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Restlessness

Restlessness can be from thyroid problems, a mental health condition, pain, or a medication side effect. Learn how to tell what’s causing your agitation and how to stop it.
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Written by
Farrah Daly, MD.
Last updated September 16, 2021

Restlessness questionnaire

Use our free symptom checker to find out what's causing your restlessness.

Restlessness is feeling the need to constantly move, being unable to calm your mind, or a combination of the two. You may also experience hyperactivity, anxiety, palpitations, agitation, or insomnia.

People with motor restlessness often feel they have cramps in their arms or legs whenever they're not moving. They may have difficulty sitting still while at work or relaxing at home, or have the urge to tap their hands or feet. Other people may experience mental restlessness, and have difficulty accomplishing tasks, managing time, or falling asleep at night.

Restlessness can be from stimulating medications, stopping medications, or drinking too much caffeine in a day. Hormonal imbalances, neurologic problems, pain, or mental health conditions can also cause restlessness.

Pro Tip

One of the most common misconceptions is that “it’s all in your head.” —Dr. Farrah Daly

1. Restless legs syndrome (RLS)

Symptoms

  • Uncontrollable urge to move the legs (akathisia) while sitting or lying still
  • Sensations in the legs or feet like creepy crawling, aching, pulling, throbbing, or itching
  • Symptoms temporarily get better with activity, like walking and stretching
  • Trouble getting to sleep or falling back asleep if you wake up during the night


Restless leg syndrome (RLS) causes an uncomfortable sensation in the legs while lying down or sitting still. You may have a strong urge to move your legs, and moving around or stretching them temporarily relieves the unpleasant feeling.

About 7% to 10% of the U.S. population may have RLS, according to the National Institute of Neurological Disorders and Stroke. Most people with RLS (80%) also have periodic limb movement of sleep (PLMS), which causes legs or arms to twitch and jerk during sleep.

Treatment

You can reduce the symptoms of RLS by taking warm baths, massaging your legs, applying warm or cool packs, exercising, and practicing good sleep habits.

If you have low levels of iron in your body, you may get better by taking iron supplements. Your doctor may prescribe medicines including dopamine agonists or nerve medications to decrease the restless feeling.

2. Hyperthyroidism

Symptoms

  • Weight loss
  • Increased appetite
  • Intolerance to heat
  • Anxiety, tremors, and restlessness

The thyroid is a small, bow-tie shaped gland in your neck. It produces several hormones that affect your body’s metabolism and make your body more sensitive to stimulating hormones like adrenaline.

Hyperthyroidism is when your body produces too much thyroid hormone. That causes your body’s engine to shift into high gear. You might feel shaky and anxious, the heart can beat too fast or irregularly, and you might lose weight despite being hungry and eating more. Causes can include autoimmune conditions, tumors, inflammation, or medications.

Treatment

Your doctor can treat your overactive thyroid after finding out what is causing it. Treatments may include:

  • Stopping certain medications
  • Blocking the effects of thyroid hormone with antithyroid medications
  • Destroying (“ablating”) the overactive thyroid gland using radioactive iodine
  • Surgically removing overactive thyroid tissue

3. Depression

Symptoms

  • Depressed mood
  • Loss of appetite
  • Trouble falling asleep or waking up too early
  • Loss of interest in fun activities
  • Anxiety, irritability, mental restlessness

Depression can make you feel sad, hopeless, and discouraged, or you may feel irritable and angry. A chemical imbalance in the brain can cause trouble concentrating, physical or mental restlessness, or trouble sleeping. You may lose your interest or enjoyment in things that once were fun. These problems can interfere with your work, your relationships, and your ability to take care of yourself.

Treatment

It’s important to see a doctor or mental health professional if you think you are depressed. You may need a combination of medications such as antidepressants and talk therapy.

Pro Tip

Some important questions to ask your doctor are: What should I be watching for that might indicate a more serious problem, need for follow-up examination, or additional testing? —Dr. Daly

4. Medications, diet, or supplements

Symptoms

  • Restlessness that starts after a medication or diet change

Many medications can cause restlessness as a side effect. These include medications for attention deficit hyperactivity disorder (ADHD), depression, nausea, or psychosis. If you start to feel restless soon after starting a new medication, talk to your doctor.

Many dietary supplements and energy drinks include chemicals with a stimulant effect. Excess caffeine intake can also cause restlessness.

Treatment

Talk to your doctor about any new symptoms after starting or changing a medication. Discuss whether you should change your dose or your medication.

Review your diet for any new supplements and consider the amount of caffeine in your drinks.  Gradual adjustments to your supplement and caffeine intake may be helpful.

5. Premenstrual dysphoric disorder

Symptoms

Premenstrual dysphoric disorder (PMDD) is a group of severe symptoms that occur about a week before a woman's period starts. It causes PMS symptoms, like bloating and cramps. But you may also have major mental and emotional symptoms, such as dramatic mood swings, severe depression, irritability, or restlessness.

PMDD might be caused by an abnormal response to the natural changes in female hormones during the menstrual cycle.

Treatment

You may get relief by improving your diet and exercising regularly. Your doctor may recommend calcium supplementation, oral contraceptives, or antidepressants. Cognitive behavioral therapy, a type of talk therapy, has also been shown to help.

6. Mild bipolar disorder I

Symptoms

Periods of depression

Periods of mania

Bipolar disorder causes periods of depression and then mania that can last for weeks or months, followed by periods when your mood is stable. During periods of depression, you may have low mood, loss of pleasure, and low energy. With mania, you have an elevated or irritable mood with erratic behavior, decreased sleep, risky behavior, and increased talkativeness.

Bipolar disorder can run in families. Symptoms often start in the teens or young adulthood.

Treatment

Treatment varies depending on your symptoms and other factors, but usually your doctor will prescribe medications, such as mood stabilizers and antipsychotics. Talk therapy can also be helpful. In severe cases, you may need to be hospitalized when experiencing symptoms.

Other possible causes

Certain types of severe pain can cause restlessness:

  • Cluster headaches: When people have a cluster headache, they may be restless and irritable as they struggle to find a position to relieve the pain.
  • Kidney stones can cause severe flank, or back, pain. When people have painful kidney stones, they are often restless and active, trying to find a position to relieve or get away from the pain.
  • Dementia and pain: People who have trouble communicating because they have dementia, brain injury, or another neurologic illness can appear restless or agitated when they are in pain.

Other conditions that may cause restlessness

When to call the doctor

  • Your restlessness interferes with your ability to sleep or work.
  • You notice changes in your appetite, mood, or weight.
  • Your restlessness starts after a medication change.
  • You’ve already checked your caffeine and supplement intake but the restlessness persists.

Dr. Rx

Help your doctor by being as specific as you can about what you are feeling. When does it happen? How long ago did it start? What part of the body is involved? What makes it worse or better?  What have you already tried to address the problem? —Dr. Daly

Should I go to the ER?

  • Your heart is racing or beating irregularly.
  • You're having trouble catching your breath.
  • You're confused or having difficulty seeing.
  • You’re having auditory or visual hallucinations.
  • You have a new severe pain.
  • You are having thoughts of hurting yourself or others.

At-home treatments

  • Check for caffeine in your diet and try to lower the amount. It can be in coffee, tea, soda, chocolate, or energy drinks. Some supplements also contain caffeine or other stimulants. You may need to cut out caffeine altogether or after a certain time of day.
  • Exercise may help improve your thinking while reducing stress and anxiety.
  • Meditation and mindfulness practices can help calm the mind.
  • Talk to your doctor before changing the dose of a medication or stopping it. Although your medication could be causing your restlessness, stopping it can be dangerous.
Share your story
Dr. Farrah Daly, MD is a Hospice & Palliative Medicine Specialist in Leesburg, VA and has over 19 years of experience in the medical field. She graduated from Drexel University College of Medicine medical school in 2002.

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