When Restless Legs Aren’t Just About the Nerves

Restless Leg Syndrome (RLS) is one of those conditions that can make life miserable. The unrelenting urge to move your legs—especially at night—can rob you of sleep, affect your mood, and drain your energy. Many patients are told RLS is purely neurological, often managed with medications.

But what happens when those medications don’t work? Or when they cause side effects you’d rather avoid? Sometimes, the real cause is hiding in plain sight—inside your veins.

This is the story of a 56-year-old gentleman who came into my office after years of battling RLS, hoping there might be another way forward.

The Patient’s Journey: Sleepless Nights and Frustration

When he first sat across from me, this patient—let’s call him John—looked tired. He had been dealing with restless legs for years. His symptoms were classic:

• Uncomfortable leg sensations in the evening and at night
• An irresistible need to move his legs to get relief
• Trouble falling asleep and staying asleep
• Constant fatigue during the day

Like many patients, John had been prescribed medications for RLS. While they provided minimal relief at first, over time they stopped working. Worse, he didn’t like the idea of depending on medication indefinitely. His goal was clear:

“I want to figure out what’s actually causing this, so I can get off the meds.”

Looking Beyond the Neurological: A Venous Evaluation

Restless legs can be tricky to treat because the exact cause isn’t always clear. In many cases, it’s thought to be related to dopamine regulation in the brain, but emerging research has shown that chronic venous insufficiency (CVI) can also trigger RLS symptoms.

Given John’s history, I recommended a comprehensive venous evaluation. This included:

• Detailed duplex ultrasound imaging of both legs
• Evaluation of the great saphenous veins (GSV) and other superficial veins
• Assessment for reflux, tributary involvement, and reticular/spider vein disease

The findings were striking:

• Bilateral GSV reflux (blood flowing backward instead of upward toward the heart)
• Multiple refluxing saphenous tributaries
• Extensive reticular vein disease and spider veins

This pattern of venous disease can lead to chronic pooling of blood, increased venous pressure, and microvascular irritation in the legs—all of which may contribute to RLS symptoms.

Connecting the Dots: Vein Disease and Restless Legs

When blood pools in the legs due to vein valve failure, it can cause:

• Aching, heaviness, and fatigue in the legs
• Nighttime leg discomfort or cramping
• Restlessness, especially when lying down
• Skin changes, swelling, or varicose veins

In fact, several studies have shown a significant overlap between RLS and venous reflux. In some patients, treating the underlying vein problem leads to complete resolution of RLS symptoms—sometimes eliminating the need for medication entirely.

The Treatment Plan: ELVT and Sclerotherapy

Because John’s symptoms and ultrasound findings matched, we moved forward with a stepwise treatment approach to address all sources of reflux and diseased veins:

1. Endovenous Laser Therapy (ELVT) – Performed on both great saphenous veins to seal the faulty veins and reroute blood flow into healthy veins.
2. Ultrasound-Guided Foam Sclerotherapy – Targeted the refluxing tributaries identified on imaging. Foam sclerosant allows for precise closure of abnormal veins under real-time ultrasound guidance.
3. Visually Guided Sclerotherapy – Addressed the extensive reticular veins and spider veins contributing to discomfort and cosmetic concerns.

By treating both the main sources of reflux and the smaller diseased veins, we maximized the likelihood of symptom improvement.

The Results: Restful Nights, No More Medication

Over the course of his treatment and follow-up, John began noticing changes:

• After ELVT: The heaviness and throbbing in his legs diminished noticeably.
• After Sclerotherapy: The nightly restlessness that had plagued him for years began to fade.
• Within weeks: He started tapering his RLS medication, with his prescribing physician’s guidance.

A few months later, John reported something remarkable:

“I’m completely off my restless leg medication, and I’m sleeping through the night for the first time in years.”

He no longer experienced the urge to move his legs at night. His energy levels improved. His mood lifted. And he was thrilled to have addressed the problem at its root instead of just masking symptoms.

Why This Matters: RLS May Be a Sign of Vein Disease

John’s case isn’t unique. I have seen numerous patients with stubborn RLS symptoms improve—or resolve completely—after vein treatment.

Here’s why this matters for patients and clinicians alike:

1. Misattribution is common. RLS is often considered purely neurological, so the vascular component may be overlooked.
2. A venous evaluation is non-invasive. Duplex ultrasound is quick, painless, and highly informative.
3. Treatment can be curative. If venous reflux is contributing to symptoms, closing the diseased veins can provide lasting relief.
4. Less dependence on medication. Many patients can reduce or eliminate RLS drugs after successful vein treatment.

What to Look For: Signs Your RLS Might Be Venous

If you or someone you know has restless legs, especially if medications aren’t working, pay attention to these clues that vein disease might be involved:

• Visible varicose veins, spider veins, or reticular veins
• Leg swelling that worsens as the day goes on
• Leg heaviness, aching, or fatigue in the afternoon or evening
• Nighttime cramping or restlessness
• Skin discoloration around the ankles
• A family history of varicose veins or venous insufficiency

Modern Vein Treatments: Minimally Invasive, Highly Effective

Procedures like ELVT and sclerotherapy are performed in-office under local anesthesia. There’s no hospital stay, no general anesthesia, and minimal downtime. Most patients return to normal activities within a day or two.

Benefits include:

• Quick recovery
• High success rates for closing diseased veins
• Significant symptom relief
• Long-term durability when combined with lifestyle support (compression stockings, leg elevation, walking)

Takeaway: Don’t Overlook the Veins in RLS

John’s story is a reminder that restless legs aren’t always about the nervous system. For some patients, the source of the problem lies in the veins, and addressing that root cause can change everything.

If you have RLS that hasn’t improved with medication—or if you prefer a non-drug approach—ask your doctor about a venous evaluation. A simple ultrasound could reveal an entirely treatable condition.

You don’t have to live with restless legs. Relief may be closer than you think.

If you’re struggling with restless legs or other signs of vein disease, schedule a consultation at our clinic. We’ll evaluate your circulation, discuss your options, and help you get back to sleeping—and living—comfortably

‍

Restless Leg Syndrome (RLS) is one of those conditions that can make life miserable. The unrelenting urge to move your legs—especially at night—can rob you of sleep, affect your mood, and drain your energy. Many patients are told RLS is purely neurological, often managed with medications.

But what happens when those medications don’t work? Or when they cause side effects you’d rather avoid? Sometimes, the real cause is hiding in plain sight—inside your veins.

This is the story of a 56-year-old gentleman who came into my office after years of battling RLS, hoping there might be another way forward.

The Patient’s Journey: Sleepless Nights and Frustration

When he first sat across from me, this patient—let’s call him John—looked tired. He had been dealing with restless legs for years. His symptoms were classic:

• Uncomfortable leg sensations in the evening and at night
• An irresistible need to move his legs to get relief
• Trouble falling asleep and staying asleep
• Constant fatigue during the day

Like many patients, John had been prescribed medications for RLS. While they provided minimal relief at first, over time they stopped working. Worse, he didn’t like the idea of depending on medication indefinitely. His goal was clear:

“I want to figure out what’s actually causing this, so I can get off the meds.”

Looking Beyond the Neurological: A Venous Evaluation

Restless legs can be tricky to treat because the exact cause isn’t always clear. In many cases, it’s thought to be related to dopamine regulation in the brain, but emerging research has shown that chronic venous insufficiency (CVI) can also trigger RLS symptoms.

Given John’s history, I recommended a comprehensive venous evaluation. This included:

• Detailed duplex ultrasound imaging of both legs
• Evaluation of the great saphenous veins (GSV) and other superficial veins
• Assessment for reflux, tributary involvement, and reticular/spider vein disease

The findings were striking:

• Bilateral GSV reflux (blood flowing backward instead of upward toward the heart)
• Multiple refluxing saphenous tributaries
• Extensive reticular vein disease and spider veins

This pattern of venous disease can lead to chronic pooling of blood, increased venous pressure, and microvascular irritation in the legs—all of which may contribute to RLS symptoms.

Connecting the Dots: Vein Disease and Restless Legs

When blood pools in the legs due to vein valve failure, it can cause:

• Aching, heaviness, and fatigue in the legs
• Nighttime leg discomfort or cramping
• Restlessness, especially when lying down
• Skin changes, swelling, or varicose veins

In fact, several studies have shown a significant overlap between RLS and venous reflux. In some patients, treating the underlying vein problem leads to complete resolution of RLS symptoms—sometimes eliminating the need for medication entirely.

The Treatment Plan: ELVT and Sclerotherapy

Because John’s symptoms and ultrasound findings matched, we moved forward with a stepwise treatment approach to address all sources of reflux and diseased veins:

1. Endovenous Laser Therapy (ELVT) – Performed on both great saphenous veins to seal the faulty veins and reroute blood flow into healthy veins.
2. Ultrasound-Guided Foam Sclerotherapy – Targeted the refluxing tributaries identified on imaging. Foam sclerosant allows for precise closure of abnormal veins under real-time ultrasound guidance.
3. Visually Guided Sclerotherapy – Addressed the extensive reticular veins and spider veins contributing to discomfort and cosmetic concerns.

By treating both the main sources of reflux and the smaller diseased veins, we maximized the likelihood of symptom improvement.

The Results: Restful Nights, No More Medication

Over the course of his treatment and follow-up, John began noticing changes:

• After ELVT: The heaviness and throbbing in his legs diminished noticeably.
• After Sclerotherapy: The nightly restlessness that had plagued him for years began to fade.
• Within weeks: He started tapering his RLS medication, with his prescribing physician’s guidance.

A few months later, John reported something remarkable:

“I’m completely off my restless leg medication, and I’m sleeping through the night for the first time in years.”

He no longer experienced the urge to move his legs at night. His energy levels improved. His mood lifted. And he was thrilled to have addressed the problem at its root instead of just masking symptoms.

Why This Matters: RLS May Be a Sign of Vein Disease

John’s case isn’t unique. I have seen numerous patients with stubborn RLS symptoms improve—or resolve completely—after vein treatment.

Here’s why this matters for patients and clinicians alike:

1. Misattribution is common. RLS is often considered purely neurological, so the vascular component may be overlooked.
2. A venous evaluation is non-invasive. Duplex ultrasound is quick, painless, and highly informative.
3. Treatment can be curative. If venous reflux is contributing to symptoms, closing the diseased veins can provide lasting relief.
4. Less dependence on medication. Many patients can reduce or eliminate RLS drugs after successful vein treatment.

What to Look For: Signs Your RLS Might Be Venous

If you or someone you know has restless legs, especially if medications aren’t working, pay attention to these clues that vein disease might be involved:

• Visible varicose veins, spider veins, or reticular veins
• Leg swelling that worsens as the day goes on
• Leg heaviness, aching, or fatigue in the afternoon or evening
• Nighttime cramping or restlessness
• Skin discoloration around the ankles
• A family history of varicose veins or venous insufficiency

Modern Vein Treatments: Minimally Invasive, Highly Effective

Procedures like ELVT and sclerotherapy are performed in-office under local anesthesia. There’s no hospital stay, no general anesthesia, and minimal downtime. Most patients return to normal activities within a day or two.

Benefits include:

• Quick recovery
• High success rates for closing diseased veins
• Significant symptom relief
• Long-term durability when combined with lifestyle support (compression stockings, leg elevation, walking)

Takeaway: Don’t Overlook the Veins in RLS

John’s story is a reminder that restless legs aren’t always about the nervous system. For some patients, the source of the problem lies in the veins, and addressing that root cause can change everything.

If you have RLS that hasn’t improved with medication—or if you prefer a non-drug approach—ask your doctor about a venous evaluation. A simple ultrasound could reveal an entirely treatable condition.

You don’t have to live with restless legs. Relief may be closer than you think.

If you’re struggling with restless legs or other signs of vein disease, schedule a consultation at our clinic. We’ll evaluate your circulation, discuss your options, and help you get back to sleeping—and living—comfortably

‍