Complaints & connections · borters.ch
An urge to move that comes in the evening and steals sleep — often an iron deficiency lies behind it.
Also known as: restless legs syndrome · RLS
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A hard-to-describe pulling, tingling or restlessness deep in the legs, together with an almost irresistible urge to move them. Four things belong together and make the diagnosis, which is reached by listening alone: the urge comes at rest, it gets better with movement, it is strongest in the evening and at night, and nothing else explains it. That very pattern separates it from cramps, from circulation problems and from nerve damage. The consequence is nearly always broken sleep, and the daytime tiredness is then experienced as a problem of its own, with no connection made to the legs. The most important correctable reason is the iron store: the brain needs iron to make dopamine, and a different yardstick applies here — a ferritin that looks unremarkable on the lab report can be too low for restless legs. So ferritin belongs measured and, when low, topped up before anything else is considered. Further reasons are pregnancy, weak kidneys and some medicines, in particular certain anti-sickness drugs and part of the antidepressants.
Iron from animal sources is best absorbed — red meat, liver, fish.
Vitamin C with the meal markedly boosts absorption of plant iron.
Effective when deficient; every-other-day dosing is often better absorbed and tolerated than daily.
A higher lower limit applies here. A value that looks unremarkable on the report can be too low for restless legs — ask about this explicitly.
Some anti-sickness drugs and part of the antidepressants clearly worsen it. That belongs discussed, not stopped on your own.
A walk, stretching, a warm or cold bath — what helps varies. Very hard exercise late in the evening makes it worse for some.
Both increase the restlessness in some people. A two-week trial shows whether you are one of them.
With some medicines for restless legs the condition can worsen in the long run under rising doses. Anyone needing more should report it rather than increase it.
Dopamine agonists help immediately. After months to years they can intensify the symptoms and shift them earlier in the day — this is called augmentation. So the iron store is filled first: here the target is a ferritin above 100, not the usual lower reference limit.
Five to ten in a hundred adults are affected, women more often. It often begins before the age of forty and slowly grows stronger over the years. In pregnancy it is common and usually disappears again afterwards.
Get up, a few steps, stretch the calves, shower cold or warm. The urge eases with movement — that is both the hallmark and the lever.
At the cinema, on the train, in bed. It is not the time of day alone but sitting still that brings it on.
That is the most reliable hallmark. As soon as rest returns, the urge returns.
A rhythm of its own, independent of how long you have been sitting. If it is missing, the diagnosis often does not fit.
Often what brings people in — the legs are not mentioned at all. Which is exactly why asking about them pays.
A cramp is a hard, visibly shortened muscle and it hurts. The urge in restless legs is unpleasant, but it is not pain in the muscle.
Above all in the last third, and usually over after the birth. Iron needs are then especially high.
Complements ferritin in the iron work-up. In restless legs a rather high target ferritin is aimed for, because brain iron deficiency worsens symptoms — even with a “normal” blood count.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
The messenger this is about — and it follows a daily rhythm with a low point in the evening. That is exactly why the restlessness in the legs begins when one comes to rest.
To make this messenger the brain needs iron. That is why the ferritin is the most important blood value here of all — even with a completely normal blood count.
In pregnancy, especially in the last third, the complaints often appear and usually disappear again after the birth.
In restless legs a ferritin below 75 is considered worth treating — a markedly higher threshold than elsewhere. After correction symptoms clearly improve in some, often only after 8–12 weeks.
All three increase the restlessness in the legs for many. Two weeks without show whether it applies personally.
A low ferritin is the most common treatable cause — the target here is higher than elsewhere.
Regular, moderate movement relieves; intense exertion in the evening worsens it.