Restless Legs

What restless legs feel like

People describe a crawling, pulling, aching, or tingling feeling deep in the legs, along with a strong urge to move them.

The feeling usually appears when you are at rest, especially in the evening, and eases as soon as you move or walk. Because it is worse at night, it often disrupts sleep for the person and their partner.

The National Institute of Neurological Disorders and Stroke describes it as: an irresistible urge to move the legs.

Causes include low iron, pregnancy, nerve conditions, and some medications. Vein disease in the legs can also cause restless, aching symptoms in the evening that feel similar, and those often improve when the vein problem is treated. That is why a circulation check can be worthwhile.

What is worth trying, and what to ask to have checked

Restless legs is often treated as something to put up with. A fair amount of it responds to changes that cost nothing, and two of the common causes are found with a blood test, so it is worth working through the list before accepting it as permanent.

Start with the things that make it worse. MedlinePlus is direct about these: avoid caffeine, alcohol, and tobacco. They may make symptoms worse. Caffeine is the one people underestimate, partly because afternoon coffee feels harmless and partly because it hides in tea, cola and some painkillers. Give any change a fortnight before judging it, since one bad night proves nothing either way.

Then ask to have your iron checked. It is the single most useful test in this condition, and the reason is that iron can be low enough to drive symptoms while a routine blood count still looks acceptable. On the same guidance, iron replacement may be necessary and may help reduce the symptoms of RLS in some people. Ask specifically for iron studies rather than for a general blood test, and ask what the result was rather than whether it was normal.

A few other things are worth raising in the same conversation.

• Your medication list. Several common medicines, including some antihistamines and some antidepressants, can make restless legs worse. This is a question for the person who prescribed them, not a reason to stop anything on your own.
• Your sleep pattern. Symptoms are worst in the evening and at rest, so a later bedtime and a consistent one often help more than they sound like they should.
• Movement in the evening. Gentle activity, stretching and walking tend to help. Intense exercise late at night tends not to.
• Your legs themselves. Vein disease can produce a restless, aching, need-to-move feeling in the evening that is very hard to tell apart from this, and it is treatable, which is why a circulation check is worth having rather than assuming the diagnosis.

If the symptoms are disturbing sleep several nights a week despite all of that, it has stopped being a nuisance and become a treatable medical problem. That is the point to stop managing it alone.

What a specialist can do

A specialist will review your symptoms and sleep, then look for treatable causes. That may include:

• Iron and blood tests: low iron is a common and correctable cause.
• Vein evaluation: an ultrasound can find vein disease that causes restless, aching legs at night.
• Nerve and medication review: to check for neuropathy or contributing medications.

Many people improve with simple lifestyle changes, correcting iron levels, or treating an underlying vein condition. The right plan depends on the cause.