What to Do When You’re Ready to Sleep But Your Legs Aren’t

Dr. Janet Zand
November 18, 2018


Do you have an uncontrollable urge to move your legs, especially at night? Does this twitching and crawling feeling cause you to get up and walk even when you’re tired, interfering with your sleep and daytime activities? Until recently, many doctors would dismiss you by saying it’s all in your head.

Well, it’s not. I’m here to tell you what causes it and give you some simple, effective solutions to help you get a better night’s sleep while avoiding daytime tremors.

The condition is called restless legs syndrome (RLS), and it often goes under-diagnosed and under-treated. Some researchers call it “the most common disorder that you never heard of.”

RLS is the fourth leading cause of insomnia. It can keep you up at night and exhaust you during the day. This lack of sleep interferes with your ability to think clearly and contributes to depression. What’s more, it’s dangerous. If you have RLS, you must be extra careful. Poor sleep quality can cause you to fall asleep while driving. Or fall down.

One woman with RLS spent most of each night walking around or standing to get relief from her twitching. As a result, she fell numerous times and broke both of her arms, several ribs, and her nose. This may be the exception, but the exception happens. And you don’t want it to happen to you.

But RLS Can Cause Even Worse Problems

A study out of Harvard Medical School found that people with RLS had double the risk for having a stroke or heart disease. Twice as many of them were women as men. This study included more than 3,000 adults in their 60s. There was a stronger association in people who had RLS symptoms 16 times a month or more, and who reported their symptoms as being severe.

When people had hundreds of leg movements each night, these movements were associated with higher blood pressure and higher heart rate. Researchers believe this may contribute to heart disease and stroke over time.

Is It Even Real?

RLS made the news several years ago – and was proclaimed “real” – when two studies identified the genes responsible for RLS. Gene identification may be helpful for genetically based RLS. But other forms of this “real” movement disorder have other causes. These include medications, pregnancy, or nutrient deficiencies.

RLS is more common in women than in men and tends to be worse in people over 60. This could be due to age-related nutrient deficiencies.

RLS is different from peripheral neuropathy, leg cramps at night, or vascular disease. You have RLS if you have all of the following:

* An uncontrollable urge to move your legs

* Symptoms that get worse at rest

* Symptoms that are rapidly relieved with movement

* Symptoms that are worse at night and improved in the morning

Here’s what causes RLS, along with possible solutions:

Pregnancy: Pregnancy increases a woman’s need for iron by three to four times, and folate by as much as 10 times. Pregnancy is stressful, both physically and emotionally, and stress causes the body to excrete higher amounts of magnesium. This often creates a magnesium deficiency. All pregnant women should be evaluated periodically for sufficient levels of these three nutrients. A deficiency of any of them can trigger RLS.

Donating blood: Researchers at the famed Mayo Clinic found that all patients in an RLS study group had donated blood at least three times a year for the preceding three years. Every one had iron deficiency (blood ferritin levels less than 20 microg/L). You don’t have to be anemic to need iron.

Medications: Some antidepressants can induce RLS or make it worse. They include SSRIs (selective serotonin reuptake inhibitors) like Prozac, Zoloft, and Paxil, as well as tricyclic antidepressants like Elavil and Tofranil. If you have RLS and are taking any medications for anxiety or depression, ask your pharmacist whether or not there could be a connection. Mood disorders frequently respond to lifestyle changes, nutrient therapy, and dietary changes. If you need medication, ask your doctor for recommendations that won’t trigger RLS.

Migraines: The association between RLS and migraines is not as far-fetched as you might think. Scientists now believe that the two conditions may have a joint origin. They have found the same gene in an Italian family that plays a role in both diseases. What’s more, they’ve found a correlation between both RLS and migraines with fibromyalgia. RLS, fibromyalgia, and migraine headaches frequently respond to magnesium therapy.

Here Are Several Solutions

Iron: Generally, I do not recommend iron supplementation for postmenopausal women. And many postmenopausal women avoid iron supplements because they know that iron is an oxidant. It can produce dangerous free radicals that can lead to illnesses from heart disease to cancer. In women who have RLS, however, blood levels of iron can drop by 50-60% at night, which coincides with worsening RLS symptoms at that time. In addition, RLS patients’ brains often lack sufficient iron.

Studies show that the lower the ferritin, the more severe the RLS symptoms. Tell your doctor to run an ordinary ferritin blood test. If your levels are lower than 50 mcg/L, you may want to take an iron supplement. A British study found that 200 mg of ferrous sulfate (iron), taken three times a day for two months, gave excellent results when ferritin levels were low.

One of the best absorbed forms is iron picolinate. It doesn’t cause constipation and you might be able to take less of it. It’s available in health food stores or from Thorne Research (800-228-1966).

Magnesium: A pregnant woman with a 13-year history of evening tremors went to the hospital in premature labor. Her doctor gave her intravenous magnesium as part of her treatment for this pre-term labor. Her RLS stopped completely. Here’s why: Magnesium relaxes muscles. Several studies found that magnesium supplementation decreased symptoms in people with mild to moderate RLS.

Stress is a serious factor in RLS, and both insomnia and pregnancy are physically and emotionally stressful. Stress triggers your body to increase its excretion of magnesium, often leading to a deficiency.

Since ordinary blood tests for magnesium are often inaccurate, and subclinical magnesium deficiencies are common, I give all of my RLS patients magnesium to bowel tolerance – from 100 to 1,000 mg per day. In some cases, that’s all they need. I’ve found magnesium is often all or part of their solution. Magnesium glycerinate will often be the preferred form if other forms cause digestive issues or diarrhea.

Folate: Some cases of RLS are hereditary. If this is your case, you may need folic acid supplementation. Deficiencies are common in RLS sufferers. Ask your doctor to check your blood levels of folic acid. It should be 10-12 ng/mL. When participants in one study took enough folic acid to bring their blood levels up to normal, their RLS disappeared. Their IQ significantly improved, also.

Don’t depend entirely on blood tests, though. In some cases, lab tests showed no folate deficiency, yet symptoms improved with supplementation. Patients have responded to 1-10 mg of folic acid. Most people will need 5-10 mg. You can reduce this amount if you’re using methylfolate. Methylfolate is a form of folic acid that is much more easily absorbed.

Lifestyle changes: Give nutrients the best chance to work by avoiding medications that could lead to RLS and decreasing or eliminating caffeine, alcohol, and cigarettes. Stretch your legs daily for 5-15 minutes to loosen up tight muscles. You may get temporary relief by taking either a hot or cold bath, or rubbing your legs manually or with a vibrator or massager before bedtime. The key is to increase circulation.

You also might want to try an excellent herbal formula that increases circulation in the legs. Doctors using it report it has helped RLS when poor circulation and inflammation are involved. The formula is called Padma Basic and it consists of 20 herbs with antioxidant properties. Give it a three-month trial (two tablets with each meal) and let me know how it works for you.


Allen, R.P. and C.J. Earley. “The role of iron in restless leg syndrome,” Movement Disorder, June 12, 2007.

Bartell, S. and S. Zallek. “Intravenous magnesium sulfate may relieve restless legs syndrome in pregnancy,” J Clin Sleep Med, April 15, 2006.

Hornyak, M., et al. “Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study,” Sleep, August 1998.

Kuzniar T.J. and M.H. Silber, “Multiple skeletal injuries resulting from uncontrolled restless legs syndrome,” J Clin Sleep Med,  February 15, 2007.

Patrick, L., ND. “Restless legs syndrome: pathophysiology and the role of iron and folate,” Alt Med Rev, June 2007.

Sabayan, B., et al. “Possible joint origin of restless leg syndrome (RLS) and migraine,” Med Hypothesis, 2007.

Silber M.K. and J.W. Richardson. “Multiple blood donations associated with iron deficiency in patients with restless legs syndrome,” MayoClin Proc, January 2003.

Sun, E.R., et al, “Iron and the restless legs syndrome,” Sleep, June 15, 1998.

Winkelman, J.W., et al. “Association of restless legs syndrome and cardiovascular disease in the Sleep Heart Health Study,” Neurology, 2008.

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