It’s 1am, and I’m doing calf stretches. No, I’m not doing some weird kind of clubbing move or about to tackle an extreme nocturnal fitness challenge: I’ve got restless legs again.

My restless legs have been waking me up in the middle of the night since my early 20s. At first, it happened a couple of times a year. In the past year, it’s been more like once or twice a month and recently, I’ve been jolted awake almost every other night. It doesn’t keep me awake for long but it’s bit annoying and a little concerning to suddenly be woken up by the overwhelming urge to move my legs. And it turns out that this annoying tic has a name: restless legs syndrome (RLS).

According to the NHS website, the disorder can also cause “an unpleasant crawling or creeping sensation in the feet, calves and thighs”. People can also get it in their arms, with symptoms generally being worse at night. They vary from mild to severe, with people experiencing them any time from occasionally to every day. And because it interferes with sleep, RLS is also considered a sleep disorder.

Oh, and you can also get RLS even if you don’t actually have legs any more, as this 2004 study on a 62-year-old double amputee demonstrated.

Scroll through any RLS internet forum or speak to another person kept awake by it, and you’ll find that the community is conflicted about potential causes and treatments. I’m constantly being asked if I’m anaemic, whether I need to exercise more – or if I’ve exercised too much. From drinking coffee to having too much salt or sugar, everyone’s got a suggestion.

Meanwhile, advice for treatment ranges from sleeping with a pillow between your legs to taking anticonvulsants. 

There’s only one guaranteed way of calming symptoms, and that’s getting out of bed and walking around for a bit. But there’s no known cure for RLS; walking around may get rid of it for one evening but we don’t have a long term solution. And that’s because no one can actually agree on what the syndrome actually is or what causes it. 

“RLS is a perplexing condition,” says GP and author Dr Fred Pescatore. “The cause is unknown, yet research points to a few potential root causes including poor microcirculation and an imbalance of dopamine in the brain, which sends imbalanced messages to the muscles. Poor circulation stands out to me as a significant factor.”

Iron deficiency anaemia

Caroline, 32, has suffered from RLS since childhood. “I’m sure mine is due to being anaemic,” she tells Strong Women. “I’m on iron supplements now. It’s early days but I haven’t noticed a difference yet.” Iron deficiency anaemia (IDA) causes poor circulation throughout the body from the lack of red blood cells, which is why people with this condition can suffer from cold hands and feet. Some studies have shown that RLS affects up to 40% of people with IDA.

Dr Shelby Harris, clinical psychologist and director of sleep health at sleep resource Sleepopolis, supposes that iron deficiency could be the reason that RLS is considerably more prevalent in women than men. “Women are more likely than men to have an iron deficiency,” she says.

In the past, my iron levels have been low enough to have me sent away from the blood donation clinic, so that link certainly sounds like a possibility. 

Sleeping positions

Despite achieving moderate success with managing my RLS with nightly leg messages and magnesium tablets (the mineral can help with muscle cramps), Dr Pescatore reckons sleeping on a super-springy bed probably didn’t help either.

“Sleeping positions can often cause problems in the legs,” he says. “I would suggest checking the date you last changed and rotated your mattress. I’s also look at how and where you work. As more of us work more hours at home, some of the chairs and surfaces may be less ergonomic, which can cause circulation issues and play into a condition like RLS.”

Stress

Curious to know more, I put a call out on social media for folks with RLS to share their experiences and find that the same subject comes up again and again:

“I think it’s linked to stress and maybe when I push myself when I exercise.”

“I signed a new contract and moved to a different country. It’s all to do with stress for sure.”

“I suffer from anxiety and find it comes on sometimes when I’m stressed.”

Caroline also tells me she’s more likely to get RLS symptoms when she’s stressed. While there haven’t been many studies as to why this is, it’s generally agreed in the medical community that increased stress contributes to RLS. It certainly checks out with the link between RLS and dopamine imbalance, with one 2004 study concluding that “significantly greater anxiety and depression symptoms were observed among patients with RLS than in the control subjects”. Of course, it’s not clear whether people were depressed before RLS kicked in, or if being kept awake by RLS symptoms led to depressive symptoms.

It all starts making sense. Am I stressed? Actually, yes. I’ve got some big, personal issues going on and the moment one of those is resolved, I don’t have restless legs for a good two weeks. It’s not been cured but draining the stress bucket even slightly has an immediate effect. 

Stress is a tricky beast; recognising you’re struggling doesn’t make it any easier to dissolve stress. The good news is, however, that there’s a whole bunch of ways for people to successfully manage RLS symptoms more generally.

Try supplements

Erica, a fellow RLS sufferer, tells me she’s started drinking cold water tea infusions with added magnesium. “I feel like it’s helped but it could just be a placebo effect,” she says.

Nikki, who lives in New Zealand, manages her symptoms with a mouth spray by Australian brand Martin & Pleasance called Restless Legs Relief. “I am learning to live with it now,” she tells Strong Women. “At the beginning it really affected me but now I have to accept that it’s part of who I am. If it starts happening, I take that as a cue that I need to slow down.”

Reduce stimulants

“Limiting caffeine and alcohol,” says Dr Harris. “Gentle massages, warm baths and avoiding strenuous exercise in the evening can also help lessen the symptoms of RLS.”

Eat more iron

“Diet also plays an important role,” adds Dr Pescatore. “Try incorporating a variety of iron-rich foods and look for natural ingredients backed by science. A promising study found Pycnogenol, a natural plant extract, improved all prominent symptoms of RLS, including a 63% decrease in throbbing and 61% decrease in sleep problems.”

Find triggers (like 0ver-exercising)

“There’s no one perfect way to relieve it,” Dr Harris reminds me. “It is more about figuring out what the triggers are for you (eg caffeine, certain medications, an iron deficiency, over-exercise) and working on that trigger.”

Ah yes, over-exercise, another way of putting your body under too much stress. “I’m a marathon runner,” Dr Harris says, “and when I’ve had a very long or strenuous run earlier in the day, I might have some RLS at night.”

If there’s no known trigger and it’s disrupting your sleep regularly, both Dr Harris and Dr Pescatore advise talking with your GP about medications and other treatments to help manage your RLS.

Images: Getty