ADHD And Restless Legs Syndrome: Understanding The Connection

Many people with ADHD experience challenges with sleep, but the connection between ADHD and restless legs syndrome may come as a surprise. People with ADHD may be more likely to experience RLS, a sleep disorder that causes an uncomfortable urge to move the legs, particularly at night. Symptoms can make it hard to fall asleep, potentially leading to sleep deprivation and other concerns. Understanding why these conditions may occur together, how to tell the difference between ADHD-related fidgeting and RLS, and what treatment options exist may help those affected find relief and improve their quality of life.

What is attention-deficit/hyperactivity disorder (ADHD)?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that first appears during childhood. It's characterized by differences in the brain that can affect executive function, which is your ability to do things like focus, plan ahead, and control your impulses.

The exact cause of ADHD is still being researched. However, it's thought that differences in dopamine, a brain chemical that contributes to pleasure and motivation, may be involved. Studies have also shown a potential connection between iron deficiency and ADHD symptoms.

ADHD symptoms can take two main forms: inattentiveness and hyperactivity/impulsivity. People may experience just one type or the other, or they may experience both.

Symptoms of ADHD inattentiveness

Inattentiveness typically refers to challenges with focus and attention. Symptoms may include the following:

• Struggling to start and finish tasks, especially ones that the person finds uninteresting.
• Daydreaming or getting lost in thought often.
• Frequently forgetting things, losing things, or overlooking things.
• Making frequent "careless" mistakes at work or school.
• Becoming easily distracted.

Symptoms of ADHD hyperactivity and impulsivity

Hyperactivity and impulsivity typically refer to challenges with movement and impulse control. These can look like:

• Fidgeting or moving around when it's not appropriate.
• Having trouble relaxing, or experiencing urges to always be "up and about".
• Talking excessively, interrupting others, or blurting things out without thinking.
• Making big decisions and commitments on a whim.
• Engaging in high-risk or self-sabotaging behaviors like unsafe sex, reckless spending, or dangerous driving.

The symptoms of each ADHD group can lead to challenges at work, school, and in relationships. Left unaddressed, they may also contribute to the development of other mental health concerns like stress, depression, and anxiety. Understanding how ADHD affects daily life can also help explain why sleep disorders like RLS may compound these challenges.

What is restless legs syndrome?

Restless legs syndrome (also called "Willis-Ekbom Disease") can be defined as a sleep disorder that causes an unpleasant, overwhelming urge to move your legs. The uncomfortable sensations associated with RLS often worsen during periods of rest or inactivity, particularly at night. Although movement may relieve the uncomfortable sensation, the urge often starts up again once you stop moving. This can cause sleep disruption and make it hard to relax.

Although people of any gender can experience restless legs syndrome, it may be more common in women and those assigned female at birth, and RLS symptoms may also worsen with age. Left unaddressed, RLS can lead to poor sleep, excessive daytime sleepiness, mood changes, trouble concentrating, memory issues, and more.

Related sleep disorders

RLS is one of the most common primary sleep disorders, but it often occurs alongside other conditions, such as:

• Periodic limb movements of sleep (PLMS), a disorder that can make your legs and arms periodically jerk and spasm during sleep.
• Sleep apnea, which is when you stop breathing while you're asleep, either because your airway is blocked or because your brain stops telling your body to breathe.
• Insomnia, a disorder that can make it hard to fall or stay asleep, which it can happen on occasion due to short-term issues like stress or become chronic over time.

The connection between ADHD and restless legs syndrome

Aside from causing possible issues with concentration and energy levels, it might not seem like ADHD and RLS have much in common. As it turns out, however, there may be a significant connection between these conditions.

Prevalence of RLS in people with ADHD

People with ADHD may experience RLS at higher rates than the general population. While estimates vary, sleep disturbances, including RLS, may be more common among people who have ADHD compared to people without the condition. Multiple studies have examined this link.

Connection between ADHD and RLS

In one study from 2017, researchers looked for self-reported sleep problems among 268 adults with ADHD and 202 adults without ADHD. They found that sleep disorders like restless legs, sleep apnea, and PLMS appeared to be significantly more common in the ADHD group than in the control group.

Why ADHD and restless legs may occur together

The exact reason for this connection is still being studied. However, researchers have identified several possible explanations for why these conditions may frequently co-occur.

The role of dopamine

ADHD can involve differences in dopamine levels, which may contribute to motivation challenges. However, the dopamine system typically plays a role in movement as well. It's possible that ADHD-related dopamine differences may also contribute to the overwhelming urge to move the legs caused by RLS. When dopamine pathways don't function as expected, both attention and movement regulation may be affected.

Iron deficiency and both conditions

Iron deficiency has been linked to both ADHD symptom severity and RLS. Iron plays an important role in dopamine production, so when iron levels are low, dopamine function may be affected. This shared mechanism may help explain why some people experience both conditions. Addressing iron deficiency, when present, with the help of a doctor may help improve symptoms of both ADHD and RLS in some individuals.

Genetic factors

Genetic factors may play a role in ADHD, which can run in families. Because RLS also frequently runs in families, it's possible that the same genes that contribute to ADHD may also play a role in the development of RLS. This genetic overlap might help explain why the two conditions often appear together.

The potential impact of ADHD medications

Some ADHD medications can affect sleep patterns and may potentially worsen RLS symptoms in some people. If you're taking medication for ADHD and notice changes in your sleep or increased leg discomfort at night, it may be helpful to discuss these concerns with your prescribing clinician. Adjustments to medication timing or type may help address these issues based on a full clinical evaluation.

How to distinguish ADHD restlessness from restless legs syndrome

One common question for people with ADHD is whether their restlessness is part of their ADHD or a separate condition like RLS. Understanding the differences can help guide appropriate treatment.

Characteristics of ADHD-related restlessness

ADHD-related restlessness typically involves a general urge to move that can affect the whole body. This fidgeting often occurs throughout the day, not just in the evening, and may happen more often during activities that require sustained attention. The restlessness associated with ADHD doesn't usually involve the specific uncomfortable sensations in the legs that characterize RLS.

Characteristics of restless legs syndrome

RLS specifically affects the legs and involves uncomfortable sensations often described as crawling, tingling, aching, or pulling. These sensations typically worsen in the evening or nighttime hours. Movement may provide temporary relief, but the discomfort can return once you stop moving. RLS can significantly disrupt the ability to fall asleep due to the persistent leg discomfort.

In summary, the key differences between ADHD restlessness and RLS include the following:

• ADHD restlessness may occur throughout the day; RLS typically worsens in the evening and at rest.
• ADHD fidgeting can involve the whole body; RLS specifically affects the legs.
• RLS involves uncomfortable sensations (crawling, tingling, aching) that are temporarily relieved by movement.
• Both conditions can disrupt sleep, but RLS specifically prevents falling asleep due to leg discomfort.

When to seek evaluation

If you experience leg discomfort at night that interferes with your sleep, it may be worth discussing with a healthcare provider. A professional evaluation can help determine whether RLS, ADHD-related restlessness, or both may be contributing to your symptoms. Getting an accurate assessment can guide effective treatment approaches.

Managing ADHD and restless legs syndrome

Untreated RLS and ADHD can both contribute to sleep deprivation, focus problems, and other mental and physical health challenges. While they cannot be "cured," both conditions may be managed for a better quality of life and improved daily functioning. If either one is having negative effects on you, consider talking to your doctor about starting a treatment plan.

Lifestyle changes that may help

Making adjustments to daily habits can support symptom management for both conditions. Here are some strategies that may be helpful:

• Practicing good sleep hygiene by maintaining a consistent sleep schedule and creating a comfortable sleep environment.
• Exercising regularly, though not too close to bedtime, as physical activity may help reduce RLS symptoms.
• Limiting caffeine and alcohol consumption, particularly in the afternoon and evening.
• Incorporating stress management techniques like mindfulness, deep breathing, or journaling.
• Eating iron-rich foods, though it's important to consult a doctor before adding iron supplements to your regimen.
• Establishing a relaxing bedtime routine to help signal to your body that it's time to wind down.

Medication considerations

Different medications may be considered for ADHD and RLS when clinically appropriate. In some cases, addressing one condition may help improve symptoms of the other. If you're interested in exploring medication options, consulting your doctor, psychiatrist, or another licensed psychiatric provider can help you understand what might work best for your specific situation based on a full evaluation.

BetterHelp now offers psychiatry services through Uplift as an additional care option alongside therapy. Psychiatry services may include medication management when clinically appropriate. Medication availability and coverage may vary by member location, clinical appropriateness, and individual pharmacy/insurance benefits. Prescribing decisions are made by the treating clinicians. We do not guarantee that any specific medication will be prescribed or covered by a member's insurance plan. Learn more.

*Medication is prescribed only when clinically appropriate and is not guaranteed. Pricing, availability, insurance coverage, and copays vary by plan, location, and provider availability are not guaranteed.

How therapy may help with ADHD and sleep concerns

Therapy may be useful for managing ADHD symptoms. In particular, cognitive behavioral therapy (CBT) may be helpful for changing negative thought patterns that might worsen ADHD symptoms. CBT may also help address sleep-related anxiety and support a person in developing healthier sleep habits. For those who have RLS as well, improving ADHD symptoms through therapy may contribute to better overall sleep quality.

Benefits of online therapy for ADHD and sleep challenges

For people experiencing sleep deprivation from RLS or other sleep disturbances, leaving home to attend in-person therapy appointments may feel overwhelming or exhausting. As an alternative, online therapy allows you to connect with a licensed therapist from the comfort of your own home—no commuting required. Additionally, many online therapy platforms offer messaging features that allow you to reach out to your therapist between sessions if symptoms are affecting your daily life.

The effectiveness of online therapy for ADHD and sleep challenges

In addition to offering convenience, online therapy may be an effective form of care for people managing ADHD and related concerns. For example, a 2022 study suggests that online therapy can often be an effective intervention for treating ADHD symptoms.

BetterHelp outcomes data may support these findings. In 2024, 72% of BetterHelp users experienced a reduction in symptoms in 12 weeks. Users also gave a 4.9 out of five average session rating (based on over 1.7 million reviews). Together, this evidence suggests that online support may often be a practical, effective option for people seeking help.