Why do my legs feel restless at night?

Your legs won't keep still, however you lie. You get up and they ease. You lie back down and it all starts over. It's hard to put into words. It isn't quite pain and it isn't a cramp, so people reach for all sorts of descriptions: a fizzing under the skin, an itch somewhere too deep to scratch, a stretch that stretching never finishes. In a survey of more than fifteen thousand adults in the US and Europe, about seven in a hundred had felt it in the past year, and nearly three in a hundred at least twice a week with real distress³⁴3 Winkelman & Wipper, 20264 Allen et al., 2005.

Doctors call it restless legs syndromerestless legs syndrome An urge to move your legs, often with uncomfortable feelings in them, that comes on when you rest, especially in the evening, and eases when you move., and four things mark it out¹⁵1 Winkelman et al., 20255 Manconi et al., 2021: an urge to move the legs, sometimes the arms too, that comes on or grows when you're still, eases while you move and is worst in the evening or at night. The feeling that comes with the urge is often described as creeping, itching or pulling, or as an ache or a tingle²³2 Tang et al., 2023.

Lying still and willing it away is the one thing that tends not to work, because stillness is what brings it on and moving is what brings relief¹.

There's no blood test or scan that shows restless legs, and no need for a night in a sleep lab to find it¹³1 Winkelman et al., 20253 Winkelman & Wipper, 2026. A doctor recognizes it from what you describe, so your own account of your evenings is the most useful thing you can bring. They'll also want to rule out a few things that can feel similar, among them nerve damage in the feet, a restlessness some medicines bring on, discomfort from lying awkwardly, sore joints and nighttime cramps¹⁷⁸7 Allen et al., 20148 Rizek & Kumar, 2017.

A cramp is the easiest of these to tell apart once you've had both. A nighttime leg cramp is a sudden, painful tightening of the calf, the back of the thigh or the foot, with a muscle that goes hard, and it lasts seconds to minutes, usually ten at most⁹9 Hallegraeff et al., 2017. What restless legs brings instead is the urge to move, which eases while you're moving and returns each time you're still again¹.

If you've mentioned it to a doctor before and come away with talk of nerves or circulation, or with nothing at all, you'll recognize what that same survey found. Among the people whose symptoms were frequent and troubling, eighty-one percent had raised them with their doctor. Of those, only about six percent had been told it was restless legs⁴⁵4 Allen et al., 20055 Manconi et al., 2021. Those conversations took place in the early 2000s, and recognition may be better now.

It keeps time, rising and ebbing on much the same schedule night after night. If you were once told it was nerves, that steadiness says something, because a rhythm this regular points to something happening in the body. On a usual sleep schedule, symptoms tend to climb through the evening, peak between about 11pm and 4am, and fall to their lowest from about 9am to 2pm²2 Tang et al., 2023. So the sofa after dinner, a late film in the cinema, a long drive home and the first hours in bed all meet it near its height, while the same legs can sit through a morning meeting without complaint.

That rhythm seems to come from the body clockbody clock The timekeeper in your brain that runs on a cycle of about a day, setting when you feel sleepy and when you feel alert. Daylight, especially in the morning, keeps it in step with the clock on the wall. itself, more than from tiredness. In a small laboratory study, seven people with restless legs and seven without stayed awake for twenty-eight hours in unchanging conditions. The leg discomfort still rose and fell on its daily rhythm¹⁰10 Michaud et al., 2004. They'd gone twenty-eight hours without sleep, and their legs were still keeping time. The researchers also saw a rise in melatonin, the hormone of the body's night, come just before the symptoms climbed¹⁰. They read that as a sign of the clock at work, though nobody has shown that melatoninmelatonin A hormone your brain releases as darkness falls, telling the rest of your body that night has come. It's also sold as a tablet. causes the symptoms. Reports from shift workers and long-haul flyers describe the symptoms shifting later after flying west and earlier after flying east², as you'd expect of something set by an inner clock.

One leading idea ties the clock to iron. In this model, low iron in the brain upsets the signaling of dopamine, one of the brain's messengers. Dopamine naturally dips in the evening and night, so the signal may fall below a threshold then and set off the urge². It's still a hypothesis, and researchers agree that the cause is only partly understood, with genes mattering alongside iron and other brain chemicals still to be fitted into the picture¹⁵1 Winkelman et al., 20255 Manconi et al., 2021.

You may already have had bloods taken and been told they were fine. The brain can be short of iron while the blood looks normal¹²1 Winkelman et al., 20252 Tang et al., 2023. Iron in the blood doesn't reliably show iron in the brain, and some people whose blood iron tests were normal still improve with iron treatment¹². So “your bloods were fine” can be true by the usual measure and still leave the question open.

The test that matters is ferritinferritin A protein that stores iron, measured with a blood test. The level shows roughly how much iron the body has in reserve., the measure of the body's iron store, and guidelines recommend checking it for everyone with troublesome restless legs, along with transferrin saturation¹. If you've had it checked before, your result was most likely read against a typical lab range, and those ranges call ferritin normal from a much lower level¹¹11 MedlinePlus, 2026c than the one used for restless legs. Where restless legs is concerned, guidelines suggest iron treatment when ferritin is 75 nanograms per milliliter or below¹¹²12 Allen et al., 2018, and that's the number to compare your own result with. The line is expert consensus that trials haven't tested, and a 2026 review draws it at 100³3 Winkelman & Wipper, 2026, so a result a little above 75, or a low transferrin saturation, is still worth talking over with your doctor. A woman told her ferritin of 20 was normal could still be far below the line for restless legs, and only the number itself will show her that.

If your ferritin is low, iron can be given in two ways. Iron by drip has a strong guideline recommendation for restless legs, while tablets have a weaker one and often cause constipation¹1 Winkelman et al., 2025. Please have the test before taking iron on your own, because iron can be harmful in excess, and iron tablets are especially dangerous if a child gets hold of them¹¹¹¹³11 MedlinePlus, 2026c13 MedlinePlus, 2026b.

It could, and this is one of the most useful things to check. The evening drink, the afternoon coffee and a prescription you've taken for years can all play a part. When guidelines set out treatment, they begin with what feeds it: alcohol, caffeine, antihistamines, many antidepressants and untreated sleep apnea, along with medicines that block dopamine, such as antipsychotics¹¹⁴1 Winkelman et al., 202514 Garcia-Borreguero et al., 2016. Some anti-nausea drugs block dopamine too, so they belong on that list. Going short on sleep tends to make it worse as well²2 Tang et al., 2023, which is hard to escape when your legs are the reason you're short of it.

Of these, the antihistamineantihistamine A medicine that blocks histamine, a chemical that helps keep you awake. Some older ones make you drowsy and are sold as nighttime sleep aids. may be the one already waiting in the bathroom cabinet. Diphenhydramine is one of the medicines linked to restless legs, and it's the sleep ingredient in many over-the-counter sleep aids and PM painkillers³⁶3 Winkelman & Wipper, 20266 MedlinePlus, 2026d. So the pill taken at 2am to get through can add to the very thing keeping you up. There's little research yet on how often that happens, and Are sleeping pills safe to take? looks at the wider question.

Perhaps it began, or grew worse, soon after you started a new antidepressant. In one study of people newly starting one, about one in eleven developed restless legs or found it worse, usually within the first few days¹⁵15 Rottach et al., 2008. The rate was highest with mirtazapine, at about twenty-eight in a hundred¹⁵. If you think a prescribed medicine is part of it, please talk to whoever prescribed it before stopping, since there may be an alternative, and some medicines cause problems if they're stopped suddenly³.

For caffeine, How long does caffeine stay in your system? can help you see how far into the evening an afternoon cup reaches, and Does alcohol help you sleep? covers what a drink does to the night.

If you share a bed, the other person may know what your legs do after dark better than you do: the kicks that wake them, or the covers you find tangled in the morning with no memory of having moved. Restless legs often comes with periodic limb movements once you're asleep, brief jerks or flexes of the legs that come again and again, mostly early in the night¹1 Winkelman et al., 2025. They're often what a bed partner feels as kicking. If you're that partner, the one who has been kicked awake or watched someone pace the hallway at midnight, it can help to describe what you've seen at the doctor's, as a picture of the night from the one person who was awake for it.

When you're out in the hallway again, the walking is doing real work, since relief while you move is part of how doctors recognize restless legs¹1 Winkelman et al., 2025. Getting up to do something on your feet is the most direct use of that.

Maybe you've tried more than walking: a cold pack, a vibrating pad, a hot bath before bed. Researchers have tested a few of these in trials, though the trials are few and not of high quality¹⁶16 Harrison et al., 2019. In them, exercise and leg compression devices may ease it. Vibration pads and cold therapy didn't lower its severity, though they did help some measures of sleep¹⁶. That review didn't include massage or a warm bath, so there's little or no trial evidence on them either way, and if one of them eases your legs at midnight, it's yours to keep.

If you're already taking a medicine for restless legs, you may have noticed the evenings starting earlier than they used to. The legs might start up on the sofa after dinner now, or the feeling might have crept into your arms. That change has a name, augmentationaugmentation A worsening of restless legs caused by the medicine used to treat it, most often a dopamine drug: symptoms start earlier in the day, come on faster or spread to other parts of the body.: symptoms start earlier in the day, come on faster when you sit, or spread to the arms or elsewhere¹³1 Winkelman et al., 20253 Winkelman & Wipper, 2026. It comes with the dopamine drugs that were for years a usual first choice, pramipexole, ropinirole, rotigotine and levodopa¹.

One clinic went back through its records to see how often it happened. About seven in a hundred people a year on pramipexole developed it, and the rate stayed at much the same level year after year¹⁸18 Silver et al., 2011. So a medicine can work well for a long time and then slowly start making the evenings longer.

That's why the American Academy of Sleep Medicine now advises against dopamine drugs as standard treatment¹. They tend to work well at first. Over time they can make the condition itself worse, and they can cause impulse-control problems too¹. Treatment now usually begins with the iron tests and a look at what you take. If you need a medicine, the first choice is the gabapentin family, whose main side effects are sleepiness and dizziness¹³. For the hardest cases, a doctor can offer a low-dose opioid, which brings risks of misuse, dependence and slowed breathing, or a wearable device that stimulates a nerve below the knee¹.

If you're on a dopamine drug and your evenings have been creeping earlier, it's something to raise with your doctor, since there are other treatments to move to. Please don't stop it abruptly, because symptoms can rebound badly, and the usual plan is to add another treatment and then taper off slowly with your doctor¹.

It usually eases after the birth. About one in five pregnant women gets restless legs. It climbs as pregnancy goes on, most of all in the third trimester, then drops to about four in a hundred after the birth¹⁹19 Chen et al., 2018. So far fewer women have it once the baby is here. If the evenings of late pregnancy have you pacing, there's a good chance yours will ease too.

Guidelines for pregnancy start with reassurance, exercise, avoiding what makes it worse and iron where it's needed. They keep medicines for severe cases and choose them with the pregnancy in mind¹²⁰1 Winkelman et al., 202520 Picchietti et al., 2015. Please talk to your midwife or doctor before taking anything for it, including a sleep aid from the pharmacy shelf. Why is it so hard to sleep while pregnant? covers the rest of pregnancy's nights.

If your legs are still going as you read this, the walking is the right thing for tonight, and the bed will still be there when they ease. Tomorrow, you could ask for one number, your ferritin, and set it against 75, whatever the lab's range calls normal. That's the line guidelines draw¹1 Winkelman et al., 2025 for legs like yours.