The Surprising Reason You’re Not Sleeping Through the Night

young couple sleeping in bed

Written by Dr. Daniel Barone 

There are few things more frustrating than not being able to sleep. It seems like it should be so simple: you get tired, you lie down, and the next thing you know, it’s morning. But for so many of you, it’s not simple at all – it’s a struggle. Unfortunately, figuring out what’s preventing you from getting the rest you need can also be a challenge. As a sleep doctor, I see this every day in my office. One cause of sleepless nights that many people don’t realize they are living with is restless legs syndrome (RLS).

Curious whether you might have RLS? Here are a few questions based on a medical screening tool, to ask yourself:

  • Have you ever had unpleasant or uncomfortable feelings in your legs that occurred mainly while you were either sitting or lying down?
  • Have you ever felt the need or urge to move your legs that occurred mainly while you were sitting or lying down?
  • Are these feelings in your legs worse at night or when you are trying to go to sleep, compared to other times of the day?
  • If you move your legs, do you get any relief from these feelings, even temporarily?

If you answered yes to these questions, you may have RLS, so you’ll want to keep reading and maybe even see a sleep doctor.

Patients I’ve worked with who have RLS often describe the feeling as “creepy-crawly,” “tugging,” or “pulling” sensations in their legs (usually the lower part), usually in the evening, and only when at rest. The major issue with RLS is that it can prevent you from being able to fall asleep. That’s because every time you lie down, this awful sensation comes on full force and prevents you from feeling comfortable enough to actually fall asleep. In an attempt to relieve the feeling, you may find yourself getting out of bed and pacing for minutes to hours until your legs feel comfortable enough to let you rest.

And in case all that wasn’t bad enough, once you do fall asleep, you (or your bed partner) may be woken up by you kicking your legs in your sleep. We call this periodic limb movements of sleep.

So, the question is, what can we do about these conditions? Fortunately, a lot.

The first thing I do in my practice is look for a vitamin deficiency. It turns out that RLS can result from low levels of iron in the blood. Iron helps us to make the brain chemical dopamine, which has a role in RLS symptoms. This becomes an issue mostly in young menstruating women who may or may not be anemic. Vegetarians who don’t get enough iron-rich foods can also be susceptible to anemia. I start people with RLS and low iron on iron pills

Next, if iron doesn’t appear to be the problem, or is only part of it, I look for habits that can make RLS worse. The prime suspects are nicotine and caffeine. I have patients reduce or stop the use of these stimulants entirely, especially in the hours before bed. I find caffeine is particularly problematic. It can stay in our system for hours, so even having it quite a while before bed can make RLS worse.

Some people who can’t sleep turn to an alcoholic beverage or two in the evening for help. Unfortunately, alcohol can actually increase the likelihood of an episode of RLS, so it’s important to skip too.

Another tool for insomnia many people try are over-the-counter drugs containing ingredients that make you drowsy. These sleep aids can help with insomnia, but in the case of RLS, they can actually make the symptoms worse.  I have seen more than a couple of instances in which simply cutting out an antihistamine dramatically improved RLS.

After eliminating things that can may RLS worse, it’s time to build habits that can make things better. Stretching before bedtime can be a big help. I recommend a calf stretch, up against the wall. Prop your toes up on the wall, heel on the floor. Hold this stretch for 30 seconds, rest, and repeat – for five cycles.

Another trick is to preoccupy your mind. I’ve found that distracting yourself from the symptoms can help. Do a puzzle, play a board game or video game, or have a conversation with a friend or spouse before bedtime.

If these tricks aren’t providing relief, we have a more advanced technique called counter-stimulation therapy. The idea is to have a different sensation in your legs to relieve the restless feeling.  This might mean applying pressure to the legs with compression stockings or using a special foot wrap. Some people find relief from vibration using a special pad. Relaxing the calf muscles with a warm bath or a lower leg massage can also help relieve symptoms.

If lifestyle changes like these don’t work, don’t get discouraged. A sleep doctor may decide it’s time to try a medication.

If you think that you or a loved one may be suffering from RLS, first, you should realize you’re not alone. Estimates show that up to 15% of the adult population may experience RLS symptoms. And second, you can find relief. Try some of the tips I’ve provided above, or see a sleep doc who can help you get that restful sleep that’s been eluding you.

Daniel A. Barone, MD is currently an Assistant Professor of Neurology at Weill Cornell Medical College’s Center for Sleep Medicine, where he sees patients with all forms of sleep disorders. He is the author of “Let’s Talk About Sleep,” a book written for the lay public to better understand sleep and sleep disorders, and what to do about them.