Restlessness, characterized by an inability to stay still or focused, can result from various factors like sleep deprivation, stress, and physical discomfort—or, conditions like obsessive-compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), and restless leg syndrome. In individuals with OCD, restlessness often manifests as compulsive behaviors that temporarily alleviate anxiety but exacerbate the overall OCD cycle; exposure and response prevention (ERP) therapy can help you learn healthier ways to cope.
Do you frequently find yourself awake at night, tossing and turning? Do thoughts seem to race through your mind while you’re trying to relax? Do you often feel the need to pace? These are all symptoms of restlessness, and can be related to many factors—from what you ate or drank in a given day, to how much energy you’ve recently exerted, or how much stress you’re under.
“Restlessness can present both mentally and physically,” says NOCD therapist Heather Brasseur, LMC, LPC. It may show up through physical actions, like fidgeting or that up-all-night tossing and turning. Or, it can manifest as mental behaviors, like racing thoughts or an inability to concentrate.
While restlessness can be tied to social and environmental factors, it also shows up as a symptom of various physical and mental health conditions. Read on to understand what can cause restlessness, and how to tell if your restless behavior is a sign of a larger diagnosis.
What does it mean to feel restless?
Restlessness is often defined as a difficulty staying still—psychologically and/or physically. “Mentally, it often involves difficulty focusing, jumping between thoughts, speaking rapidly, trouble making decisions, and feeling irritable or moody,” Brasseur says. “Physically, it may manifest as leg tapping, an inability to remain still, sleep disturbances, a constant sense of being on edge, or pacing.” If you’re feeling restless, you may experience “urges” to suddenly move your body.
What causes restlessness?
- Sleep disturbances or deprivation affect the body’s natural clock, making it harder to fall back and stay asleep. A lack of sleep can contribute to anxiety and agitation.
- Certain emotional states such as stress, anxiety, boredom, excitement, nervousness, agitation, irritability, unease, overwhelm, and discomfort can contribute to restlessness. “Stress and anxiety activate parts of the brain that trigger the urge to do something,” Brasseur explains. When we don’t have a specific outlet to release that energy into, restlessness occurs.
- Intrusive thoughts, which are unwanted, persistent, distressing thoughts, can cause restlessness—or vice versa. “Intrusive thoughts are often anxiety-provoking, activating the part of the brain that signals the need for action,” Brasseur explains. “When there is nothing to act on, restlessness often follows.”
- Physical issues like chronic pain, digestive issues, and irregular heartbeat may cause feelings of agitation, which can manifest as restlessness.
- Various medications—notably antipsychotics—can cause akathisia, a movement disorder that causes an uncontrollable need to move—usually affecting the lower body. Medications that impact sleep can also contribute to restlessness. Finally, some recreational drugs can cause restlessness, as can withdrawal.
- Caffeine and alcohol both interfere with the sleep cycle, can contribute to insomnia, and are diuretics—so drinking either close to bedtime may cause you to wake up to urinate, further disturbing your sleep. Caffeine blocks sleep-inducing chemicals, while boosting adrenaline and cortisol—hormones that can exacerbate anxiety. Alcohol increases drowsiness but sometimes causes a rebound effect later in the night. Some people are more sensitive to caffeine and alcohol, and sensitivity can change with age, or after developing certain medical conditions.
Restlessness can also be caused by (or may be a symptom of) various medical diagnoses, including:
- Restless leg syndrome, also known as Willis-Ekbom Disease, is a condition that causes uncomfortable sensations in the legs that are relieved through movement.
- Hyperthyroidism speeds up the body’s metabolism, which can cause tremors, irregular heartbeat, and other sensations associated with restlessness.
- Neurological disorders, like Parkinson’s, may cause restless legs, tremors, or involuntary movements, according to Brasseur. Dementia can trigger restlessness in the form of verbal agitation or aimless wandering.
- Mental health conditions such as anxiety, depression, bipolar disorder specific phobias, and obsessive-compulsive disorder (OCD), can all contribute to restlessness. People with anxiety, phobias and OCD may experience restlessness as a result of intrusive thoughts, while those with bipolar disorder or depression may deal with trouble concentrating, issues making decisions, or a feeling of being emotionally unsettled.
- Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder marked by high levels of hyperactivity and impulsivity where “restlessness often shows up as irritability, difficulty making decisions, an inability to sit still, pacing, or trouble staying focused,” Brasseur says.
Understanding restlessness and OCD
OCD is a complex mental health condition characterized by intrusive thoughts, sensations, images, feelings, or urges that become obsessions. These obsessions typically trigger intense anxiety, which can drive restlessness. This restlessness usually manifests as compulsions, which are repetitive behaviors or mental acts done in an attempt to ease discomfort or try to prevent a bad thing from happening. However, compulsions only provide temporary relief, furthering the OCD cycle.
Common OCD compulsions include:
- Ruminating over obsessions, which can take the form of mind-racing thoughts.
- Constantly checking to make sure you haven’t done something wrong. This behavior can become endlessly repetitive, and be physically exhausting.
- Energetically repeating an action until it ‘feels just right,’ even though you never achieve that sense of perfection.
- Excessively researching a topic that causes you anxiety, in an attempt to find total certainty or control.
- Constantly seeking reassurance from friends, family or strangers about your intrusive thoughts, and feeling agitated when you can’t gain total reassurance.
Restlessness in people with OCD often shows up through both physical and mental behaviors that don’t really get them anywhere productive,”
Heather Brasseur
She explains that it’s common for people with OCD to use restlessness as a form of avoidance, busying themselves to try to ward off intrusive thoughts: “These distractions can feel justified—like work, exercise, or cleaning the house—but they often take away from activities that could be more relaxing.”
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ERP therapy
OCD can be effectively treated with exposure and response prevention therapy (ERP). In ERP, a therapist like Brasseur will help you figure out what your most frequent obsessions and compulsions are. Then, you’ll be gradually exposed to the objects, situations, or ideas that trigger your intrusive thoughts. If you’ve been engaging in restless behavior as a way to distract from the anxiety OCD obsessions create, ERP can help you find healthier ways to cope.
“Contrary to what many think, compulsions usually make anxiety worse instead of better,” Brasseur explains. Instead, you’ll be taught response-prevention strategies to better manage these feelings. Having a better understanding of the OCD cycle can give you the tools to break the pattern and build insight, Brasseur explains, which can quell associated feelings of restlessness.
For instance, if you’re constantly re-organizing your apartment in an attempt to distract from intrusive thoughts about your loved ones dying, ERP therapy would focus on helping you learn to manage the anxiety that arises from your intrusive thoughts—rather than allowing restless behavior to take over. Your ERP therapist might have you journal about a scenario in which a loved one passes away, to encourage you to face these fears head-on. Once you’ve begun to tackle these emotions in the relative safety of a therapy session, you’ll be better prepared to handle them on your own. Eventually, you’ll gain the skills necessary to tolerate difficult feelings that arise, without turning to a distraction.
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Coping with restlessness
Dealing with feelings of restlessness can majorly interfere with your day-to-day functioning. “It can make it hard to relax, focus, or get things done,” Brasseur says.
Some recommended strategies to relieve restlessness include:
- Establishing a good sleep routine by aiming for at least eight hours of rest each night, and minimizing screen-time before bed.
- Eating regular meals, and cutting back on any substances that disrupt sleep or heighten anxiety.
- Finding an outlet, like a creative hobby or new form of exercise. “Engaging in physical activity can help alleviate these feelings by tiring out the body and distracting the mind.” Brasseur says.
- Engaging in relaxation techniques, like yoga, meditation, and mindfulness exercises. “At times, restlessness can stem from a lack of calming activities,” Brasseur explains.
When is professional help needed?
If you’re feeling restless and you’re not sure what’s causing it, take note of any other concerning symptoms you’re experiencing. “It is always a good idea to get a check up from your primary care provider,” Brasseur says. “They can help determine if further assistance is needed, and what type of help would be appropriate.”
If restlessness is making it hard to regulate your emotions, causing major changes to your mood, or exacerbating intrusive thoughts, seeking support from a mental health professional is the best path forward.
Everyone experiences restlessness from time to time, but when the feeling is interfering with your well-being, it’s best to reach out to a professional.
Key takeaways
- Restlessness can stem from feelings of agitation, anxiety, and discomfort and often looks like an inability to sit still, relax, or focus.
- Restlessness can be caused by issues related to sleep, substances, and emotions, as well as physical and mental health conditions.
- People with OCD may be more likely to feel restless, due to the anxiety brought on by obsessions.
- Some people with OCD engage in compulsions that fuel restlessness—in an attempt to distract from intrusive thoughts.
