April 22, 2008
When the mind begins to wander and the body relaxes, restless legs often act up.

When the mind begins to wander and the body relaxes, restless legs often act up.(RAW FILE/RADIUS/MASTERFILE)
While severe restless legs syndrome (RLS) can affect patients 24 hours a day, most cases act up at night. In fact, one of the criteria necessary for an RLS diagnosis is that symptoms are worse in the evenings, especially when you are lying down.

No one knows for sure why RLS peaks just as you're winding down for the night, but doctors suspect that the body's natural sleep-wake cycle plays a role.

Dopamine levels drop at night
"A lot of our biorhythms take on a circadian pattern: body temperature, hormones, appetite," says Charlene Gamaldo, PhD, an assistant professor of neurology at Johns Hopkins Sleep Disorders Center. "It's speculative, but there's a thought that maybe the neurochemical dopamine, which is associated with RLS, also drops at night and increases during the day."

Restless Legs Syndrome: 3 Patients Stories

Julie's nights were torturous before she found treatment Read moreMore about restless legs syndrome

Your thoughts begins to drift
Another theory has to do with the mental aspect of RLS: As the mind begins to wander, whether drifting off to sleep or relaxing during a movie, that's when people most notice RLS symptoms.

While it doesn't work for everyone, some patients find that a mentally stimulating activity helps their RLS subside. For example, Mimi Gauthier, 47, a movie set decorator in New Orleans, learned to build computers to pass the time when her restless legs kept her up at night. "The more active my mind is, the less active my legs are," she says.

Dreading bedtime worsens the problem
RLS patients often associate their bed with fear and anxiety, which leads them to chronic insomnia or patterns of sleeping at the wrong times. Before she began taking medication for RLS, Gauthier would often stay awake all night long, and if she didn't have to be at a movie set in the morning, she'd finally get to sleep at 11 a.m. and nap throughout the day. She knew that daytime sleeping only hurt her chances of getting rest at night, but at the time it was the only thing that kept her going.

"People wanted to meet for lunch while I was sleeping," says Gauthier. "Friends and family don't get it; it's still considered a lazy thing. They don't know how hard I'm struggling to stay awake. I still wonder what it would feel like to be a really awake person. I feel really envious."