Causes of leg restless at night

Overview

Restless legs syndrome (RLS) is a condition that causes an uncomfortable feeling in your legs and a strong urge to move them. It often happens in the evening or at night when you are sitting or lying down, and moving your legs can bring temporary relief.

Yes, restless legs syndrome is a common condition. It affects up to 10 in 100 people at some point in their lives.

RLS can affect people of any age, but it is more common as you get older. Women are slightly more likely to have it than men. It can also occur during pregnancy, usually in the last 3 months.

Symptoms

Common symptoms

• An uncomfortable feeling in your legs, such as crawling, tingling, pulling, or aching.
• A strong urge to move your legs to make the feeling go away.
• Symptoms that get worse when you are resting, like sitting or lying down.
• Symptoms that are worse in the evening or at night.
• Temporary relief when you move your legs, stretch, or walk.

Symptoms in children

• Children may describe the leg discomfort as 'creepy-crawly' or 'pins and needles.'
• They may have trouble falling asleep or staying asleep.
• They might complain of leg pain or have restless sleep, which can affect their mood and schoolwork.

Symptoms in older adults

• Symptoms in older adults can be more frequent and more severe.
• Restless legs may be mistaken for normal aging or other conditions like arthritis.
• Sleep problems from RLS can make other health issues worse.

Causes

Main causes

• Genetics: RLS often runs in families. About half of people with RLS have a family history.
• Iron deficiency: Low iron levels in the brain may affect how signals travel between nerve cells.
• Pregnancy: Hormonal changes can trigger RLS, especially in the third trimester. Symptoms usually go away after the baby is born.
• Kidney failure: People with advanced kidney disease may develop RLS due to changes in minerals and iron.
• Some medications: Certain drugs for depression, allergies, or nausea can cause or worsen RLS.

Risk factors

• Being middle-aged or older.
• Having a family member with RLS.
• Having iron deficiency or anaemia (low red blood cells).
• Having certain health problems like diabetes, Parkinson's disease, or kidney disease.
• Pregnancy, especially in the last trimester.

When to see a doctor

See a doctor urgently if:

• If your leg symptoms come on suddenly and are severe.
• Along with leg swelling, redness, or warmth – see a doctor the same day or call your local health service.

Book a routine appointment if:

• If your symptoms happen regularly and disturb your sleep or affect your daily life.
• If you feel tired during the day because of poor sleep from RLS.
• If you have tried self-care measures for a few weeks without improvement.

Diagnosis

Your doctor will talk with you about your symptoms and medical history. There is no single test for RLS. The diagnosis is based on what you describe. Your doctor will ask about when your symptoms happen, what makes them better or worse, and whether anyone in your family has similar problems.

Tests that may be done

• Blood tests to check for iron levels, anaemia, and other conditions.
• Sometimes a sleep study (called polysomnography) to look for other sleep problems like periodic limb movement disorder.

What to expect at your appointment

Your doctor may ask you to keep a sleep diary for a week or two. They will also check your legs for any other cause, like nerve damage or circulation problems. Most of the time the diagnosis can be made during the office visit.

Treatment

Treatment for restless legs syndrome depends on how severe your symptoms are and what is causing them. For mild cases, self-care and healthy habits may be enough. For moderate to severe symptoms, doctors may recommend treatments to help you sleep and feel better.

Self-care at home

• Do gentle leg stretches before bed.
• Take a warm bath or use a heating pad on your legs before sleep.
• Massage your legs to help relax the muscles.
• Avoid caffeine, alcohol, and nicotine in the evening.
• Establish a regular bedtime routine and try to go to sleep at the same time each night.
• Get enough physical activity during the day but avoid intense exercise close to bedtime.

Medical treatments

If self-care is not enough, your doctor may suggest treatments such as iron supplements if your blood test shows low iron. They may also prescribe medications that affect certain brain chemicals (like dopamine or calcium channel activity) to reduce symptoms. Always take any medicine exactly as your doctor directs. Never start or stop a medication without medical advice.

When is surgery considered?

Surgery is not used to treat restless legs syndrome.

Living with this condition

Having RLS can be frustrating, but many people learn to manage it. Planning your day so you can rest when needed, and having strategies to deal with nighttime symptoms, can help you feel in control.

Lifestyle tips

• Keep a regular sleep schedule.
• Stay active but avoid exercising too close to bedtime.
• Reduce stress with relaxation techniques like deep breathing or meditation.
• Limit or avoid caffeine, especially after midday.

Diet and exercise

A balanced diet rich in iron (like lean meat, beans, and leafy greens) can help. If you have low iron, your doctor may recommend supplements. Gentle exercise like walking, swimming, or yoga can improve symptoms, but don't overdo it right before bed.

Mental health and emotional wellbeing

Chronic sleep loss from RLS can lead to feeling irritable, anxious, or down. It is important to talk to your doctor if your mood is affected. Treating RLS often improves both sleep and mental well-being.

Prevention

There is no sure way to prevent restless legs syndrome, especially if it runs in your family. However, you may be able to reduce your risk by maintaining a healthy lifestyle, managing stress, and addressing any underlying conditions like iron deficiency.

Screening programmes

There are no routine screening tests for RLS. If you have a family history or related health conditions, your doctor may check your iron levels as part of a general health check.

Complications

If left untreated

• Severe sleep problems can lead to daytime tiredness, trouble concentrating, and poor performance at work or school.
• Chronic sleep loss increases the risk of depression and anxiety.
• Long-term RLS can affect your quality of life and relationships.

Long-term outlook

The outlook for people with RLS is generally good. Many people find relief with self-care and treatment. Even if symptoms last for many years, they can often be managed well so they do not interfere too much with sleep and daily life.

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