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What Causes Restlessness at Night?

Tossing and turning, constantly waking up, difficulty falling asleep – these are all signs of restlessness at night. While occasional restlessness is normal, chronic restlessness or insomnia can be detrimental to your health. So what causes restlessness at night and restless legs syndrome? Here are some of the most common culprits.

Stress and Anxiety

One of the most common causes of restlessness and insomnia is stress and anxiety. When you’re stressed or anxious, your body goes into fight-or-flight mode, releasing hormones like cortisol and adrenaline. These hormones increase alertness, which makes it difficult to relax and fall asleep. Stress and worry can also occupy your mind at night, making it hard to unwind. Things like work, relationships, finances and health issues can all contribute to stress that leads to a restless night.

Discomfort and Pain

Physical discomfort or pain is another major cause of restless nights. Conditions like arthritis, injuries, menstrual cramps, acid reflux and migraines can make it hard to get comfortable and fall asleep. The aches and pains take your attention away from relaxing into sleep. Discomfort from pregnancy, like back pain and frequent urination, can also disrupt sleep in the second and third trimesters.


Certain prescription medications and over-the-counter drugs can cause restlessness, insomnia and restless legs as side effects. Some common culprits include antidepressants, cold and flu medications containing pseudoephedrine, stimulants for ADHD, diuretics and corticosteroids like prednisone. Always check the label for sleep-disrupting side effects.

Caffeine, Alcohol and Nicotine

Consuming stimulants too close to bedtime can backfire and cause restlessness at night. Caffeine from coffee, tea, soda and energy drinks can linger in your system for 6-8 hours. Nicotine is another stimulant that disrupts sleep. Alcohol may help induce sleep at first, but it often causes restless sleep later in the night as it wears off.

Poor Sleep Habits

Improper sleep hygiene can sabotage your sleep. Going to bed and waking up at inconsistent times night after night can disrupt your circadian rhythms. Using electronic devices at night, an uncomfortable sleep environment and exposure to light and noise can also impair sleep. Getting insufficient exercise or eating too close to bedtime can further promote restlessness.

Digestive Issues

Gastrointestinal problems like indigestion, gas, GERD and irritable bowel syndrome often flare up at night and cause restlessness. Eating large, late night meals and lying down too soon after eating can worsen these issues. Food sensitivities and allergies may also contribute to an unsettled stomach and sleep problems.

Hormonal Changes

Shifts in hormones are a common cause of restless nights for women. During menopause, fluctuations in estrogen and progesterone cause hot flashes, night sweats and insomnia. Monthly hormonal changes also disrupt sleep for many women, causing insomnia and sleeplessness before or during menstruation. During pregnancy, growing hormones like progesterone and estrogen cause increased urination, back pain and other discomforts that interfere with sleep.

Sleep Disorders

Underlying sleep disorders may be to blame for chronic restlessness and insomnia. Conditions like sleep apnea, periodic limb movement disorder (PLMD) and narcolepsy can impair your ability to fall and stay asleep. Sleep apnea causes breathing pauses that awaken you throughout the night. PLMD causes involuntary limb jerking movements that disrupt sleep. Narcolepsy leads to extreme daytime sleepiness and irregular sleep-wake cycles.

Restless Legs Syndrome

Restless legs syndrome (RLS) is a disorder that causes uncomfortable sensations in the legs along with an irresistible urge to move them. These sensations are most bothersome at night and in the evenings while lying down and relaxing, making it very difficult to fall asleep. The exact cause is unknown, but it may involve abnormalities in brain chemicals like dopamine. Things like pregnancy, iron deficiency, kidney disorders and some medications may trigger or exacerbate RLS.

Other Medical Conditions

Certain medical conditions are linked with insomnia and restless sleep. Examples include chronic pain disorders like fibromyalgia, neurodegenerative disorders like Alzheimer’s and Parkinson’s, respiratory disorders, hyperthyroidism, acid reflux, cancer and heart disease. The underlying condition causes discomfort or other symptoms that interfere with sleep.

While occasional restlessness is normal, chronic insomnia and restless legs are detrimental to your mental and physical health. See your doctor if it persists to determine any underlying causes or conditions. Sleep aids, stress management, pain relief, dietary changes and treating underlying disorders may help minimize restless nights. Maintaining good sleep hygiene habits can further promote restful slumber.