How to cope with restless legs while traveling

Through the windows of an express train from Kyoto, Japan, to a whisky distillery on Mount Kaikoma, my colleagues admired the views and calmly discussed the agenda for the day. Distracted and annoyed, I punched my quads while counting down the minutes until we could get off the train. I envied anyone in a state of calm.

My decades-long problem with restless legs interrupted what should have been an unparalleled experience. Every time I traveled, I found myself squished into a confined space or restricted with prolonged stillness — both triggers for my twitchy limbs.

Eventually I was diagnosed with restless legs syndrome (RLS), but the treatment plan for mitigating symptoms while traveling was not clear. On trips, I implemented my own treatments to assuage the annoying twitching in my legs — meditation, marijuana, stretching and taking muscle relaxers. My remedies didn’t reliably work, and the struggle left me feeling distracted, frustrated and helpless.

I’m not alone in the journey to mitigate symptoms. According to Karla Dzienkowski, executive director of the Restless Legs Syndrome Foundation, nearly 12 million adults and children in the United States deal with the condition. And travel in particular is known to exacerbate RLS.

What causes restless legs syndrome?

“The hallmark symptom of RLS is the uncontrollable urge to move the legs. Individuals often describe the accompanying RLS sensations as throbbing, aching, twitching, bubbling in the legs, or insects crawling under the skin,” Dzienkowski explained in an email. It’s also known as Willis-Ekbom disease, and my doctor identified genetics as the leading cause.

RLS is notoriously difficult to treat. Andy Berkowski, a physician and founder of ReLACS Health, says that RLS is unfortunately marginalized in the medical community, as the condition lacks a diagnostic treatment protocol. Berkowski said that RLS is the third-most-common sleep disorder, “but it doesn’t get the attention it deserves.”

According to the Restless Legs Syndrome Foundation, a single unifying cause of RLS has not been identified. The group says RLS often runs in families, and it’s more common in people with Type 2 diabetes. Also, up to 25 percent of women develop the syndrome during pregnancy, but symptoms often disappear after giving birth. Many experts say RLS is neurological.

“RLS is not a leg condition; it’s a brain condition,” Berkowski said.

How can restless legs syndrome affect you while traveling?

Traveling creates conditions that make it more difficult to mitigate RLS symptoms — particularly, the inability to move freely. In a confined space with limited mobility, the legs can twitch with aggression. “People call the airplane a torture chamber for restless legs,” Berkowski says.

For me, RLS flares up in the evening, especially if I’m traveling. If I am sleep-deprived or otherwise anxious, the symptoms dominate with increased intensity. And, as someone who is on and off planes frequently for work, my symptoms are exacerbated by sleep deprivation, limited mobility, and increased alcohol and caffeine intake.

During an overnight flight from Chicago to Paris, my sleep was interrupted by jarring kicks seemingly from deep inside my legs. Unfortunately, moving around the cabin, massaging my legs and flexing my toes did not offer relief.

Experts say anxiety also plays a role when traveling with RLS. “There’s the psychological effect that makes things worse. As with any sensation condition, the more you draw your attention to RLS, the more you will notice it,” Berkowski said.

How to mitigate RLS when traveling

Brian Koo, associate professor of neurology at Yale and director of Yale Medicine’s Restless Legs Syndrome center, recommends avoiding evening or overnight travel altogether if possible. Koo explains that sleep and RLS are intrinsically linked. “Try to get a good night’s sleep in the days leading up to travel,” Koo said. “If you’re changing time zones, adjust your schedule several days before the trip.” Koo warns patients that if they don’t get quality sleep, they are likely to have a bad bout with RLS during the trip.

Koo also voices a strict warning for patients who plan to use over-the-counter sleep aids. “The OTC sleep aids that contain antihistamines will make RLS worse,” he says. He recommends managing your sleep schedule before a trip and has seen improvement in people who avoid alcohol and sugar while traveling.

Berkowski agrees: “You’re not on the same schedule. You’re up early, and may grab that high-sugar mocha latte at the airport before your flight.” He warns that caffeine, sugar and alcohol are culprits of RLS, especially when combined with sleep deprivation.

Berkowski tells his patients that while traveling, mobility is key. “Mild to moderate activity throughout a trip is essential,” he advises. “Simple choices will mitigate symptoms: choose an aisle seat on a flight, avoid the moving walkway at the airport and walk beside it instead, board the flight or train as late as possible, stay standing in the airport before your flight, and on road trips, get out and walk briskly as often as needed.”

An important accompaniment to movement is ensuring proper blood flow to the legs while traveling. Sarah Hans, a physician at United Vein and Vascular Centers, treats patients with RLS. She advises wearing compression socks or stockings while traveling to help with blood flow. She says that “simple exercises such as calf raises with your feet on the ground and pulling your knees toward your chest can help.” Hans also recommends staying well hydrated.

Over the last 20 years, I’ve learned that punching my quads and obsessing over the sensation are not productive coping mechanisms. For me, pre-adjusting my schedule to the destination, avoiding caffeine and wearing compression stockings have helped the most.

Andrea Javor is a Chicago-based writer. Follow her on X or Instagram: @AndreaEJavor.