Restlessness: Causes and Ways to Manage It

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Restlessness: Causes and Ways to Manage It

By Your Health Magazine Health Information Team

Restlessness is a feeling of being unable to relax, sit still, or settle your thoughts. It may involve fidgeting, pacing, an urge to move, irritability, muscle tension, or difficulty sleeping. Common causes include stress, anxiety, insufficient sleep, caffeine, medication effects, restless legs syndrome, attention-deficit/hyperactivity disorder (ADHD), pain, and certain medical conditions. The best way to manage restlessness depends on its pattern and underlying cause.

What Does Restlessness Feel Like?

Restlessness can be mainly mental, physical, or both. Some people experience racing thoughts and an inability to unwind. Others notice repetitive movement, such as tapping their feet, shifting in a chair, pacing, or repeatedly standing up.

These patterns provide clues, but they cannot confirm a diagnosis. More than one factor may be involved.

Common Causes of Restlessness

Stress and Anxiety

Stress activates the body’s alert system, which can produce muscle tension, increased heart rate, shallow breathing, and an urge to move. Anxiety may continue even after the immediate stressor has passed. The National Library of Medicine’s overview of anxiety symptoms and treatment notes that anxiety can cause restlessness and tension, along with physical symptoms such as a rapid heartbeat.

Sleep Loss and Daily Habits

Being overtired does not always make a person feel calm or sleepy. Sleep loss can instead contribute to irritability, poor concentration, and an unsettled or “wired” feeling. Irregular sleep schedules, late-night screen use, and untreated sleep disorders may play a role.

Caffeine, nicotine, energy drinks, some pre-workout products, and other stimulants can also cause or worsen restlessness. Alcohol may initially feel sedating but can disrupt sleep later in the night. Withdrawal from alcohol, nicotine, sedatives, or other substances may cause significant agitation and sometimes requires medical treatment.

Medication Effects

Restlessness can begin after a new medicine is started, a dose is increased, or a medication is stopped. One specific medication-related movement disorder is akathisia, an intense inner restlessness that commonly produces pacing, rocking, leg movement, or an inability to remain seated. It is particularly associated with certain antipsychotic medicines but may occur with other drugs. An NCBI clinical overview of akathisia explains that symptoms often appear after treatment begins or a dose changes.

Contact the prescriber promptly if marked restlessness develops after a medication change. Do not stop or alter a prescription without medical guidance. Medication timing can also affect alertness, sleep, and daily functioning. People prescribed guanfacine can review factors involved in timing guanfacine for ADHD and discuss any concerns with their prescriber.

Restless Legs Syndrome

Restless legs syndrome typically causes an irresistible urge to move the legs, often with crawling, aching, pulling, itching, or throbbing sensations. Symptoms usually occur during inactivity, become worse in the evening or at night, and temporarily improve with movement. The National Institute of Neurological Disorders and Stroke’s restless legs syndrome guide describes these characteristic patterns and possible contributing conditions, including iron deficiency, pregnancy, kidney disease, and certain medications.

Other Health Conditions

ADHD may involve long-standing fidgeting, excessive movement, or an internal sense of restlessness. Physical discomfort from pain, fever, breathing problems, or other illness may also make it difficult to settle. In some cases, restlessness can accompany thyroid disorders, low blood sugar, anemia, heart rhythm problems, mood disorders, substance use, or neurological conditions.

How to Identify Possible Triggers

A brief symptom record can help a healthcare professional recognize patterns. Note:

1. When it happens: Record the time of day, duration, and whether symptoms begin while resting, working, or trying to sleep.
2. What it feels like: Describe worry, inner tension, racing thoughts, leg discomfort, pacing, or involuntary movements.
3. Recent changes: List new medicines, dose changes, supplements, illnesses, sleep disruption, and changes in caffeine, nicotine, alcohol, or other substance use.
4. What provides relief: Note whether walking, stretching, eating, resting, or leaving a stressful situation helps.
5. Associated symptoms: Record palpitations, tremor, sweating, pain, fever, shortness of breath, confusion, mood changes, or sleep problems.

Ways to Manage Mild Restlessness

If symptoms are mild and there are no warning signs, the following measures may help while you assess possible triggers:

• Take a brief walk or perform gentle stretching rather than forcing yourself to remain still.
• Try slow, comfortable breathing, progressive muscle relaxation, or a short mindfulness exercise.
• Reduce caffeine and other stimulants, especially later in the day.
• Eat regular meals and stay adequately hydrated.
• Maintain consistent sleep and wake times, including on weekends.
• Create a quiet transition before bedtime by dimming lights and reducing stimulating activities.
• Use a written task list if unfinished responsibilities or racing thoughts are making it difficult to relax.

The National Institute of Mental Health offers additional strategies for coping with stress and anxiety, including exercise, journaling, relaxation practices, regular meals, and a consistent sleep routine.

Do not begin iron or other high-dose supplements solely because of restlessness. A clinician may recommend testing when iron deficiency, anemia, thyroid disease, or another medical cause is suspected.

When to Seek Care

Schedule an appointment with a primary care clinician if restlessness is persistent, frequently disrupts sleep, interferes with work or relationships, or occurs with other unexplained symptoms. A mental health professional may help when anxiety, mood changes, or ADHD symptoms are prominent. A sleep medicine specialist or neurologist may be appropriate for suspected restless legs syndrome or unusual movements.

Contact a prescriber promptly if severe inner restlessness starts after beginning, stopping, or changing a medication. Seek urgent medical care for restlessness accompanied by sudden confusion, fainting, chest pain, serious breathing difficulty, high fever, severe muscle stiffness, seizures, or rapidly worsening agitation. If restlessness occurs with thoughts of self-harm or an inability to stay safe, call or text 988 in the United States or call 911 for an immediate emergency.