8 Restless Legs Syndrome Triggers - Prevent RLS Symptoms by Treating These Causes

You want to relax but your legs have other plans. Where does that creepy crawly feeling come from? It could be iron deficiency, pregnancy or even weak veins. Here's how to treat these common restless leg symptoms...

Millions of women can’t sit (or lie) still long enough to take a flight, see a movie, watch their daughter’s dance recital, make love or fall asleep.

Blame restless legs syndrome (RLS), a neurological sleep and movement disorder that causes painful, crawling sensations in the legs and an irresistible urge to move them.

“For some women, the only solution is to walk all night,” says Mark Buchfuhrer, M.D., an internist and pulmonary specialist at SomnoMedix Sleep Disorders Center in Los Angeles and co-author of Restless Legs Syndrome: Coping with Your Sleepless Nights (Demos Medical Publishing).

Although it’s not known what causes RLS, research suggests it’s related to a dysfunction in the brain's basal ganglia, a group of nerve cells that use the neurotransmitter dopamine. It transmits brain messages, helps control body movements and alters central nervous system function.

“Dopamine levels are lower at night, which may explain why restless legs syndrome symptoms are worse in the evening,” says Jacci Bainbridge, Pharm.D., president of the RLS Foundation board and a professor of pharmacology and neurology at the University of Colorado in Denver.

It also strikes during pregnancy.

About 10% of women and 33% of pregnant women have RLS, says Jennifer Hensley, R.N., coordinator of nurse-midwifery and women's health options at the University of Colorado College of Nursing in Denver and a member of the International RLS Study Group, which is investigating RLS in pregnancy.

But many can prevent or ease symptoms by avoiding known triggers, RLS experts say.
“To isolate triggers, record your eating, exercise, medication and sleep habits in a diary and watch for patterns,” Bainbridge says. (For a seven-day diary, visit rls.org.)

If symptoms don’t quit, see your doctor. You may need blood tests for iron deficiency, thyroid disease, kidney disease, liver disease and/or diabetes – all of which are associated with RLS, says Buchfuhrer.

Read on for 8 things that trigger restless legs syndrome symptoms and how to prevent them.

Restless legs syndrome trigger #1: Medications
“The most common RLS triggers are prescription and over-the-counter medications,” Buchfuhrer says.

Because they block dopamine, the worst culprits include:

Over-the-counter antihistamines, cold and allergy medications (Sudafed, Tylenol, Alka-Seltzer, Benadryl)

Anti-nausea drugs (Antivert, Phenergan, Bonine)

Selective serotonin-reuptake inhibitors, or SSRIs (Celexa, Prozac, Paxil)

Tricyclic antidepressants (Cymbalta, Serzone, Effexor)
To avoid a flare:
“Know which medications are safe for you,” says Buchfuhrer, who approves the following drugs for people with RLS:

Clarinex, Allegra and Zyrtec and nasal sprays such as Nasonex and Flonase

Anti-nausea drugs like Zofran, Transderm Scop patches and Anzemet

Antidepressants such as Wellbutrin, Pamelor, Norpramin and Trazodone

Stick to dosing requirements if you take RLS medications. Not taking them as prescribed could trigger symptoms, so don’t stop or reduce your dosage without your doctor’s approval, Bainbridge warns.

Restless legs syndrome trigger #2: Sitting still
“RLS can also flare when people are forced to sit for long periods without being able to get up,” Buchfuhrer says.

To avoid a flare:

Book an aisle seat on flights, in movie theaters and at entertainment and sports events so you can get up and walk around.

Use an upright desk at work so you can work standing up.

Don’t watch movies or read in bed. Hit the sack only when you’re sleepy enough to fall asleep quickly.

If you can’t fall asleep because you need to move your legs, get up and walk around, do some gentle stretching or yoga or take a warm bath.
Restless legs syndrome trigger #3: Boredom
Daytime boredom and inactivity can also trigger an RLS attack.

“Activities that increase alertness often improve RLS symptoms [for a few hours] by changing the mental state and activating the body’s motor system (and production of dopamine),” Buchfurher says.

To avoid a flare:
Do something to get your mind absorbed in a game or hobby.

For example, play a video game, do a crossword puzzle or needlework, play cards or read an interesting book.

Or try activities that focus your attention on different physical sensations, “which decrease painful restless legs syndrome symptoms,” advises Alice Churchill Hoagland, Ph.D., a sleep medicine specialist and director of Insomnia Services at Unity Sleep Disorders Center in Rochester, N.Y.

For example, “get a massage or a back rub, try putting ice packs or hot compresses on your legs, take a warm bath, wear compression stockings or alternate hot and cold,” she says.

Restless legs syndrome trigger #4: Iron deficiency
Reduced amounts of iron in central brain neurons are believed to disrupt the brain’s dopamine system, says Rebecca Gray, ob-gyn with Baylor Medical Center in Irving, Texas.
Patients with RLS had decreased iron stores in their cerebrospinal fluid, according to a 2007 meta-study conducted at Durango Natural Medicine in Colorado that reviewed studies involving more than 35,000 patients.

“While not well-documented, scientists suspect that deficiencies in vitamin B6 and magnesium may also cause flares,” says Jeffrey Durmer, M.D., Ph.D., a sleep medicine doctor, researcher and chief medical officer of FusionHealth & FusionSleep outside Atlanta, Ga.

To avoid a flare:
Get your iron levels tested annually. According to the Durango study, 90% of American women are deficient.

Ask your doctor about taking iron, magnesium and B6 supplements.

You can maintain healthy iron levels by eating foods rich in the metal, such as leafy greens, egg yolks, red meat, dried fruit, iron-fortified cereals and grains, turkey, beans, lentils, soybean and artichokes.

Eat them with foods high in vitamin C (citrus fruit, strawberries, papayas, bell peppers) because they increase iron absorption, Durmer says.

Restless legs syndrome trigger #5: Pregnancy
RLS is the most common movement disorder in pregnancy: Up to a third of women experience it, often during the third trimester, according to the 2007 Durango study.

The major culprits are iron and folate (B vitamin) deficiencies, although increased levels of estrogen may also be a factor, Bainbridge says.

During pregnancy, iron needs increase 3-4 times while folate needs increase 8-10 times, the study says.
“If you have a genetic predisposition to RLS but never had symptoms until you became pregnant, your symptoms are likely to [disappear] after you deliver,” Hensley says.

“If you already had RLS when you got pregnant, your symptoms are likely to worsen in pregnancy and get progressively worse with each pregnancy.”

To avoid a flare:
If you have RLS or a genetic predisposition for the disease, get a blood test as soon as you become pregnant, Hensley advises.

If your parent, sibling, grandparent, aunt or uncle has RLS, you may too, according to a 2010 study conducted in Quebec on 671 familial cases.

According to the study, women who developed familiar RLS did so at a much younger age (before 40) than those who had sporadic RLS. Women with familial RLS also had the disease longer, and symptoms were more severe.

“Your blood ferritin levels (ferritin is a protein in cells that binds to iron) should be 50 or above,” Hensley says.

If you’re iron deficient, take iron supplements – only after consulting a doctor – and eat lots of iron-rich foods. They can dramatically ease or eliminate your RLS symptoms.

In the study, just 9% of women who took supplements during pregnancy suffered RLS symptoms compared to 80% of women who didn’t take them.

“Don’t take iron supplements if you’re not deficient. They could hurt your baby,” Hensley says.

Taking too much iron during pregnancy can be toxic to both you and your baby and interfere with your child's development, she says.
Restless legs syndrome trigger #6: Exercising too hard
Moderate exercise can help relieve RLS symptoms, but "overly strenuous exercise – especially if you’ve never done it before – can aggravate symptoms by irritating and inflaming leg tissues,” warns Donald Watenpaugh, Ph.D., director of Sleep Consultants in Fort Worth, Texas, and an RLS sufferer.

What’s considered strenuous?

“Training for a marathon, long-distance cycling and even working out on machines in the gym that overstress your legs, such as elliptical trainers and leg presses, can provoke RLS symptoms,” says Michelle Bommarito, a Los Angeles-based certified fitness instructor and personal trainer who works with RLS sufferers.

To avoid a flare:
“Get your medication under control before you start an exercise program," Bommarito advises. "It can take RLS meds a few weeks to a few months to kick in.”

Do moderate aerobic exercise and lower-body resistance training. These significantly reduced RLS symptoms, according to a 2006 study at Pennsylvania State University and Eastern Tennessee State University on 200 people with RLS.

“Exercise a minimum of three times a week for 30 minutes to an hour, focusing on gentler exercises, like stretching, walking and water aerobics, and avoiding high-impact, high-cardio exercises like running, which make RLS worse, Bommarito says.
Limit your sessions if you're new to exercise.

“If you’re taking aerobics classes at the gym, don’t do the entire hour," Bommarito advises. “Start with 15-20 minutes and work up gradually over six months.”

And stretch.

“Stretching exercises, including yoga, can relieve RLS symptoms temporarily so you can fall asleep,” Buchfuhrer says. “Try stretches that apply tension to the calf or thigh muscles, such as standing on tip-toe or holding a half-deep knee bend until fatigued.”

Restless legs syndrome trigger #7: Caffeine and alcohol
Anecdotal research suggests that both may aggravate RLS by interfering with normal sleep patterns, says Buchfuhrer, though no substantial studies have been conducted on why caffeine or alcohol worsen RLS symptoms.

One theory: Consuming caffeine too close to bedtime can increase alertness and make it hard to fall asleep.

Alcohol before bedtime may help you fall asleep faster, but it also increases the number of times you wake up during the night so you feel less refreshed in the morning, he says.

To avoid a flare:
Reduce your intake of caffeine and beware of hidden caffeine in over-the-counter cold and flu meds.

And don’t drink, especially before bedtime.
Restless legs syndrome trigger #8: Weak veins
“There’s a strong correlation between weak veins (venous insufficiency) – which cause varicose and spider veins – and RLS,” says Jeffrey Miller, M.D., a radiologist, phlebologist and owner of Miller Vein in Michigan.

“In venous insufficiency, blood flows in the wrong direction and pools, which can cause symptoms including lower extremity pain, fatigue, swelling, itching, varicose veins, spider veins, night cramps and RLS,” he says.

“Fortunately, [most] patients treated for weak veins see a significant improvement, if not a cure from RLS symptoms,” Miller says.

To avoid a flare:
Consult a physician if you have varicose or spider veins, night cramps or pain in your legs. An in-office procedure called endovenous thermal ablation, or laser therapy, can treat the vein and underlying RLS symptoms.

For more information, visit our Restless Legs Syndrome Health Center.

What’s Your Restless Legs Syndrome IQ?
Restless legs syndrome (RLS) might sound like a simple case of someone feeling on edge. After all, many people shake their legs when they’re antsy, bored or nervous. But there’s more to RLS than restless legs.