Attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS) may have a correlation.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

RLS, also called Willis-Ekbom disease, causes uncomfortable feelings or sensations in the legs and an overwhelming desire to move them. Symptoms of the condition commonly occur in the evening and often worsen at night when sitting or lying in bed.

Doctors classify RLS as a sleep disorder, as resting triggers the symptoms. They may also consider it a movement disorder, as people must move their legs to ease symptoms. However, some experts believe it to be a neurological sensory disorder, as the brain produces the symptoms. This subjective feeling of restlessness is also called akathisia. Health experts characterize it as the inability to sit still or stay in one position, which commonly leads to frequent pacing or adjusting. The condition also shares a strong relationship with RLS.

Estimates suggest up to 10% of adults in the United States have RLS, which affects more females than males. Additionally, people with ADHD are far more likely to experience RLS.

Keep reading to learn more about ADHD and RLS, including the causes, diagnosis, and treatment options.

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Various studies report a strong association with sleep issues, such as RLS and insomnia, in individuals with ADHD.

Doctors have linked ADHD and RLS with reduced sleep quality and iron deficiency, believing that systemic iron deficiency contributes to around 43% of RLS-associated conditions. Research also suggests that iron deficiency lowers the amount of dopamine and serotonin in the body. However, these are still theories, and more studies are necessary to confirm these findings.

Although doctors remain unsure as to the precise causes of ADHD, it seems that genetics, environmental factors, and neurotransmitters, such as dopamine, all play a role.

Research suggests that individuals with ADHD may have fewer dopamine receptors in their frontal lobes. A decrease in dopamine receptors in combination with a reduced amount of circulatory dopamine could be why people with ADHD experience RLS and akathisia.

Additionally, doctors remain unsure about the effects of ADHD medication on sleep. Health experts say these stimulant medications may cause sleep problems. However, some studies indicate they may improve sleep quality by lowering the frequency of cataplexy. Cataplexy refers to the loss of muscle function when conscious. In individuals not taking ADHD medication, reports of worsening RLS symptoms and sleep quality are more common.

RLS is common in people living with ADHD.

Among the general population, after the age of 30 years, females are significantly more likely to experience RLS than males. However, even when experts adjust figures to account for sex and age differences, ADHD has significant correlations with RLS and other sleep disorders.

It is also difficult to state precise figures for the number of individuals experiencing both ADHD and RLS syndrome, as reports vary.

Some research suggests people with ADHD have around 14.5 times the likelihood of reporting restless legs “usually” or “always” during the previous 4 weeks. In children with ADHD, some figures indicate the prevalence is close to 18%.

Doctors have not identified one single cause of RLS in ADHD, but there are likely multiple factors involved, including:

  • Genetics: RLS frequently runs in families, so scientists are looking for the genes involved.
  • Other conditions: Some health conditions can worsen RLS.
  • Pregnancy: Around 25% of females develop RLS during pregnancy, and symptoms disappear after giving birth.
  • Anemia: Low iron levels can contribute to more severe symptoms.
  • Renal disease: RLS is common among individuals receiving dialysis for end stage renal disease.
  • Nerve damage: Damage to the nerves of the hands or feet may contribute to RLS.

Some researchers believe that people with RLS and those with ADHD share a common issue with dopamine. However, not everyone with ADHD has RLS, and vice versa.

When diagnosing RLS, doctors need to listen to an individual’s symptom history and rule out other potential conditions that could be causing them.

They will check for the following five features:

  • an irresistible urge to move the legs that accompanies uncomfortable leg sensations
  • symptoms that start or worsen when resting
  • symptoms that improve with movement
  • symptoms that worsen at night or only occur during the evening or night
  • other conditions, such as leg cramps or arthritis, cannot account for symptoms

The doctor may also check the person’s iron levels, as low iron levels can contribute to RLS.

Additionally, they may ask the individual to complete an overnight sleep study to diagnose their sleep disruption.

Healthcare professionals may recommend various nondrug and medical therapies to ease RLS symptoms.

Diet

Eating a balanced diet is vital for overall health and well-being. Because certain foods and beverages can trigger or worsen RLS symptoms, people may find it helpful to keep a food and symptom diary to see if they should avoid certain foods and drinks. For example, caffeine can cause an increase in symptoms, and some individuals find that refined sugar and alcohol have similar effects.

Lifestyle changes

Making specific lifestyle changes may help individuals with mild-to-moderate RLS symptoms. These include:

  • avoiding alcohol and tobacco
  • following a regular sleep routine
  • performing regular, moderate exercise and stretching
  • massaging the legs
  • using heat packs
  • taking warm baths

Iron

Doctors associate low iron levels with RLS and other symptoms such as fatigue, depression, and thinking and reasoning issues. Therefore, they may suggest checking an individual’s iron levels. If tests confirm an iron deficiency, healthcare professionals will likely recommend iron supplements. However, it is essential to note that individuals must only take iron supplements under the supervision of a doctor.

Learn more about foods high in iron.

For those following plant-based or vegetarian diets, learn more about the best plant sources of iron.

If an individual experiences no symptom relief from the above treatments, doctors may recommend medications for RLS. However, the potential options depend on existing medications a person may be taking for their ADHD, so people should work with their doctor to find a suitable combination.

Options include:

  • antiseizure drugs, such as gabapentin, enacarbil, and pregabalin
  • dopaminergic agents that increase the effects of dopamine, such as ropinirole and pramipexole
  • opioids, such as codeine, may help those with severe RLS who do not respond to other options
  • benzodiazepines, such as clonazepam

However, a person should remember that a healthcare professional needs to evaluate these medications before use — especially opioids and benzodiazepines — as they have the potential for misuse.

Doctors currently have no cure for RLS, and it is usually a lifelong condition. Additionally, some individuals may find symptoms worsen with age.

However, many treatment options can help individuals minimize symptoms and restore sleep quality.

Many people also have remissions from RLS, where the symptoms disappear for varying amounts of time, sometimes up to several years.

Research indicates RLS is more common in individuals with ADHD. However, while experts are not entirely sure of the link, they believe iron deficiency and dopamine play a role.

RLS causes unpleasant sensations in the legs and an urge to move them. Most individuals experience symptoms in the evening, and these sensations usually worsen at night.

Although there is no cure for RLS, lifestyle changes, avoiding triggers, and medications may help ease symptoms.