Restless Legs: Differences Between Night and Day

Most people think of restless legs syndrome (RLS) as a sleep disorder. This makes sense. Having a spate of RLS at bedtime can lead to significant delays in falling asleep. Two or 3 hours of lost sleep every single night because of unbearable sensations in the legs is worrisome.

It is recommended that adults get 7 or more hours of sleep a night.¹

If you try for 8 hours and RLS strikes, you may only get 5 or 6 hours. Ongoing sleep debt can result if you’re losing this much sleep every single night.

Sleep debt is a risk factor for all kinds of health concerns, including:²

• Cardiovascular disease
• Drowsy driving accidents
• Mood disorders
• Diabetes

But RLS doesn’t only happen at night. It carries dual identities, as both a sleep disorder and neurological sensory disorder.³

If you have RLS during the day, should you worry?

What does RLS look like during the day?

If you experience RLS while awake, it can happen later in the day or at any time when you’re sitting somewhere for long periods. For some, RLS becomes a big problem during car or plane travel when trips are long with few opportunities to stretch the legs.

Daytime symptoms

These waking symptoms mirror those felt at bedtime, including:

• An irresistible urge to move the legs
• Creepy crawly sensations in the legs
• A sense of leg muscles pulling, aching, throbbing, or itching
• Distinct relief when moving the legs after experiencing these sensory symptoms

It’s important to note that these symptoms aren’t typically the result of other health conditions. For instance, if you have leg cramps, swollen feet, or arthritis, then these concerns may explain your leg sensations, at least partly.

However, for clarity, it’s important to talk to your doctor to confirm that RLS causes your symptoms. After all, your symptoms might be prompted by a different medical condition, pregnancy, or as a medication side effect.

Are daytime restless legs a problem?

It depends upon how severe your waking RLS is. Some people rarely notice it during the day. Others may be so bothered by their legs’ endless need to move that it becomes disruptive to their normal lives.

Meanwhile, people with RLS who don’t feel daytime but only nightly symptoms may find themselves struggling to stay awake during the day. This can wreak havoc on a busy lifestyle where staying awake and alert is key to workplace productivity, safe daytime activities, and healthy relationships.

Nondrug relief

You may instinctively know what to do when a bout of RLS starts up. For instance, you might already do one, some, or all of the following. If not, consider these approaches to fend off RLS’s unpleasant sensations:^4,5

• Go for a walk or bicycle ride to relieve the sensations
• Distract yourself (such as doing puzzles, reading, or calling a friend)
• Avoid triggering substances (caffeine, tobacco, alcohol, high-sugar foods, dairy)
• Massage your legs
• Take a quick bath or shower to relax your legs
• Treat with hot or cold compresses
• Wear compression socks

Drug therapies

If your RLS becomes a daily uninvited guest that you can’t control through nondrug strategies, you may need to consider medication for treatment.

The range of drug therapies for RLS can include:

• Iron supplements
• Dopamine agonists (pramipexole, ropinirole, and rotigotine, for example)
• Alpha-2-delta calcium channel ligands (gabapentin, pregabalin, and gabapentin enacarbil, for example)
• Dopamine precursors (such as levodopa)
• Benzodiazepines (such as clonazepam)

As with any drug or supplement, you should discuss risks of side effects with your prescribing doctor or pharmacist.⁴

RLS and augmentation

In addition to the regular concerns about side effects, augmentation poses a special concern for those who take long-term dopamine therapies for RLS. Augmentation can increase symptom severity that’s dose-dependent. This means that the more medication you use, the worse your symptoms for RLS will become. This can mean symptoms come earlier, increase in intensity, return more quickly after treatment, happen more quickly once at rest, or even spread to the arms or the trunk. Relief from symptoms may also grow shorter between doses.⁴

Whether daytime RLS is worth tending to really depends upon how much of an impact it has on your activities of daily living. However, if you feel like you are limited in your activities because of RLS, please seek the advice of a doctor. They should be able to help you find the relief you need.