Print this page and use
it to record your answers. Read the following descriptions and make a note,
yes or no, if they match your symptoms.
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YES
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NO |
| Before I fall asleep, I develop an unpleasant or creepy, crawly sensation in my legs. |
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To relieve this sensation, I have to get up and walk, do deep knee bends, take a hot or cold bath, massage my legs, or perform some other activity.
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| I develop this unpleasant or creepy, crawly sensation when I sit for a period of time, such as when watching television or a movie, riding in the car, attending the theater, or participating in a meeting.
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| The sensations bother me most in the evening or at night.
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| I often have trouble staying asleep or falling asleep. |
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| My bed partner tells me that I jerk my legs (or my arms) when I am asleep; sometimes, I have involuntary leg jerks when I am awake.
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| I frequently feel tired or fatigued during the day.
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| No medical tests have revealed a cause for my sensations.
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| I have other family members who experience these same sensations.
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If you answer "yes" to 2 or more of the above statements, you may have restless legs syndrome, and you should discuss this further with your doctor. |
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