7 Major Causes Restless Legs at Night

Lying in bed at night should feel relaxing. Your body is tired, the lights are off, and you are ready to sleep. But instead, your legs feel uncomfortable. There is a strange crawling, pulling, or aching sensation deep inside them. You feel a strong urge to move. No matter how tired you are, you cannot stay still.

If this sounds familiar, you are likely experiencing restless legs at night, a common sign of restless legs syndrome (RLS). Also known as Willis-Ekbom disease, this condition affects about 1 in 10 people at some point in their lives.

While it can feel like a minor annoyance at first, the resulting sleep deprivation and daytime fatigue can seriously impact your long-term health. At Everlab, we test over 100 health markers to identify what's actually happening in your body, whether that's low iron, vitamin gaps, or blood sugar issues that could be contributing to your symptoms.

What is Restless Legs Syndrome?

Restless legs syndrome (RLS) is a condition where your brain sends signals that create an overwhelming urge to move your legs. These sensations usually happen deep within your thigh, calf, or foot.

The reason it's called restless legs at night is that symptoms get worse in the evening and peak during the night when you're trying to fall asleep. This significantly lowers your sleep quality. While it can affect anyone at any age, including children, RLS is more common in women than men and becomes more frequent in people over 50.

Since the sensations happen inside the muscles rather than on the skin, individuals describe them differently:

• Creeping or Crawling - Like something is moving under the skin.
• Electric or Fizzing - A buzzing feeling deep in the tissues.
• Aching or Throbbing - A dull, persistent discomfort.
• Tugging - A feeling that the muscles are being pulled.

Symptoms of Restless Legs at Night

To diagnose RLS, doctors look for specific patterns in your symptoms. It is a clinical diagnosis, meaning there is no single specific test. Instead, your doctor relies on your description of what you're experiencing.

• The Strong Urge to Move - The main sign is a strong urge to move your legs. This is usually triggered by uncomfortable sensations that only go away when you kick, shake, or get out of bed to walk around.
• Symptoms get worse at night - For most people, the condition is barely noticeable during the day. However, as the sun goes down, the symptoms of restless legs become more intense. This makes staying asleep or returning to sleep after waking up very difficult. Walking or moving your legs may provide temporary relief.
• Rest brings it on - Whether you are lying in bed or sitting on a long flight, being still is what triggers symptoms. This is why many people find it difficult to sit through a movie or a dinner party in the late evening.
• How It Affects Your Day - Because RLS disrupts sleep, the effects often spill into the next day. You might experience severe tiredness, irritability, difficulty concentrating, and difficulty falling asleep the following night because you're worried about the sensations returning.

Why Symptoms Worsen at Night

Restless legs syndrome follows a "circadian rhythm," pattern meaning symptoms peak when your body is winding down for sleep.

When you lie down, these sensations become more noticeable because there's less competing for your attention.

This creates a cycle: you try to relax, the sensations start, you move your legs to find temporary relief, and the process repeats. This often leads to sleep deprivation, as the body does not get enough rest.

Several factors explain the night-time pattern:

• Dopamine levels naturally drop in the evening.
• Your body's internal clock affects how sensitive your nerves are
• Less activity means symptoms surface more easily
• The basal ganglia (the part of the brain controlling movement) are most active in their "restless" signalling during these hours.

What Causes Restless Legs at Night?

Understanding the causes of restless legs syndrome helps explain why proper testing matters. Here are the factors at play:

1. Low Iron Levels

Iron deficiency is one of the most common causes of restless legs at night. Iron helps produce a brain chemical that controls smooth muscle movement. When iron levels drop too low, your brain can't manage movement signals properly. This leads to that strong urge to move.

2. Genetics and Family History

Family history plays a major role. Approximately 50% of RLS cases are inherited. If a parent has restless legs syndrome, you're at increased risk of developing it, often before age 40.

The genetic form of RLS typically starts earlier in life and may be more persistent than RLS that develops later from other causes.

3. Vitamin and Mineral Deficiencies

Beyond iron, other deficiencies can contribute to restless legs syndrome:

• Magnesium is involved in over 300 reactions in your body, including muscle and nerve function. Low magnesium can make your nerves more excitable, which may trigger or worsen RLS.
• Vitamin B12 is essential for nerve health. Your nerves need B12 to stay healthy and function properly. Without enough B12, nerve signals can misfire, creating abnormal sensations in your legs.
• Folate works closely with B12 in your body. Low folate levels have been linked to RLS, particularly during pregnancy when folate needs increase.

4. Kidney Disease

Kidney disease is strongly linked to restless legs syndrome. Between 20% and 50% of people with kidney failure experience RLS.

When your kidneys aren't working properly, several things happen:

• Waste products build up in your blood, affecting how nerves function
• Your body produces less of a hormone needed to make red blood cells, leading to low blood counts
• Minerals get out of balance
• Iron deficiency becomes more common

5. Diabetes and Nerve Damage

High blood sugar over time damages nerves throughout your body, particularly in your legs and feet. When nerves become damaged, they can send incorrect signals to your brain. These mixed signals produce unpleasant sensations, such as burning, tingling, numbness, or the uncomfortable sensations associated with RLS.

The longer someone has had diabetes, and the less controlled their blood sugar has been, the more likely nerve damage becomes. Better blood sugar control often means fewer symptoms.

6. Thyroid Problems

Both underactive and overactive thyroid can be linked to restless legs syndrome (RLS). Your thyroid controls your metabolism and affects how every system in your body functions.

When thyroid hormones are out of balance, this can affect:

• How your body uses and stores iron
• Nerve function and sensitivity
• Sleep quality and patterns
• Brain chemical production

7. Other Health Conditions

Several other conditions occur more frequently in people with restless legs syndrome (RLS):

• Sleep disorders: People with conditions such as sleep apnoea have a higher risk of RLS. The conditions may share common mechanisms, or the sleep disruption from one may worsen the other.
• Parkinson's disease: While different from RLS, Parkinson's disease shares some similarities in how the brain produces and uses certain chemicals.
• Rheumatoid arthritis and fibromyalgia: These conditions occur more frequently in people with RLS, possibly due to shared inflammatory pathways or chronic pain affecting sleep patterns.

Medications That Worsen Symptoms

Certain medicines may make restless legs syndrome worse. These medications affect brain chemicals in ways that can trigger or worsen RLS:

• Some Anti-nausea drugs - Some of these work by blocking chemicals in the brain that RLS also involves.
• Certain antidepressants - Specifically, those that change certain brain chemicals like serotonin.
• Antihistamines -  Common in over-the-counter cold, allergy, and sleep medicines.
• Some antipsychotics - Many of these medications can trigger or worsen RLS symptoms.

Never stop medications without talking to your healthcare provider. They can help explore alternatives that won't affect your symptoms. Sometimes switching to a different medication within the same class can make a difference.

Periodic Limb Movement Disorder

About 80% of people with restless legs also have periodic limb movement disorder (PLMD).

While RLS is felt while awake, PLMD causes jerking movements of the arms or legs while you are asleep. These jerking movements can happen every 20 to 40 seconds and can wake you up (or your partner) without you even realising it. This prevents you from reaching deep sleep.

You might not know you have PLMD because it happens during sleep. Often, a bed partner notices the movements first. Or you might wake up with your sheets in disarray, your muscles feeling tired, or feeling unrefreshed despite spending enough time in bed.

A sleep study is often needed to accurately diagnose these movements and their impact on your sleep quality.

How is Restless Legs Syndrome Diagnosed

There is no specific test for restless legs syndrome. Your doctor will make a clinical diagnosis by reviewing your symptoms, medical history, and family history. They will look for five key signs:

An urge to move your legs, usually with uncomfortable sensations.

• Symptoms that start or get worse during rest.
• Symptoms that improve with movement.
• Symptoms that are worse in the evening or at night.
• Symptoms not explained by another condition.

Since there is no single lab test, your description of what you are experiencing is the most important part. However, blood tests can help identify underlying causes like low iron or blood sugar imbalances.

This is where comprehensive testing becomes valuable. Instead of guessing at the cause, blood work can reveal the specific factors contributing to your symptoms.

Lifestyle Factors That Help

For many individuals, making small lifestyle changes can provide temporary relief:

• Watch your diet - Cut caffeine after midday and limit alcohol consumption, particularly in the evening.
• Nutrient-rich foods - Include more iron-rich foods like lean red meat, dark leafy greens, and legumes.
• Sleep habits - Keep a consistent sleep schedule and avoid screens an hour before bed.
• Movement - Do moderate activities like walking or yoga earlier in the day, but avoid intense workouts late in the evening.
• Stress management - Relaxation practices such as deep breathing can help prevent stress from worsening your symptoms.
• Quick Relief Measures - When symptoms strike at night, take a warm bath, apply an ice pack, or massage your legs firmly to settle the nervous system.

Finding Relief

Restless legs at night do not have to control your life. Understanding your symptoms and identifying the underlying causes through proper diagnostic testing is the first step toward effective management. Instead of just masking the urge to move, the goal is to find out why it is happening in the first place.

At Everlab, we test over 100 health markers across 50+ medical categories to provide the data needed for a precise treatment plan. This includes checking:

• Iron stores (ferritin levels): Low iron is a primary driver of RLS, and we ensure your levels are optimal, not just "normal."
• Vitamin B12, magnesium, and folate: Essential nutrients for healthy nerve signalling.
• Kidney and liver function: To rule out secondary causes of nerve irritation.
• Blood sugar and thyroid indicators: Identifying metabolic shifts that trigger restlessness.

Your results come with clear explanations reviewed by qualified Everlab doctors.

Depending on what your data reveals, Everlab doctors will guide you through the most appropriate treatment options, such as:

• Iron Supplements - Only if blood tests confirm your ferritin levels require a boost.
• Prescription Management - If lifestyle changes are not enough, Everlab doctors can discuss first-line medications like specific nerve-calming agents or dopamine agonists to help your muscles relax.
• Medical Device Referrals - For some, FDA-approved devices that use gentle electrical stimulation may be recommended.

Ready to find out why your legs won't stay still? Start your health journey with Everlab today and get the deep, restorative sleep you’ve been missing.