Anxiety and Restless Legs Syndrome

Why does anxiety cause restless leg syndrome?

The exact cause of restless legs is currently not fully understood. However, there are many theories and known triggers.

For instance, one concept suggests it might be related to an imbalance in the brain chemical dopamine. Dopamine plays a key role in controlling muscle movement and disruptions in healthy levels could lead to the involuntary leg movements associated with restless legs.

Furthermore, RLS could be caused by underlying medical conditions such as iron deficiency, anemia, or kidney failure, known as secondary RLS. Pregnancy, certain medications, and lifestyle can also exacerbate RLS symptoms.

Some of the known triggers of restless legs include:

• Some prescription and non-prescription medications can aggravate this symptom, including antihistamines, anti-nausea, antidepressants, and beta blockers. Talk with your doctor and pharmacist if you think medication is aggravating this symptom.
• Being still for lengths of time, such as on long trips, sitting in a movie theatre or concert, or confined to bed due to an illness or other medical reason.
• Lack of sleep.
• Alcohol.
• Caffeine or other ingested stimulants.
• Recreational drugs.
• Smoking.
• Warm temperatures.
• Restrictive clothing.

Stress

Stress is also a common cause of restless legs.

As part of the body’s survival mechanism, the moment we believe we could be in danger, the body produces a stress response.

The stress response secretes stress hormones into the bloodstream, where they travel to targeted locations to bring about specific physiological, psychological, and emotional changes that enhance the body’s ability to deal with a threat—to either fight or flee.

This survival reaction is often referred to as [1][2][3][4]:

• The fight or flight response.
• The freeze response(some people become so frightened that they freeze with fear like a “deer caught in headlights”). This response is thought to be a survival mechanism that allows the person to blend in with their surroundings and avoid detection by a predator.
• The faint response (some people faint when afraid). This response is thought to be a last resort for survival in situations where fighting or fleeing is not possible or likely to be successful.
• The submit response (some people easily surrender to their threats when afraid). This response is thought to be a way of avoiding further harm or injury and may be seen in situations where the person feels powerless or overwhelmed.
• The appease response(some people attempt to calm or placate the threat to avoid harm or conflict). This response is thought to be a way of avoiding or reducing the severity of the threat.

Visit the “Stress Response” article for the many changes caused by an active stress response.

When stress responses occur infrequently, the body recovers relatively quickly from the stress response changes. Typically, from a few moments to 30 minutes or more, depending on the degree of the stress response.

However, when stress responses occur too frequently, such as from overly anxious behavior, the body can remain in a state of semi-stress response readiness. We call this state “stress-response hyperstimulation” since stress hormones are stimulants (also often referred to as "hyperarousal").[3][4][5][6][7]

A body that becomes hyperstimulated can experience a wide range of symptoms due to the elevated level of chronic stimulation. Having “restless legs” and “nervous energy” are two examples.

There are many reasons why hyperstimulation can affect the body so profoundly.

For example, research has found that chronic stress (hyperstimulation) reduces GABA, the body’s primary neurotransmitter responsible for inhibition, and increases Glutamate, the body’s primary neurotransmitter responsible for excitation.[8][9][10] This change increases excitability and hyperarousal in the part of the brain's motor cortex responsible for leg movement.

"This basically means that inhibition is reduced or weakened in people with restless legs syndrome compared to people without the condition," says Rachel Salas, M.D., associate professor of neurology at Johns Hopkins. "The reduced response means that the region of the brain controlling the legs shows increased cortical excitability in the motor cortex."[11]

This change also causes hyperactivity in the nervous system overall,[12][13] which can affect any muscle or group of muscles. Because the nervous system is responsible for muscle movement, when the nervous system becomes hyperstimulated, and when GABA and Glutamate levels change, this can cause all sorts of muscle-related anomalies, including a “restless,” “trembling,” and “antsy” feeling anywhere in the body.[14]

Research has found a high correlation of anxiety and depression symptoms in patients with restless leg syndrome [15].

Other Factors

Other factors can create stress and cause anxiety-like symptoms, as well as aggravate existing anxiety symptoms, such as restless legs, including:

• Medication
• Recreational drugs
• Stimulants
• Sleep deprivation
• Fatigue
• Hyper and hypoventilation
• Low blood sugar
• Nutritional deficiencies
• Dehydration
• Hormone changes
• Pain

Select the relevant link for more information.