Restless Legs: Why Your Legs Will Not Settle at Night

The dishes are done, the lights are off, and you are finally in bed after a long day. Just as you're about to fall asleep, you feel something strange in your legs. A crawling, pulling sensation deep in your calves that makes it almost impossible to keep them still. You stretch, turn over and move your feet around, but nothing helps. Finally, you get up and walk around for a few minutes. The feeling disappears, only to return when you lie down again. If this sounds familiar, you may be experiencing restless legs syndrome (RLS), also known as Willis-Ekbom disease. It is a neurological condition that causes a strong urge to move your legs, particularly when you are resting or trying to sleep. According to the US National Institute of Neurological Disorders and Stroke, movement often brings temporary relief, which is why the discomfort tends to return once you settle down again. The good news is that restless legs syndrome can often be managed. Knowing how to recognise the symptoms, what might be causing them and which treatments can help is a useful first step towards getting a better night’s sleep.

What does restless legs feel like?

People struggle to describe it, which is one reason it can go unrecognised. The NINDS lists the sensations as aching, throbbing, pulling, itching, crawling or creeping. It usually affects both legs. It can sometimes reach the arms. Some people simply say their legs feel ‘jumpy’ or that they cannot keep them still. The feeling tends to show up in quiet moments:

• Lying in bed at night

• Sitting through a long film or a family function

• A long car ride or an overnight train ride

• A slow afternoon meeting where you cannot get up

Symptoms can vary from day to day. The NINDS notes that some people have spells of weeks or months when symptoms ease or disappear, usually early on, though symptoms often return.

The features doctors look for

There is no blood test or scan that confirms RLS. A doctor diagnoses it from your description. The International Restless Legs Syndrome Study Group sets out five essential criteria. The fifth was added in 2014 to make sure other conditions are not mistaken for it. In plain words, a doctor checks that:

1. You feel an urge to move your legs, usually with an unpleasant feeling in them

2. The urge starts or gets worse when you rest, sit or lie down

3. Moving, walking or stretching brings relief for as long as you keep moving

4. It is worse in the evening or at night than during the day

5. Another problem, such as cramps, swelling, arthritis or an awkward sitting position, does not explain it better

Many people with RLS also have periodic limb movements during sleep. These are small jerks of the legs that the NINDS says typically happen every 15 to 40 seconds and can go on through the night. Your spouse may notice them before you do.

Is it restless legs or a leg cramp?

The two get mixed up all the time. A night cramp is a sudden, hard, painful tightening of a muscle, often the calf. It locks the muscle and can leave it sore the next day. RLS is an urge with an odd sensation that eases the moment you move and returns when you stop. If your night trouble is mostly sharp knots in the calf, a cramp is the more likely culprit. The NHS also notes that leg cramps and nerve damage (peripheral neuropathy) can cause similar symptoms. The fifth criterion above is there to rule these out.

What causes restless legs syndrome?

In most people there is no single clear cause. RLS often runs in families. The NHS explains that it is thought to be linked to the levels of iron and the brain chemical dopamine. Dopamine helps the brain control smooth movement. Iron is needed to make it. That link may help explain some of the triggers below.

Low iron stores

Low iron in the brain may play a part even when your haemoglobin looks normal. Women with heavy periods can run low on iron. Our Aora guide on iron deficiency in women covers the wider symptoms and testing. For RLS, doctors look at iron stores more closely than usual. The American Academy of Sleep Medicine (AASM) advises that everyone with troublesome RLS should have iron studies including ferritin and transferrin saturation, ideally in the morning, avoiding iron supplements and iron-rich foods for at least 24 hours before the sample. The guideline notes that the iron levels used for RLS are different from those used for the general population. So a ferritin result marked ‘normal’ on your report may still be worth discussing with a doctor who knows RLS. Start iron only after that blood test and on medical advice.

Pregnancy

RLS is common in pregnancy, particularly in the last few months. A review of 27 studies covering 51,717 pregnant women found that about 21% had RLS across pregnancy. The rate rose from 8% in the first trimester to 16% in the second and 22% in the third. After delivery, it fell to 4%. If you are expecting, mention it at your next check-up, because many medicines are not suitable in pregnancy.

Kidney disease

RLS is more common in people with kidney failure. A 2024 review of 57 studies covering 12,573 people on maintenance haemodialysis found that 24% had restless legs syndrome. The AASM guideline includes specific advice for this group, so tell your kidney team if your legs keep you up.

Some medicines

Certain medicines can make RLS worse. The NINDS lists some anti-nausea drugs, antipsychotic drugs, antidepressants that increase serotonin and some antihistamines. Some cough and cold or allergy tablets contain sedating antihistamines. Never stop a prescribed medicine on your own. Ask your doctor whether a change is possible.

Other links

The NINDS also connects RLS with nerve damage (neuropathy), sleep apnoea, too little sleep and the use of alcohol, nicotine and caffeine. People with Parkinson's disease have a higher risk. Nerve damage from low vitamin B12 can cause tingling that looks similar, which our guide to vitamin B12 deficiency explains.

Why does it hurt your sleep so much?

The urge peaks just as you try to fall asleep. It can return each time you wake. The leg jerks during sleep can break up deeper sleep without you knowing. Over weeks this adds up. The NINDS notes that people with RLS may have exhaustion and daytime sleepiness, trouble concentrating, mood changes, depression and anxiety.

If you find yourself awake in the small hours night after night, our guide on why you keep waking up at night walks through other common reasons. To understand what broken nights cost, read how much deep sleep adults need.

What can you do tonight and this week?

The AASM says the first step is to deal with things that make RLS worse, such as alcohol, caffeine, certain medicines and untreated obstructive sleep apnoea. The NHS adds a set of practical habits. Put together, they look like this:

• Exercise during the day, at a moderate and steady pace.

• Keep tea, coffee and energy drinks to the morning. The NHS suggests no caffeine after midday, which means the after-dinner chai may need to go.

• Avoid alcohol for at least two hours before bed. If you smoke, get help to stop.

• Keep fixed sleep and wake times. Skip daytime naps.

• Avoid a heavy dinner or hard exercise late at night.

• Try a warm bath or a heat pad on your calves before bed.

• When the feeling comes, get up and walk, stretch or massage your legs.

• Keep your mind busy with a book, a crossword or a puzzle when you have to sit still.

Exercise has some trial support. In a small 12-week trial, adults who did aerobic exercise with lower-body strength work three days a week had a significant improvement in RLS symptoms compared with a control group. Only 23 people finished the study, so the result is encouraging but early. The NINDS also suggests exercising moderately and consistently.

What can a doctor offer?

The NINDS notes that blood tests may help rule out other causes, such as kidney failure and low iron levels. Your doctor will also review your medicines. Correcting low iron stores can help. When symptoms are moderate to severe, there are prescription medicines. The 2025 AASM guideline now favours gabapentin-type medicines and iron when iron stores are low. It suggests against the standard use of older dopamine medicines because over time they can make symptoms come earlier in the day and spread, a problem called augmentation. These are decisions for your doctor, based on your health and other medicines.

When should you see a doctor?

The NHS advises seeing a GP if you have symptoms of restless legs syndrome and:

• It is stopping you from sleeping

• It is affecting your mental health

• You have tried things you can do yourself but they have not helped

Also tell your doctor if you are pregnant, on dialysis or have kidney disease, if the symptoms began after starting a medicine such as an antidepressant, antihistamine or anti-nausea drug, or if you also have numbness, burning feet or weakness.

One painful, swollen leg is a different problem. The NHS DVT page lists the symptoms of a blood clot in the leg as throbbing pain in 1 leg (rarely both legs), usually in the calf or thigh, swelling in 1 leg, red, blue or darkened skin around the painful area and swollen veins. It advises an urgent GP appointment if you think you have DVT. Call 112 or go to the emergency department if you have DVT symptoms such as pain and swelling and you feel short of breath or have chest pain. Sudden weakness or numbness down 1 side of your body can be a sign of a stroke. The NHS stroke page says to call 999 now (112 in India) if you think you are having, or have had, a stroke, or you have had signs of a stroke within the last 24 hours, even if they have now stopped.

Restless legs can make the end of a long day feel like a second shift. A morning blood test, a look at your evening cup of chai and a calm talk with your doctor can make a real difference. Many people find a mix of steps that lets them lie still and sleep again.

Sources

• Restless Legs Syndrome (National Institute of Neurological Disorders and Stroke, NIH)

• Restless legs syndrome (NHS)

• Restless Legs Syndrome Diagnostic Criteria: Updated IRLSSG Consensus Criteria (Sleep Medicine, 2014)

• Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder: An AASM Clinical Practice Guideline (Journal of Clinical Sleep Medicine, 2025)

• Prevalence of Restless Legs Syndrome During Pregnancy: A Systematic Review and Meta-Analysis (Sleep Medicine Reviews, 2018)

• Prevalence of Restless Legs Syndrome in Maintenance Hemodialysis Patients: A Systematic Review and Meta-Analysis (Sleep Medicine, 2024)

• Exercise and Restless Legs Syndrome: A Randomized Controlled Trial (Journal of the American Board of Family Medicine, 2006)

Medical Disclaimer: This article is for general information and is not a substitute for advice from your doctor. Speak to a qualified healthcare professional before starting any supplement, especially if you are pregnant, breastfeeding or taking medication.