Restless Legs Syndrome (RLS), also called Willis‑Ekbom Disease, is a neurological condition characterised by an uncontrollable urge to move the legs, usually accompanied by uncomfortable sensations like crawling, tingling, throbbing, or aching. Often, it’s worse at rest — especially in the evening or night — and movement brings temporary relief.
Understanding what causes RLS, and what triggers its flare‑ups, is important for effective management. Below is a detailed look at what is known so far.
What Causes RLS?
Many cases of RLS do not have a single identifiable cause; researchers distinguish between primary (idiopathic) RLS and secondary RLS.
Primary (Idiopathic) RLS
RLS often runs in families, suggesting a genetic predisposition. Multiple gene variants have been associated with the condition.
Problems with dopamine, a neurotransmitter that helps regulate movement, seem involved. In particular, dopamine activity in the brain’s basal ganglia may be disrupted.
Low iron in certain brain regions, even when blood iron levels are borderline, is thought to impair dopamine function and contribute to RLS.
Secondary RLS
Here, RLS is linked to other medical or physiological conditions. These may either trigger RLS onset or worsen existing symptoms. Known secondary causes include iron deficiency anemia and other low‑iron conditions, chronic kidney disease especially during dialysis, peripheral neuropathy such as from diabetes, and pregnancy, particularly in the third trimester. Other conditions such as Parkinson’s disease, rheumatoid arthritis, spinal cord disorders, and some sleep-related conditions may also play a role.
What Triggers or Makes RLS Flare‑Up
Even for those with RLS, symptoms are not constant. Various triggers or aggravating factors can cause symptom severity to increase. These are not causes per se, but they worsen or bring on episodes.
- Certain medications can make RLS worse. These include antidepressants like SSRIs and SNRIs, some antihistamines, anti‑nausea medicines, antipsychotics, beta‑blockers, and lithium.
- Alcohol, caffeine, and nicotine are known to precipitate or worsen symptoms, especially if consumed late in the day.
- Poor sleep quality, irregular sleep patterns, or general sleep deprivation can intensify symptoms.
- Long periods of being still — such as during flights, long car rides, or sitting in a theater — can provoke RLS sensations.
- Low levels of iron, and sometimes vitamin B12 or magnesium, are associated with worsening symptoms.
- Hormonal fluctuations and the physiological demands of pregnancy can trigger or worsen RLS.
- Underlying health conditions like kidney disease, diabetes, and neuropathy may exacerbate symptoms.
- Stress, smoking, excessive caffeine or alcohol intake, and irregular bedtime routines are also known to make RLS worse.
Risk Factors & Who’s More Likely to Be Affected
RLS becomes more common with age. It is more prevalent in women than men. Family history plays a significant role, especially when RLS starts relatively early in life. Underlying medical conditions like iron deficiency, kidney disease, and diabetes further increase risk.
Why Symptoms Tend to Be Worse at Night
RLS symptoms often escalate in the evening or when trying to sleep due to natural circadian rhythms. Dopamine levels in the brain naturally fall in the evening, so any impairment in dopamine systems becomes more noticeable at night.
When lying down or sitting still for long periods, the lack of movement allows discomfort to become more prominent. During the day, distractions and activity keep the sensations less noticeable, but at night, the quiet and stillness allow symptoms to surface more intensely.
What Can Be Done: Managing Triggers & Reducing Severity
Correcting iron levels through supplementation may help when iron deficiency is identified.
If a medication is making symptoms worse, a healthcare provider may be able to adjust it or offer alternatives.
Improving sleep hygiene, maintaining a regular bedtime routine, and avoiding screens before bed can reduce symptoms.
Reducing caffeine, alcohol, and nicotine — especially in the evening — often improves sleep and decreases RLS episodes.
Staying active and avoiding long periods of rest can help. Regular exercise and movement during the day are useful.
A balanced diet with adequate iron, B vitamins, and magnesium supports overall nervous system function and may reduce symptoms. Managing stress, maintaining a healthy weight, and following a consistent sleep routine are also beneficial.
In more severe cases, medical treatment may be needed. Doctors may prescribe medications that affect dopamine or other neurological functions depending on individual needs and health status.
Summary
Restless Legs Syndrome involves an urge to move the legs, often with unpleasant sensations, particularly when resting or at night.
Causes include a mix of genetic factors, dopamine dysfunction, and brain iron deficiency. RLS may also occur due to other medical conditions like kidney failure, pregnancy, or neuropathy.
Triggers such as medications, stimulants, sleep deprivation, and inactivity can worsen symptoms. Understanding and managing these triggers can improve comfort and quality of life.
Treatment is often tailored to the individual and may include lifestyle changes, addressing nutrient deficiencies, or medication. Consulting a healthcare provider is important if symptoms disrupt sleep or daily life.
Sources:
- Mayo Clinic — Restless legs syndrome: Symptoms and causes
https://www.mayoclinic.org/diseases-conditions/restless-legs-syndrome/symptoms-causes/syc-20377168<?XML:NAMESPACE PREFIX = "[default] http://www.w3.org/2000/svg" NS = "http://www.w3.org/2000/svg" /> - MedlinePlus / Genetics — Restless Legs Syndrome
https://medlineplus.gov/genetics/condition/restless-legs-syndrome - WebMD — Restless Legs Syndrome Triggers
https://www.webmd.com/brain/restless-legs-syndrome/rest-legs-syndrome-triggers - NHS Inform — Restless Legs Syndrome (causes & triggers)
https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/restless-legs-syndrome - Johns Hopkins Medicine — RLS overview
https://www.hopkinsmedicine.org/health/conditions-and-diseases/restless-legs-syndrome-rls
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