Creeping Legs, Lost Sleep, and Worsening Pain: The Overlooked RLS-Fibromyalgia Connection

Hi Friend

Hope you are well.

Do your legs feel like they’re crawling, tingling, or burning at night? Do you get an overwhelming urge to move them – even when you’re exhausted?

If so, you might have Restless Legs Syndrome (RLS), a neurological condition that’s much more common in people with fibromyalgia. Studies show that up to one-third of fibromyalgia patients also live with RLS – and often don’t know it.

Because RLS disrupts deep sleep, it can make your pain, fatigue, and “fibro fog” even worse. The good news? Identifying and treating RLS can lead to major improvements in your overall symptoms.

What exactly is Restless Legs Syndrome?

RLS is a condition where you feel unpleasant sensations in your legs (sometimes your arms too) when you’re resting, especially in the evening or at night. People describe it as:

• Tingling or creeping

• Crawling or throbbing

• Burning or itchy sensations

• A deep ache that’s only relieved by moving your legs

The key feature: The urge to move is almost irresistible, and symptoms improve when you walk, stretch, or shake your legs.

Why is it so common in fibromyalgia?

RLS and fibromyalgia share some of the same biological pathways:

1. Nervous system hyperactivity: Both conditions involve overactive pain and sensory pathways in the brain and spinal cord.

2. Dopamine imbalance: Dopamine is a neurotransmitter needed for smooth movement and pain regulation. Low or fluctuating dopamine levels are linked to RLS – and may also play a role in fibromyalgia.

3. Low brain iron: Iron is needed to make dopamine. Low brain iron can trigger RLS and worsen fatigue.

4. Sleep disturbance cycle: Poor sleep from RLS makes fibromyalgia symptoms worse. And the pain and discomfort of fibromyalgia can make RLS more noticeable – creating a vicious cycle.

Could your symptoms be RLS?

Ask yourself these questions:

• Do you get an overwhelming urge to move your legs when sitting or lying down?

• Do these sensations get worse in the evening or at night?

• Does moving your legs (walking, stretching, shaking) relieve the discomfort?

• Does it disturb your sleep or your partner’s sleep?

If you answered yes to most of these, it’s worth speaking to your doctor.

What can help?

1. Check iron and vitamin levels

• Ask for blood tests for ferritin (iron stores), B12, and folate.

• If your ferritin is under 75 µg/L, iron supplementation (oral or IV) may be helpful.

2. Support your nervous system

• Magnesium glycinate or malate can calm muscle twitching.

• Limit caffeine, nicotine, and alcohol – they can worsen RLS.

• Gentle yoga or stretching before bed can help relax the legs.

3. Improve your sleep routine

• Stick to a consistent sleep schedule.

• Warm baths, massage, or using a weighted blanket may help.

4. Medical treatments

• If your symptoms are severe, your doctor may suggest medications that balance dopamine or calm nerve overactivity (such as pramipexole, ropinirole, or gabapentin).

• Treating underlying sleep disorders like sleep apnoea is also essential.

On a quick side note, apologies if you tried to book a 1-1 appointment with me, I had to close my list as the slots booked up. I have now added more dates in August and September, so If you would like a appointment with me, click below:

Why this matters for fibromyalgia

RLS doesn’t just disturb your legs – it fragments your deep sleep. And poor sleep amplifies pain, fatigue, and cognitive issues. Addressing RLS can significantly improve your overall quality of life if you have fibromyalgia.

Final note:

If any of this sounds familiar, bring it up with your doctor. RLS is often overlooked, but treatment can break the cycle of sleep loss → pain flares → fatigue.

You deserve better nights – and better days.

A quick update, my fibromyalgia community is so nearly ready and I will be letting all those interested in soon!! keep an eye out and join the dedicated mailing list for updates.

Regards

Dr Ahmed