements interact with other medications?
Yes. Iron can reduce absorption of certain antibiotics, thyroid medications, and some other drugs. It should be separated from these medications by at least two hours. Always inform your pharmacist or clinician about any supplements you take.
Is RLS related to vitamin D deficiency?
Observational studies have found associations between low vitamin D and increased RLS risk, and some patients report improvement after correcting a deficiency. The evidence is not strong enough to recommend vitamin D universally for RLS, but testing and correcting a deficiency is reasonable.
Can RLS be cured?
For most people, RLS is managed rather than cured. Identifying and correcting underlying contributors—such as iron deficiency—can dramatically improve symptoms. For others, symptom control through lifestyle, nutrition, and if needed medication remains the goal.
When should I see a doctor about restless legs?
See a clinician if symptoms disrupt sleep or daily life, are new or worsening, or are accompanied by signs of iron deficiency, pregnancy, kidney disease, or other chronic conditions. Proper evaluation can identify treatable contributors and rule out other causes.
The Bottom Line: Making an Informed Decision About Your RLS Treatment
Restless legs syndrome is a real, common, and often underrecognized condition. For many people, the most valuable step is not reaching for a supplement bottle—it is having an informed conversation with a clinician who can review symptoms, order the right tests, and tailor a plan. Iron is the most evidence-supported nutritional intervention, particularly when ferritin is low, and the target of 75–100 ng/mL is well established. Magnesium is a reasonable complementary option for some, especially where intake is low or sleep is disrupted. Other nutrients, including vitamin D and B vitamins, may matter in specific circumstances.
Because RLS is multifactorial, the most effective approach is usually not a single nutrient but a coordinated plan that includes nutrition, sleep habits, exercise, and—when appropriate—medical treatment. Supplements are not risk-free, and starting them without testing can delay identifying an underlying cause. Used thoughtfully, iron and magnesium can meaningfully improve quality of life for some people with RLS. Used blindly, they can cause harm. The most empowered path is personalization—guided by testing, clinical expertise, and ongoing reassessment.
If you found this guide useful, sharing it with someone who struggles with nighttime leg discomfort could help them take a more informed first step toward better sleep.
restless legs syndrome, iron for restless legs, magnesium for restless legs, RLS supplements, RLS treatment, ferritin levels, iron deficiency, iron supplementation, magnesium deficiency, magnesium glycinate, magnesium citrate, vitamin D, vitamin B6, dopamine, RLS severity, sleep quality, leg cramps, pregnancy and RLS, restless legs causes, restless legs diagnosis, restless legs symptoms, restless legs natural remedies, restless legs supplements, iron absorption, clinical guidelines, ferritin test, dopamine agonists, ropinirole, pramipexole, gabapentin, iron infusion, oral iron, RLS treatment guidelines, RLS and diet, exercise and RLS, sleep hygiene, restless legs in pregnancy, secondary RLS, primary RLS
