Restlessness

While it’s common to experience restlessness every now and then, it can be a sign of an underlying condition when it’s recurrent, severe, or prolonged. Periods of nervousness, fidgeting, and irritability are caused by various health factors, including restless legs syndrome (RLS), mood disorders, the side effect of certain medications, and hyperthyroidism. When restlessness significantly impacts your life and disrupts sleep, you should call your healthcare provider.

This article provides a quick overview of the signs of restlessness as well as its causes. It also discusses treatments for this condition and when you should get medical help.

Symptoms of Restlessness

Bouts of restlessness can take on both mental and physical characteristics; they can disrupt sleep and have a significant impact on quality of life. Typical signs of restlessness include:

• A feeling of uneasiness or nervousness
• Excessive fidgeting, inability to stay still
• Irritability
• Difficulty concentrating
• Racing thoughts

Causes of Restlessness

Feelings of restlessness and irritability can arise for many reasons, including psychological and physiological factors. Broadly speaking, the most common health conditions that cause these symptoms are:

• Mood disorders and psychiatric conditions
• Restless legs syndrome
• Hyperthyroidism

Restlessness and agitation are characteristic of anxiety, bipolar disorder, and clinical depression, and it can be a feature of schizophrenia. In addition, dementia causes these symptoms, alongside cognition, language, and memory problems. Periods of agitation and nervousness are also associated with attention deficit hyperactivity disorder (ADHD).   

Restless legs syndrome (RLS), a neurological disorder also known as Willis-Ekbom disease, causes jitteriness in the legs when you’re at rest. While the exact causes of RLS are unknown, it has a genetic component, and it may be related to iron deficiencies in the brain. Kidney disease, dialysis (treatment for kidney failure), iron deficiency, pregnancy, and neuropathy (nerve damage) are among the conditions that can lead to RLS.

Another common cause of restlessness is overactivity of the thyroid gland, or hyperthyroidism, which causes muscle weakness, tremors, irregular heartbeat, and goiter (swelling in the neck), among other symptoms. This small, butterfly-shaped gland located in the neck regulates metabolism, growth, and physical development. Hyperthyroidism can occur in those with Graves' disease (an autoimmune disorder), nodules (noncancerous growths), and excess iodine intake, among other causes.  

What Medications Can Cause Restlessness?

Restlessness, agitation, and related symptoms can also be a side effect of medications—a condition called akathisia. Antipsychotic drugs used to treat schizophrenia and dementia can contribute to the development of this condition. These include:

• Risperdal (risperidone)
• Zyprexa (olanzapine)
• Seroquel (quetiapine)
• Fluanxol (flupentixol)
• Haldol (haloperidol)
• Loxapac (loxapine)

In addition, restlessness and agitation are side effects of several other classes of drugs, including:

• Antiemetics: Antiemetics (anti-nausea drugs), including Reglan (metoclopramide), Thorazine (chlorpromazine), Clozaril (clozapine), and others can cause symptoms.
• Certain antidepressants: Antidepressants, including tricyclics and selective serotonin reuptake inhibitors (SSRIs) can cause restlessness and agitation as side effects.
• Blood pressure medications: Calcium channel blockers, including Veralan (verapamil) andNorvasc (amlodipine), among others, can also bring on symptoms.  

Generally, the chances of these side effects rise with prolonged and frequent use of medications. Be sure to let your healthcare provider know if you’re experiencing restlessness or other issues while taking these drugs.

Are There Tests to Diagnose the Cause of Restlessness?

Since restlessness is associated with a wide-range of conditions, diagnosis of the condition involves isolating what’s causing the symptoms. A variety of approaches may be necessary, including:

• Physical examination: Your healthcare provider will ask you to describe symptoms and assess for any jitteriness, nervousness, or other signs of restlessness.
• Medical history: Since medications are often at the root of this condition, your healthcare provider will ask what you’re taking. They’ll also ask about your medical history and that of your family. 
• Clinical tests: Since iron or other mineral deficiencies can lead to restless legs syndrome, you may need to have a blood sample tested. Such samples can also provide measurements of thyroid function.
• Psychiatric evaluation: Since restlessness can also accompany conditions like depression, anxiety, bipolar disorder, and ADHD, you may need clinical evaluation for these conditions with a psychiatrist. This involves careful assessment of your other symptoms and answering questionnaires, among other methods.
• Cognitive testing: If you have dementia, as in Alzheimer’s disease, you may undergo tests of memory, reading comprehension, and others assessing your cognitive function.
• Imaging: Computerized tomography (CT) scans, magnetic resonance imaging (MRI), or X-ray may be used if nodules are suspected on the thyroid gland or to screen for degradation of brain cells due to Alzheimer’s disease or other neurological conditions.

How to Treat Restlessness

The specific treatments for restlessness depend on the underlying cause. They range from taking medication or discontinuing others to taking part in therapy, among other approaches. These include:

• Medications for RLS: Several classes of drugs are prescribed for RLS, including dopamine agents (such as Levodopa, Requip, and others), opiates (e.g., Oxycodone, Percocet), benzodiazepines (Klonopin, Ativan), and alpha-2 delta drugs (Neurontin, Lyrica). 
• Medications for mood disorders: Medications can also play a role in treating anxiety and depression. SSRIs (Celexa, Lexapro, and others), selective norepinephrine reuptake inhibitors (SNRIs) (e.g., Effexor, Cymbalta), and benzodiazepines. 
• Changes in dosage: When akathisia arises due to medication side effects, discuss dosage changes with your prescribing healthcare provider. Your dosage may be reduced, and you may have to switch to a different therapy. This has to be done carefully and under the direction of your healthcare provider.
• Mineral supplementation: Taking iron supplements can treat restlessness due to deficiency.
• Therapy: Therapeutic techniques, such as cognitive behavioral therapy (CBT), can help you develop strategies for relaxation and coping with your symptoms. This can help manage anxiety and depression, and evidence suggests it’s effective for insomnia associated with RLS.

Home Management

Several home management approaches can ease the physical symptoms of restlessness, while also easing mental tension. Among these are:

• Massaging affected areas
• Hot or cold compresses
• Taking a hot bath
• Taking a walk or doing a distracting activity

Lifestyle Changes

Adopting certain strategies can help ease the burden and prevent restlessness. These include:

• Meditation and mindfulness exercises
• Ensuring you are getting quality sleep
• Eating a healthy, well-balanced diet
• Avoiding nicotine, alcohol, and recreational drugs
• Regular exercise
• Finding support from family and/or friends

Complications Associated With Restlessness

Restlessness can become problematic when it interrupts sleep and causes insomnia. If you don’t get enough rest, your daytime brain function is affected, meaning it's more difficult to concentrate, learn, or remember. You’re also prone to depression and anxiety and are more likely to get into accidents driving.

When to See a Healthcare Provider

Sometimes restlessness, irritation, and related symptoms require extra attention and care. Call your healthcare provider if you find:

• Restlessness is regularly interrupting sleep and causing insomnia.
• You suspect symptoms are medication side effects.
• You experience significant discomfort or pain.
• You’re experiencing symptoms of depression and anxiety.

Summary

Periods of restlessness and agitation are common symptoms of many conditions. It most often arises due to psychiatric or mood disorders, as a symptom of restless legs syndrome, hyperthyroidism, or as a side effect of antipsychotics and other medications. Restlessness can be especially debilitating when it leads to insomnia.

healthcare providers may prescribe dopamine agents, benzodiazepines, and opioids, among others, to ease symptoms. Iron supplements may also help. Alongside your healthcare provider’s directions, lifestyle changes and developing relaxation techniques may also help.

A Word From Verywell

Feeling consistently restless is uncomfortable and can deeply affect your quality of life. What makes it extra tricky is that it can be hard to explain and maybe even find a healthcare provider that takes you seriously. Know that your symptoms and discomfort are valid and that you deserve to find answers and a solution to restlessness.