You finally get into bed, the house goes quiet, and your legs start up. A crawling, buzzing, pulling ache deep in the calves. An urge to move them that will not let go until you do. So you shift, you stretch, you get up and walk to the kitchen and back — and for a few minutes it settles, until you lie down again. If that is your night, most evenings, you are dealing with something real, and it has a name. It may also have a cause that most people never think to check: your veins. At Northwest Cardiovascular Clinic, we evaluate restless, aching legs for patients across Tomball, Cypress, Spring, and northwest Houston. Here is how to tell what is behind yours.
First, what restless legs syndrome actually is
Restless legs syndrome (RLS) — also called Willis-Ekbom disease — is a neurological condition, and it is diagnosed entirely from your history. No blood test or sleep study confirms it. Doctors look for a specific combination:
- An urge to move the legs, usually with an uncomfortable sensation people describe as crawling, tingling, pulling, or an indescribable itch inside the muscle.
- The urge begins or worsens at rest — sitting in a recliner, on a long flight, lying in bed.
- It is partly or completely relieved by movement, for as long as the movement continues.
- It is worse in the evening or at night than during the day.
RLS is common. Depending on how strictly it is defined, somewhere around 5 to 10 percent of adults have symptoms, and a smaller share — roughly 2 to 3 percent — have them often enough and severely enough to need treatment. It runs in families, it is more common in women, and it tends to get more noticeable with age.
Where the veins come in
Here is the part that surprises people. A meaningful number of patients who meet the criteria for restless legs also have chronic venous insufficiency — leaky one-way valves in the leg veins that let blood pool downward instead of returning it to the heart. The two conditions overlap far more often than chance would predict, and a growing body of research has looked at whether treating the veins helps the legs settle.
The evidence is encouraging but modest, and it is worth being straight about that. Older work found that a substantial proportion of patients with varicose veins also reported restless legs symptoms, and that treating the refluxing veins with sclerotherapy brought rapid relief in most of them — though symptoms returned in a meaningful share within a couple of years. A more recent retrospective review of patients who had both proven superficial venous reflux and restless legs found that after vein treatment, average symptom scores fell from the moderate range into the mild range — roughly a 63 percent improvement. A 2025 systematic review confirmed a consistent association between the two conditions across studies.
What that evidence does and does not say matters. It does not mean vein disease causes restless legs syndrome, or that every person with restless legs has a vein problem. It does mean that if you have both — night-time restlessness and signs of vein disease — treating the veins is a reasonable step that has helped a lot of people sleep better, and it treats the vein disease regardless.
Signs your night-time leg symptoms may be venous
Vein disease has a fingerprint. Look for these alongside the restlessness:
- Heaviness, aching, or throbbing that builds through the day and is worst by evening — the opposite of arthritis, which is usually worst first thing in the morning.
- Relief when you elevate your legs. Propping your feet on the arm of the sofa makes it noticeably better.
- Visible veins — ropy, bulging varicose veins, or clusters of thin blue and purple spider veins on the thigh, calf, or ankle.
- Ankle swelling that leaves a sock line, especially after a long day standing.
- Skin changes low on the leg: itching, dryness, eczema-like patches, or brownish discoloration above the ankle.
- Worse in the Houston heat, during pregnancy, or in jobs that keep you on your feet or seated for hours.
The more of these you recognize, the more worthwhile a vein evaluation becomes. Our page on leg swelling goes deeper on the swelling side of the picture.
What else causes restless or aching legs at night
Not every restless night is neurological or venous. A few other causes are worth ruling out, and several are easy to fix.
Low iron
Iron deficiency is one of the strongest and most treatable drivers of restless legs, and it is routinely missed because you can be iron-deficient with a perfectly normal hemoglobin. Guidelines recommend checking ferritin in everyone with restless legs, ideally on a morning blood draw after holding iron supplements and iron-rich meals for 24 hours. Iron replacement is recommended when ferritin is below 75 mcg/L, and it can make a substantial difference on its own.
Medications and habits
Several everyday medications can trigger or worsen restless legs, including sedating antihistamines (the ones in many over-the-counter sleep aids and cold remedies), anti-nausea drugs that block dopamine, and most antidepressants. Alcohol, nicotine, and caffeine — particularly late in the day — commonly make symptoms worse. Never stop a prescribed medication on your own, but do bring the list to your appointment.
Nocturnal leg cramps — a different problem
Cramps get confused with restless legs constantly, and the distinction is clean once you know it. A cramp is a sudden, visible, painful knot in the calf or foot that lasts seconds to minutes and often leaves the muscle sore the next day. Restless legs is usually not painful, does not knot the muscle, and is relieved by moving rather than by stretching a spasm out.
Nerve and circulation problems
Peripheral neuropathy — often from diabetes — causes burning, numbness, or pins and needles that tends to be constant rather than relieved by walking. Peripheral artery disease does the reverse of vein disease: it hurts with walking and eases with rest, and in advanced cases causes foot pain at night that improves when you dangle the leg off the bed. If your legs cramp reliably at a set walking distance, our post on PAD leg pain is the better place to start. Sleep apnea and kidney disease also raise restless legs risk, and treating the apnea sometimes settles the legs entirely.
How we evaluate restless, aching legs
Most of the work-up is quick, painless, and done in one visit.
History and exam. We walk through the timing, what relieves it, your medications, sleep, and family history, and examine the legs standing up — veins hide when you are lying down.
Venous duplex ultrasound. This is the key test. It is a painless ultrasound of the leg veins performed standing, and it shows exactly which valves are leaking and how badly. It takes about 30 to 45 minutes, uses no needles or radiation, and gives a definitive answer about whether vein disease is part of your picture. You can read more about our vein treatment services.
Bloodwork. Ferritin and iron studies, a metabolic panel and kidney function, thyroid function, and a blood count.
Circulation and heart testing when indicated. If the exam suggests arterial disease we add an ankle-brachial index; if there is swelling or breathlessness that could be cardiac, an echocardiogram is straightforward to arrange in the same office.
Treatment: what actually helps
If the veins are the problem
Treating superficial venous reflux is now a same-day, in-office affair — no hospital, no general anesthesia, and most people walk out and drive home. Options include Varithena® foam, thermal ablation, and sclerotherapy for smaller surface veins. Graduated compression stockings (typically 20–30 mmHg) are usually the first step and often help evening aching within days. Insurance generally covers treatment of symptomatic reflux once conservative measures have been tried and documented.
If it is restless legs syndrome itself
Treatment starts with the reversible things: correct low iron, remove aggravating medications where possible, cut back on alcohol and evening caffeine, treat sleep apnea. When medication is needed, the 2024 American Academy of Sleep Medicine guideline made a significant change — gabapentinoids (gabapentin, gabapentin enacarbil, pregabalin) are now first-line, and the older dopamine agonists such as pramipexole and ropinirole are no longer recommended for routine first-line use because of augmentation, a paradoxical worsening and earlier onset of symptoms that can develop after months or years of use. If you have been on a dopamine agonist for a long time and your symptoms are creeping earlier into the day or spreading to your arms, that is worth raising with your physician promptly.
Things you can do tonight
Elevate your legs above heart level for 15 to 20 minutes in the evening. Walk daily — your calf muscles are the pump that pushes blood back up. Stretch your calves before bed. Keep the bedroom cool. Move the last coffee earlier and skip the nightcap. If you stand or sit all day at work, flex your ankles and take short walking breaks.
When to get it checked sooner
Restless legs is not dangerous in itself, but a few leg symptoms should not wait:
- Go to the emergency room for sudden swelling, pain, warmth, or redness in one leg — that can be a deep vein thrombosis (blood clot), particularly with chest pain or shortness of breath.
- Be seen within days for an open sore or ulcer near the ankle that is not healing, bleeding from a varicose vein, or a hard, red, tender cord along a vein.
- Schedule an evaluation if leg symptoms are costing you sleep most nights, if swelling is new or one-sided, or if you have new leg pain with walking.
Restless leg evaluation in Tomball & Cypress
Northwest Cardiovascular Clinic is located just off SH 249 (Tomball Parkway) in northwest Houston, serving Tomball, Cypress, Spring, and the surrounding communities. Dr. Ismail Dairywala is a board-certified cardiovascular specialist, and because we evaluate the heart, arteries, and veins under one roof, we can sort out whether your night-time leg symptoms are venous, arterial, neurological, or a combination — without sending you to three different offices.
If your legs will not let you sleep, it is worth an hour to find out why. Contact our office to schedule an evaluation, or call (281) 807-5253.
Frequently asked questions
Can varicose veins cause restless legs at night?
Vein disease and restless legs syndrome overlap much more often than chance would predict, and studies show that treating leaky leg veins improves restless legs symptoms in many patients — one retrospective review found roughly a 63 percent reduction in symptom scores after treatment. That is an association rather than proof of cause, but if you have both restless legs and signs of vein disease, a venous ultrasound is worth doing.
How do I know if my restless legs are from my veins?
Venous symptoms have a recognizable pattern: heaviness and aching that build through the day and peak in the evening, clear relief when you elevate your legs, visible varicose or spider veins, ankle swelling that leaves a sock line, and itching or brown discoloration low on the leg. A painless standing venous duplex ultrasound settles the question in about 30 to 45 minutes.
What is the difference between restless legs syndrome and night leg cramps?
A night cramp is a sudden, painful, visible knot in the calf or foot that lasts seconds to minutes and often leaves soreness the next day. Restless legs syndrome is usually not painful — it is an urge to move the legs with a crawling or pulling sensation that starts at rest, worsens in the evening, and eases while you are moving.
What blood test should I have for restless legs?
Ferritin, which measures iron stores. Iron deficiency is one of the most common and most treatable causes of restless legs, and you can be iron-deficient with a normal blood count. Guidelines recommend a morning draw after holding iron supplements and iron-rich food for 24 hours, and iron replacement when ferritin is below 75 mcg/L.
Which medications make restless legs worse?
Sedating antihistamines — including those in many over-the-counter sleep aids and cold remedies — dopamine-blocking anti-nausea drugs, and most antidepressants can trigger or worsen restless legs. Alcohol, nicotine, and late-day caffeine commonly aggravate it too. Never stop a prescribed medication on your own; bring the list to your appointment instead.
Where can I get my legs evaluated near Tomball or Cypress?
Northwest Cardiovascular Clinic performs venous duplex ultrasound, arterial testing, and in-office vein treatment at our location just off SH 249 in northwest Houston, serving Tomball, Cypress, Spring, and the surrounding area. Because we evaluate the heart, arteries, and veins in one place, most patients get an answer in a single visit. Call (281) 807-5253 to schedule.