What Causes Restlessness at Night? Top Causes Explained

September 7, 2023 | Casper Editorial Team

Fact checked by Jonathan Eilenberg, CPE

You slide under the covers, ready for a peaceful night of deep slumber. But as soon as your head hits the pillow, the fidgeting starts. You toss and turn, arms and legs weighed down by an irresistible urge to move. Your mind races with thoughts you just can’t turn off. Sleep feels impossible.

We’ve all experienced restless nights when sleep evades us. But what exactly causes this frustrating phenomenon that leaves us exhausted? By understanding the reasons behind restless sleep, you can take control and find relief.

At Casper, we believe that quality sleep has the power to change everything. When you wake up refreshed and restored, you’re ready to live each day to the fullest. We’re here to uncover the top contributors to restless nights, and provide solutions to help you get the restful sleep you deserve.

What Does “Restlessness” Really Mean?

Restlessness refers to feelings of agitation in both mind and body that create an inability to fully relax and be still. You might pace around, constantly fidget, or toss and turn in bed battling the urge to move.1

Physical restlessness often causes uncomfortable sensations like itching, tingling, crawling, aching, or “electricity” under the skin. They typically affect the legs or arms. Mental restlessness stems from a busy brain in overdrive with racing thoughts, worry, and anxiety.2

Both types prevent the body from transitioning into deeper sleep stages. You’ll wake frequently and struggle to fall back asleep. But what triggers these unsettled sensations in the first place? Let’s explore some of the most common causes.

Common Causes of Restlessness

Health Conditions That Lead to Restless Nights

A variety of medical conditions can spark restless legs, arms, or minds:

Restless Legs Syndrome (RLS)

This disruptive neurological disorder causes overwhelming urges to move the legs along with unpleasant crawling or itching sensations.1 Symptoms flare up when lying down and temporarily improve with movement.

Researchers believe it stems from problems with the brain’s regulation of dopamine, a chemical messenger involved in controlling movement. Genetics and low iron levels also play a role. RLS tends to worsen with age.3 Learn about the best mattress for restless leg syndrome if this applies to you. 

Mood Disorders

Anxiety disorders, clinical depression, bipolar disorder, and other mood conditions and neurological disorders are strongly linked with mental restlessness.2

The chronic worry, negative rumination, agitation, muscle tension, panic attacks, and sleep disturbances associated with these disorders make it extremely difficult to unwind at night and often result in poor sleep quality. Racing thoughts and apprehension keep sufferers stuck in a state of hyperarousal.


When the thyroid gland is overactive, it produces excessive amounts of thyroid hormones that amp up metabolism. Symptoms like unexplained weight loss, rapid heart rate, tremors, and restless sleep can result.4

Premenstrual Dysphoric Disorder (PMDD)

PMDD causes severe PMS mood changes like anxiety, depression, and irritability. Research suggests PMDD leads to decreased melatonin, hypothalamus dysfunction, and disruptions in inflammatory cytokines.5 These biological irregularities can trigger mental restlessness and sleep issues in the luteal phase preceding menstrual periods.

Mild Bipolar Disorder I

Bipolar disorder encompasses intense emotional highs and lows from elevated energy and activity to depression. Symptoms are often milder in a subtype of bipolar disorder I characterized by racing thoughts, high distraction, and sleep disturbances without full manic or depressive phases.6 This can induce disruptive restlessness.

Restlessness-Inducing Medications and Stimulants

Certain prescription and over-the-counter medications list restlessness or insomnia as potential side effects. These include:1

  • Antidepressants
  • Amphetamines and ADHD medications
  • Corticosteroids
  • Thyroid hormones
  • Estrogen and progesterone
  • Beta blockers
  • Bronchodilators
  • Nasal decongestants
  • Cough medicines
  • Non-drowsy allergy medicines

Caffeine, nicotine, ginseng, and other stimulants act on the central nervous system and can also produce jittery or restless sensations, especially when consumed in excess close to bedtime.7

Other Possible Medical Causes

Besides the primary offenders, various other conditions may also increase nighttime restlessness:

  • Chronic pain – Conditions like arthritis, nerve pain, fibromyalgia, migraines, inflammatory bowel disease (IBD), and menstrual cramps can cause discomfort that makes it difficult to get comfortable at night.8 The urge to toss, turn, and rub aching areas leads to fragmented sleep.
  • Dementia and Sundowner’s Syndrome – Confusion, mood changes, and agitation in the late afternoon/evening (Sundowner’s) often cause restless pacing and motion in dementia patients.9
  • Nocturia – Frequent nighttime trips to the bathroom to urinate interrupt sleep and can cause restless sleep. It’s common in older adults due to prostate issues, urinary incontinence, and certain medications.10
  • Sleep apnea – Interrupted breathing decreases oxygen levels and sleep quality causing daytime sleepiness and contributing to insomnia.11 Restless tossing and turning result from difficulty breathing and decreased time spent in restorative sleep stages caused by this sleep disorder. Learn more about the best sleeping position for sleep apnea and how the best mattress for sleep apnea can help alleviate symptoms.
  • Gastroesophageal reflux disease (GERD) – The backflow of stomach acid causes painful heartburn that can worsen when lying down.12 This often leads to upper body restlessness, tossing, and turning.
  • Movement disorders – Conditions like restless leg syndrome mentioned above, periodic limb movement disorder, akathisia, and tardive dyskinesia directly cause the urge for constant motion.
  • Metabolic disorders – Diabetes, thyroid dysfunction, and other metabolic conditions can indirectly contribute to restless nights.

Lifestyle Factors and Behaviors Impacting Restfulness

Daily habits and behaviors also influence nighttime restlessness:

  • Poor sleep hygiene – Irregular bedtimes, exposure to blue light from screens before bed, uncomfortable sleep environments, and napping disrupt circadian rhythms and lead to insomnia. Attempting to sleep when wired and restless just breeds frustration.
  • Excess stress – When levels of the stress hormone cortisol are chronically elevated, it’s difficult to unwind and relax at bedtime.14 Stress and anticipatory anxiety boost mental restlessness.
  • Sedentary lifestyle – Insufficient physical activity leads to pent up energy at night. Limited exercise also worsens RLS symptoms.3
  • Stimulants – Consuming stimulating substances close to bed like caffeine, alcohol, nicotine, sugar, and certain supplements (ginseng, guarana) can over-activate the nervous system making it hard to relax.7
  • Dehydration – Inadequate fluid intake exacerbates RLS symptoms. Dehydration also impairs sleep quality.13
  • Poor sleep environment – Uncomfortable mattresses, distracting noise, light pollution, and improper room temperature disrupt quality rest.

How To Stop Restlessness and Finally Get Some Sleep

It is always advisable to talk to your healthcare provider if an underlying medical issue is behind your restless nights, as treating the root cause is key to finding relief. But certain lifestyle remedies can also help you unwind and get better sleep:

Medical Treatment Options

  • RLS medication – Dopamine agonists, anticonvulsants, benzodiazepines, and opioids relieve symptoms.1
  • Antidepressants – SSRIs, SNRIs, tricyclics, and MAOIs help manage anxiety and depressive mental health disorders.
  • Hyperthyroidism treatments – Antithyroid medications, radioactive iodine, surgery, and beta blockers resolve an overactive thyroid.4
  • Hormonal therapies – Birth control, GnRH modulators, and ovariectomy may improve severe PMS/PMDD.5
  • Alternatives for restlessness-inducing medications – Talk to your healthcare provider about safer alternatives that won’t disrupt sleep.
  • Cognitive behavioral therapy (CBT) – CBT and mindfulness-based therapy help manage anxious rumination and other mental health conditions.14
  • Sleep studies – Identifying issues like sleep apnea allows for treatment through CPAP machines or oral devices.

Lifestyle Changes and Home Remedies

  • Relaxation techniques – Meditation, deep breathing exercises, progressive muscle relaxation, imagery, and mindfulness quiet the busy mind.
  • Good sleep hygiene – Stick to consistent bed/wake times, limit blue light and screen use before bed, and create a cool, dark, and quiet sleep sanctuary.
  • Limit stimulants – Avoid caffeine, nicotine, alcohol, high-sugar foods, and arousing activities for several hours pre-bedtime.
  • Get moving – Regular exercise helps dissipate pent-up energy. Light yoga and stretches before bed also calm the nervous system.
  • Cut back on dehydrating fluids – Limit diuretics like caffeine and alcohol which increase urination and disrupt sleep. Stay well hydrated earlier in the day.
  • Soak in a warm Epsom salt bath – Magnesium sulfate is absorbed through the skin to ease RLS discomfort.15
  • Massage – Gently rub and stretch restless limbs to provide relief. Warming creams add extra comfort.
  • Weighted blankets – The gentle pressure of a weighted blanket creates sensations that help override restlessness.
  • Hot/cold therapy – Warming pads or ice packs on restless legs/arms provide soothing relief.

The Vicious Cycle of Restlessness and Insomnia

Inability to relax and quiet your body and mind at night leads to significant insomnia and poor sleep quality. Extended lack of quality sleep then exacerbates anxiety and stress levels, setting off a vicious cycle.

Frustration with being unable to sleep brews more mental unrest. You start dreading the frustrating battle to rest each night which just worsens restlessness. Breaking this relentless cycle requires getting to the root of what’s causing that restless urge to move and addressing it.

Sleep Your Way to Peaceful Nights with Casper

At Casper, we’re devoted to helping you achieve restful sleep through advanced products designed for all-night comfort. Our bed mattresses cradle you in relief for your sore muscles and restless limbs. They promote alignment with ergonomic zones while gently cushioning pressure points.

You’ll drift off peacefully without any need to fidget and adjust on superior Casper mattresses. Our breathable foams maintain a cool, comfortable temperature all night long so you stay in deep slumber. Say goodbye to restless nights on a Casper!

Join us and sleep your way to rested nights full of peaceful tranquility. The first step? An amazing night of rejuvenating sleep on a Casper mattress designed for head-to-toe comfort. Experience the difference of a mattress made specifically with quality rest in mind and lull even the most restless mind and body into serene slumber.


  1. Australia H. Feeling restless. www.healthdirect.gov.au. Published November 8, 2021. https://www.healthdirect.gov.au/feeling-restless 
  2. BetterHelp Editorial Team. Why Do I Feel Restless? Understanding Restlessness In The Context Of Mental Health | BeterHelp. www.betterhelp.com. Published August 16, 2023. https://www.betterhelp.com/advice/general/why-do-i-feel-restless-understanding-restlessness-in-the-context-of-mental-health-/ 
  3. Didato G, Di Giacomo R, Rosa GJ, Dominese A, de Curtis M, Lanteri P. Restless Legs Syndrome across the Lifespan: Symptoms, Pathophysiology, Management and Daily Life Impact of the Different Patterns of Disease Presentation. International Journal of Environmental Research and Public Health. 2020;17(10):3658. doi:https://doi.org/10.3390/ijerph17103658 
  4. Thyroid Disease and Sleep Loss: What You Need to Know – Blog | Everlywell: Home Health Testing Made Easy. www.everlywell.com. https://www.everlywell.com/blog/thyroid/thyroid-disease-and-sleep-loss/ 
  5. Freeborn D. Premenstrual Dysphoric Disorder (PMDD) – Health Encyclopedia – University of Rochester Medical Center. www.urmc.rochester.edu. Accessed August 22, 2023. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contentid=p00580&contenttypeid=85 
  6. Gold A, Sylvia L. The role of sleep in bipolar disorder. Nature and Science of Sleep. 2016;Volume 8:207-214. doi:https://doi.org/10.2147/nss.s85754 
  7. Ogeil RP, Phillips JG. Commonly used stimulants: Sleep problems, dependence and psychological distress. Drug and Alcohol Dependence. 2015;153:145-151. doi:https://doi.org/10.1016/j.drugalcdep.2015.05.036 
  8. Pacheco D. Pain and Sleep: Common Sleep Disturbances & Tips. Sleep Foundation. Published 2022. https://www.sleepfoundation.org/physical-health/pain-and-sleep 
  9. Alzheimer’s Society. Sundowning. Alzheimer’s Society. Published 2019. https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning 
  10. Cleveland Clinic. Nocturia. Cleveland Clinic. Published January 6, 2020. https://my.clevelandclinic.org/health/diseases/14510-nocturia 
  11. NIH. Sleep Apnea – What Is Sleep Apnea? | NHLBI, NIH. www.nhlbi.nih.gov. Published March 24, 2022. https://www.nhlbi.nih.gov/health/sleep-apnea 
  12. Suni E. How to Sleep Better with GERD & Acid Reflux. Sleep Foundation. Published August 8, 2023. https://www.sleepfoundation.org/physical-health/gerd-and-sleep 
  13. Popkin BM, D’Anci KE, Rosenberg IH. Water, Hydration, and Health. Nutrition Reviews. 2010;68(8):439-458. doi:https://doi.org/10.1111/j.1753-4887.2010.00304.x 
  14. Hofmann SG, Gómez AF. Mindfulness-Based Interventions for Anxiety and Depression. Psychiatric Clinics of North America. 2017;40(4):739-749. doi:https://doi.org/10.1016/j.psc.2017.08.008 
  15. Gotter A. The Link Between Magnesium and Restless Leg Syndrome. Healthline. Published March 2, 2017. https://www.healthline.com/health/restless-leg-syndrome/link-between-magnesium-and-rls 
  16. Miller N. Cortisol and sleep: Do cortisol levels affect sleep? – Blog | Everlywell: Home Health Testing Made Easy. www.everlywell.com. Published January 12, 2020. https://www.everlywell.com/blog/sleep-and-stress/cortisol-and-sleep/ 

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Casper blog articles are written by skilled authors and periodically reviewed by our team of sleep experts at Casper Labs. Driven by comprehensive research and evidence-based practices, we ensure that the content we publish is reliable, actionable, and practical for enhancing sleep quality and wellness.

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