Restless Legs When Resting

What Causes Restless Legs?

To successfully treat and prevent recurrence of restless legs we need to understand and — if possible — remove the underlying causes and risk factors.  We need to ask: "What else is going on inside the body that might allow restless legs to develop?"

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Accurate diagnosis of the factors behind restless legs consists of three steps:

Step 1: List the Possible Causative Factors

Identify all disease conditions, lifestyle choices and environmental risk factors that can lead to restless legs.  Here are eight of many possibilities (more below):
  • Juvenile Rheumatoid Arthritis
  • Iron Deficiency Anemia
  • Rheumatoid Arthritis
  • Diabetes II
  • Sleep Apnea
  • Magnesium Need
  • Hypoglycemia
  • Uremia

Step 2: Build a Symptom Checklist

Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
fatigue definitely reduced by eating
frequent red blood in stools
2hr postprandial glucose 160-200mg%
low lymphocyte count
incoherent speech
waking up with a headache
minor hallucinations
coffee consumption
adverse reaction to delayed meals
frequent confusion/disorientation
inner trembling
mood swings
... and more than 110 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of restless legs:
Cause Probability Status
Sleep Apnea 98% Confirm
Uremia 23% Unlikely
Rheumatoid Arthritis 13% Unlikely
Magnesium Need 0% Ruled out
Hypoglycemia 0% Ruled out
Juvenile Rheumatoid Arthritis 0% Ruled out
Diabetes II 0% Ruled out
Iron Deficiency Anemia 0% Ruled out
* This is a simple example to illustrate the process

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

In the Nervous System Symptoms section of the questionnaire, The Analyst™ will ask the following question about restless legs when resting:
When at rest, do you ever experience 'odd feelings' in your legs, and feel the need to move them in order to stop those feelings? This is known as Restless Legs Syndrome.
Possible responses:
→ Don't know
→ No
→ Yes, slightly / occasionally
→ Yes, definitely / often
Based on your response to this question, which may indicate either not having restless legs at night or restless legs at night, The Analyst™ will consider possibilities such as:
Caffeine Intoxication

Excess caffeine levels cause restlessness.  Caffeine has been shown to increase subjects' proneness to develop RLS at lower levels of blood glucose.  It is therefore no surprise that a xanthine-free diet (no coffee, tea, cola beverages, cocoa) has been reported to be another effective dietary measure RLS sometimes following a short period of caffeine withdrawal.  [J Clin Psychiatry 39: pp.693-8, 1978; Ann Intern Med 119: pp.799-804, 1993]


Based on afternoon glucose tolerance testing, many patients with RLS – particularly if they also have spontaneous leg cramps – appear to have hyperinsulinism causing functional 'hypoglycemia' during testing.  In fact, some patients may have an attack of muscle cramps at the same time as their lowest level of plasma glucose.  In an open trial, a group of 350 patients with this type of glucose tolerance curve were placed on a sugar-free, high protein diet along with frequent nibbling and at least one night feeding.  The vast majority experienced a prompt remission or, at least, a striking reduction in symptoms.  [J Med Assoc 60(5): pp.29-31, 1973]

Iron Requirement

Iron deficiency (specifically blood ferritin below 50 mcg/L) accounts for 20% of all cases of RLS.  A 2007 study observed RLS features in 34% of patients having iron deficiency as compared to 6% of controls.

Magnesium Requirement

Magnesium deficiency, which is known to increase neuromuscular excitability, can also cause Restless Leg Syndrome.  [Rom J Neural Psychiatry 31(1): pp.55-6, 1993]

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