What helps restless legs at night?

Start with evening stretches, calf massage, a warm bath or heating pad, and a consistent sleep routine. Review medications that may worsen RLS (certain antihistamines or antidepressants) with your doctor, and test iron status if symptoms persist.

What causes restless legs syndrome?

RLS involves dopamine dysregulation in the brain and is strongly linked to low iron stores. Risk increases with age and in conditions like kidney disease or diabetes. Some medicines can trigger or worsen symptoms.

How is RLS different from night leg cramps?

RLS causes an urge to move the legs with uncomfortable, non-painful sensations that improve with movement. Night leg cramps are sudden, painful muscle contractions. The two conditions need different strategies.

When should I see a doctor for restless legs?

If symptoms occur three or more nights per week, disrupt your sleep or daily life, begin during pregnancy, or if you have chronic conditions like kidney disease or diabetes, talk to a clinician. Ask about medication review and iron testing.

Restless Legs at Night: Causes & Relief

Aug 22

Written By Better Sleep

Introduction

That irresistible urge to move your legs at night isn’t just annoying—it may be Restless Legs Syndrome (RLS). The sensations (crawling, pulling, tingling) can make it hard to fall or stay asleep, and many people don’t realize medications, iron levels, or certain health conditions can play a role. If you’ve been searching for restless legs syndrome relief, this guide explains the likely causes and the most effective, practical steps you can try tonight, plus when to see a doctor for tailored care.

What Is Restless Legs Syndrome?

RLS (also called Willis–Ekbom disease) is a neurological condition marked by an uncomfortable sensation in the legs and a strong urge to move them. Symptoms typically start or worsen at rest (evening or nighttime), improve with movement (walking, stretching), and often return when you’re still again. RLS is different from nocturnal leg cramps: cramps are sudden, painful muscle contractions; RLS is usually not painful but creates an urge to move and lasts longer. Movement offers temporary relief.

Causes of RLS

RLS is multifactorial. Understanding the drivers can help you choose the right fixes.

1) Dopamine imbalance in the brain

Research suggests RLS involves dysregulation of the dopamine system, which helps coordinate movement. This helps explain why certain dopamine-targeting medicines can reduce symptoms—and also why some drugs that block dopamine can worsen them.

2) Iron deficiency (including brain iron)

Low iron stores—even with a normal overall blood count—are linked to RLS. Iron is crucial for dopamine synthesis in the brain. Studies (including imaging and pathology) indicate “brain-iron deficiency” in people with RLS, and iron therapy is often recommended when labs confirm low stores. Your clinician may check ferritin and related iron markers.

3) Chronic conditions that raise risk

RLS is more common in people with kidney disease, diabetes, Parkinson’s disease, during pregnancy, and with some spinal cord problems. Addressing the underlying condition—alongside sleep strategies—typically yields better outcomes.

4) Medications that may worsen RLS

Some medicines can provoke or intensify symptoms. Common culprits include:

Sedating antihistamines (found in certain OTC cold/allergy aids)
Antidepressants (some SSRIs/SNRIs)
Antipsychotics
Dopamine-blocking antiemetics (e.g., metoclopramide)
If any of these coincide with a symptom flare, ask your prescriber about alternatives or timing adjustments. Do not stop a prescribed drug on your own.

RLS in Older Adults

RLS prevalence rises with age, and older adults are more likely to face polypharmacy (5+ medications), slower drug metabolism, and comorbidities like diabetes, arthritis, and kidney disease—all of which can complicate sleep. Clinicians often screen seniors for iron deficiency (and sometimes vitamin B12) and review medication lists for RLS-worsening agents. Gentle approaches—evening stretching, heat packs, light massage, and a calming wind-down routine—can meaningfully reduce nighttime symptoms and improve sleep continuity.

Relief & Management Strategies

Below are practical, evidence-informed steps you can start now. Combine several for best results.

Lifestyle strategies

Evening movement “snacks.” Try 5–10 minutes of calf and hamstring stretches, ankle circles, or a short walk after dinner; movement often brings rapid relief.
Massage + heat or contrast therapy. Gentle calf massage, a warm bath or heating pad before bed can ease sensations. Some people prefer alternating warm/cool packs.
Caffeine, nicotine, alcohol: dial them back. Caffeine and nicotine can aggravate symptoms; alcohol may fragment sleep.
Consistent sleep routine. Keep a stable bedtime/wake time and a dark, cool, quiet bedroom—RLS can feel worse when you’re overtired.

Nutrition & supplements

Iron: If labs show low ferritin or iron deficiency, iron therapy (dietary or supplemental) can reduce symptoms. Don’t start iron without testing—excess iron can be harmful.
Magnesium: Evidence is mixed for RLS specifically, but some people report improved sleep quality and fewer nocturnal symptoms with magnesium glycinate—especially if dietary intake is low.

Shop Magnesium

General diet: Iron-rich foods (legumes, leafy greens, fortified cereals), vitamin C to support absorption, and adequate hydration can support overall sleep health.

Prescription options (for moderate–severe RLS)

If symptoms remain disruptive, clinicians may consider:

Alpha-2-delta ligands (e.g., gabapentin, pregabalin)—often first-line, especially when pain or insomnia are prominent.
Dopamine agonists (e.g., pramipexole, ropinirole, transdermal rotigotine)—effective but require monitoring for augmentation (a drug-related worsening/earlier onset of symptoms over time).
Other options may be considered in specific cases under specialist care.
Work closely with your provider to balance benefits and risks, and to monitor for augmentation if a dopamine agonist is used.

When to seek medical help

Symptoms occur 3+ nights per week or severely disrupt sleep/daytime function
You’re pregnant, or you have kidney disease, diabetes, or neuropathy
You suspect a medication is triggering symptoms
You have signs of iron deficiency (or labs show low ferritin) and need a treatment plan

Conclusion

RLS is frustrating—but manageable. Start with simple strategies (evening movement, massage and heat, a steady sleep routine), review your medications, and check iron status. For people who need more help, guideline-supported therapies can provide durable restless legs syndrome relief. If symptoms persist, ask your clinician about a tailored plan.

Better Sleep