THE INTERNATIONAL RESTLESS LIMB SYNDROME (IRLS) RATING SCALE

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Please Answer All Questions

Where a question is marked with * the following is true:

  • 0-1 days/week = Mild
  • 2-3 days/week = Moderate
  • 4-5 days/week = Severe
  • 6-7 days/week = Very Severe

Where a question is marked with ** the following is true:

  • < 1 hrs/day = Mild
  • 1-3 hrs/day = Moderate
  • 3-8 hrs/day = Severe
  • > 8 hrs/day = Very Severe
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Use the information at the bottom of the form to determine your score.


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Use the following scale to determine your total score.

Total Score Categories:

  • 0 = None
  • 1 = Mild
  • 2 = Moderate
  • 3 = Severe
  • 4 = Very Severe

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