Restless Legs at Night: What Causes Them in Bed and What Helps (UK)

What is restless legs syndrome?

Restless legs syndrome (RLS) is a condition of the nervous system. It gives you an overwhelming urge to move your legs, usually with uncomfortable feelings in them, which eases while you keep moving. Because it is worst when you lie still in the evening, it often gets in the way of falling asleep.

It is common. NICE’s guidance for GPs puts it at 5 to 10% of adults in the UK, US and Europe. It becomes more common with age, and over 35, women are affected about twice as often as men. Up to half of people with RLS have a relative with it.

For many people it is mild and comes and goes. For others it is nightly and exhausting, and a real cause of insomnia.

Restless legs symptoms and how it’s diagnosed

No blood test or scan confirms restless legs. A GP diagnoses it from your description, using four features set by the International Restless Legs Syndrome Study Group:

1. An urge to move your legs, usually with unpleasant feelings in them.
2. It starts or gets worse when you rest, such as sitting on the sofa or lying in bed.
3. Moving eases it, at least for as long as you keep walking or stretching.
4. It is worse in the evening or at night than during the day.

And the symptoms must not be better explained by something else, such as cramps, swollen legs or an awkward position.

People describe tingling, burning, itching, throbbing, a creepy-crawly feeling or “fizzy water in the veins”, often worst just below the knee. NICE notes it is painful for 30 to 50% of people, and the arms can be affected too.

iYour GP may still suggest blood tests to look for a cause: NICE recommends a full iron check, ideally in the morning after an overnight fast, and sometimes kidney function, thyroid, blood sugar and vitamin B12.

What causes restless legs in bed?

Why it’s worse at night and when you lie down

Two things come together in bed. RLS is triggered by stillness, and lying down is the stillest you are all day. And dopamine, the brain chemical most involved in RLS, follows a daily rhythm that NICE says may explain why symptoms build in the evening.

Primary restless legs (no clear cause)

In most people there is no single cause. This is primary (idiopathic) RLS. It often runs in families, and dopamine and the way the brain handles iron both seem to play a part, even when blood iron looks normal. It tends to get slowly worse over the years.

Secondary restless legs (a cause you can find)

Sometimes RLS is brought on by something else, and treating that can ease it. The most common links, according to NICE:

Medicines and drinks that can make it worse

NICE lists several medicines that can trigger RLS or make it worse:

• antidepressants, including SSRIs, SNRIs and tricyclics
• antihistamines, including some in over-the-counter sleep aids and allergy tablets
• some antipsychotics, and lithium
• some anti-epilepsy medicines
• anti-sickness medicines such as metoclopramide and prochlorperazine
• beta-blockers

iHeavy use of alcohol, caffeine or chocolate is on the same list. If your legs got worse after starting a new medicine, don’t stop it yourself. Speak to your GP or pharmacist, who can check whether a change is possible.

What helps restless legs at night?

How to help restless legs at night: get up and walk, stretch or massage your calves and thighs, and have a warm bath or use a heat pad before bed. A book or puzzle can distract you. Cut caffeine after midday and alcohol in the 2 hours before bed. For mild symptoms, these NHS steps may be all you need.

When your legs start up in bed:

1. Get up and walk. Moving eases RLS while you do it, and a few minutes walking around can settle it enough to try again.
2. Stretch. Try a calf stretch against a wall, a standing thigh stretch holding a chair, or, in bed, point and flex your feet and draw slow circles with your ankles.
3. Massage your legs. Firm strokes up your calves and thighs. If you like a cooling rub, our CBD Balm with peppermint, eucalyptus and juniper is a cosmetic balm for adults; it isn’t a treatment for restless legs. Our balm’s product description mentions wintergreen oil, so ask a pharmacist before using it if you’re allergic to aspirin or take a blood thinner.
4. Use warmth. A warm bath before bed, or a heat pad on your legs, is on both the NHS and NICE lists. Some people prefer something cool instead, which is fine to try.
5. Distract your brain. Reading, a puzzle or a relaxation exercise takes your attention off the sensations.
6. Don’t lie there fighting it. Get up, do something calm in dim light and go back when sleepy. If it wakes you in the small hours, see waking up in the middle of the night.

Daily habits that make restless legs less likely

The NHS and NICE prevention steps, with a note on the evidence:

Restless legs treatment in the UK

Restless legs treatment in the UK starts with self-help: walking, stretching, massage, a warm bath and no caffeine after midday. The NHS says iron supplements may be needed if a blood test shows your iron is low. If symptoms stay moderate or severe, a GP can prescribe medicines such as pregabalin, gabapentin, ropinirole or pramipexole.

Ropinirole and pramipexole can cause augmentation over time, with symptoms starting earlier in the day and getting stronger, so NICE now puts them second (see prescription medicines). For supplements, see what can you take for restless legs?

Do compression socks help restless legs?

Possibly, but the research is thin, and there are two very different things to separate.

Ordinary compression socks and stockings. A 2024 trial in Turkey gave 63 pregnant women with RLS either compression stockings or look-alike placebo stockings to wear by day for 3 weeks. Both groups improved, showing how much expectation matters, but the real stockings group improved more. It is one small study: a hint, not proof.

Pneumatic compression devices. These sleeves inflate and deflate around the legs for about an hour in the evening. In a 2009 US trial with 35 adults, real devices beat sham ones over a month, and a third of the real-device group had complete relief. They are medical devices, not socks, and aren’t part of NICE’s guidance for GPs.

iIf you want to try socks, choose a light, well-fitting pair and give it a couple of weeks. If you have circulation problems in your legs, diabetes or numb feet, or you’re pregnant, ask a pharmacist, GP or midwife first.

Magnesium cream and magnesium tablets

Magnesium is a hugely popular remedy, but the evidence is weak and mixed: a 2019 systematic review found only one randomised trial, which showed no clear effect, though small newer studies look more hopeful. There is also little evidence that creams, sprays or bath flakes get useful amounts through the skin, although the massage and warmth may feel soothing.

The studies, creams and best form to try are in our guide to magnesium for restless legs. See also does magnesium spray work? and the best magnesium for sleep.

Our Magnesium Glycinate Sleep Complex gives 290mg of magnesium per serving as an evening drink. Magnesium contributes to normal muscle function and to a reduction of tiredness and fatigue. It isn’t a treatment for restless legs, and it’s for adults only. If you have kidney problems or take regular medication, check with your GP or pharmacist first.

Is quinine used for restless legs?

No. Quinine isn’t one of the treatments NICE lists for restless legs, and in the UK it is tightly limited even for leg cramps, a different condition.

The MHRA, the UK medicines regulator, advised in 2010 that quinine should not be used routinely for night-time cramps: only when they regularly disrupt sleep, are very painful or frequent, other causes are ruled out and stretching hasn’t worked. It warned of a rare but potentially life-threatening fall in blood platelets, blindness in overdose, and interactions with warfarin and digoxin.

Tonic water is often suggested online, but it isn’t part of any UK guidance for restless legs. If you think your symptoms are really cramps, see leg cramps at night.

Iron and restless legs: get your ferritin checked

Iron is the best-supported thing to check. Low iron in the brain is thought to affect dopamine, and a 2019 Cochrane review of 10 trials (428 people) concluded that iron treatment probably improves restlessness and RLS severity compared with placebo.

You can be low enough in iron to matter for RLS without being anaemic. NICE advises GPs to look for a cause and prescribe iron if your ferritin (iron stores) is below about 50 to 75 micrograms per litre, so ask for your actual number rather than just whether it’s “normal”.

• Don’t self-dose high-strength iron. The NHS says 17mg a day or less from supplements is unlikely to cause harm; higher doses can cause constipation, nausea and stomach pain, and very high doses can be fatal, especially to children. Take more only if your GP advises it.
• Food still matters. See iron-rich foods, and iron tablets: who needs them and how to take them.

Prescription medicines: pramipexole, ropinirole, gabapentin and pregabalin

If self-help and iron haven’t helped and symptoms are moderate or severe, a GP may suggest medicine. This is always a decision for your GP or a specialist. NICE’s guidance for GPs (revised July 2026):

Why dopamine agonists like pramipexole are used less

Pramipexole and ropinirole often work well at first, but over time many people develop augmentation: symptoms start earlier in the day, get stronger or spread to the arms, and the dose creeps up. NICE says this affects 40 to 70% of people over 10 years. They can also cause impulse control problems such as gambling or compulsive shopping (6 to 17% of people with RLS), and pramipexole can cause sudden sleepiness, which matters for driving.

If you take one of these, don’t stop suddenly, as symptoms can rebound badly; speak to your GP about a plan. A 2025 US sleep medicine guideline reached similar conclusions, and also advised against valerian for RLS. The BNF, the UK prescribing reference, has the full dosing and safety details.

Restless legs in pregnancy

Restless legs are very common in pregnancy. An analysis quoted by NICE found about 21% of pregnant women have them, from 8% in the first trimester to 22% in the third. Symptoms usually go after the birth, though RLS in pregnancy raises the chance of it returning later in life.

• Tell your midwife or GP, especially if it’s disturbing your sleep.
• Check your iron. Iron deficiency can trigger RLS. Your midwife can arrange a blood test, and iron may be prescribed if you’re low.
• Self-help first: the walking, stretching, massage, warmth and evening habits above.
• No self-medication. NICE says RLS medicines are not recommended during pregnancy or breastfeeding. Check with your midwife before taking any supplement; see magnesium in pregnancy.
• Know the signs of a blood clot. Pain, swelling, warmth or red or darkened skin in one leg needs an urgent call to your GP or 111. Call 999 if you also have chest pain or feel breathless.

We don’t recommend our products during pregnancy or breastfeeding.

Restless legs, leg cramps, periodic limb movements or hypnic jerks?

Several night-time leg problems get mixed up. Here’s how to tell them apart:

When to see a GP about restless legs

The NHS advises seeing a GP if restless legs are stopping you sleeping, affecting your mental health, or haven’t improved with self-help. It’s also worth going if symptoms started after a new medicine, if you’re pregnant (or see your midwife), or if you have kidney disease, diabetes or numbness in your feet. A GP can check your iron and other bloods, review your medicines and, if needed, refer you to a neurologist or sleep specialist.

Get urgent advice (GP or 111) if one leg is swollen, red, warm or painful, as that can be a blood clot (DVT) rather than RLS. Call 999 if this comes with chest pain or breathlessness.

Related guides

• Thinking of trying magnesium? See how long magnesium takes to work before you judge it.
• Many people try a cream at bedtime; here’s what the research says about magnesium cream.
• Broken nights add up: if you feel always tired no matter how much sleep you get, restless legs is one of the reasons worth ruling out.
• Total Relief Magnesium Cream: ingredients, delivery and the evidence on magnesium creams.