Insomnia is one of America’s most common health complaints, affecting millions of adults who struggle to fall asleep, stay asleep or wake up feeling unrefreshed.
Most blame stress, anxiety, hormones, screen time or caffeine.
But specialists say another, less obvious cause is often missed entirely: poor circulation in the legs.
Emerging research suggests vein disorders such as varicose veins and chronic venous insufficiency (CVI) may be linked to poorer sleep, nighttime pain, leg cramps and symptoms that mimic restless legs syndrome.
That means some people seeking help for ‘insomnia’ may actually have an underlying leg-vein problem.
‘Vein disease, especially chronic venous insufficiency, often becomes most noticeable at night, causing aching, restlessness and symptoms that can resemble restless legs syndrome,’ Dr Sanjiv Lakhanpal, president and CEO of Center for Vein Restoration, told the Daily Mail.
‘When vein valves don’t function properly, blood pools in the legs, increasing pressure and discomfort.
‘This disruption in circulation can interfere with the body’s ability to fully relax, leading to poor sleep quality.’
While insomnia can have a variety of causes, doctors are sounding the alarm about an unlikely culprit: vein disorders in the leg (stock image)
Restless legs syndrome itself is hardly rare.
Estimates suggest it affects around 7 to 10 percent of US adults at some point, with women and older people more likely to suffer.
It can cause an overpowering urge to move the legs, often paired with crawling, tingling, pulling or electric-shock sensations that strike in the evening just as sufferers are trying to switch off.
Treatment can be frustratingly hit-and-miss.
Doctors may look for triggers such as iron deficiency, kidney disease, pregnancy or medication side effects, while some patients are offered lifestyle advice or drugs that act on dopamine pathways.
But many continue to struggle with symptoms, or never get a clear explanation for why their legs seem to come alive at bedtime.
Now, growing evidence suggests that in some cases the answer may lie not in the nerves or the brain, but in the veins.
So could your aching, twitching, sleepless nights actually be a circulation warning sign? We examined the latest studies and spoke to Dr Lakhanpal to answer the questions millions may be asking.
Common leg condition millions may not realize they have
Chronic venous insufficiency occurs when veins in the legs cannot efficiently return blood to the heart.
Normally, one-way valves inside veins stop blood from falling backward. When they weaken, blood can pool in the lower legs, increasing pressure and causing swelling, heaviness and pain.
Some estimates suggest CVI affects between 10 and 35 percent of adults, particularly older people, those with obesity, people who stand or sit for long periods, and pregnant women.
Varicose veins are one visible sign of this process – but many people with venous disease do not have dramatic bulging veins.
The warning signs are often easy to miss. Legs may feel heavy or tired by evening, ankles may swell after a long day, or aching and throbbing may strike once you finally sit down or get into bed.
Others notice night cramps, itchy skin, restless legs – and, for some, the broken sleep and insomnia that follow.
Why symptoms often flare the moment you get into bed
Patients who suffer CVI frequently say their legs are manageable all day – then start aching the second they lie down.
Doctors say gravity is part of the reason.
After hours upright, blood and fluid may have accumulated in the lower limbs. Then, once in bed, movement drops sharply.
‘Reduced movement at night also limits the muscle contractions that help circulate blood, making symptoms more noticeable,’ Dr Lakhanpal said.
The calf muscles normally act as a natural pump during walking. When that pump switches off overnight, heaviness, throbbing and discomfort can become more obvious.
The study that found 60% had poor sleep
A 2025 clinical paper examining patients with chronic venous insufficiency found that around 60 percent reported poor sleep quality, using the Pittsburgh Sleep Quality Index – a standard sleep questionnaire widely used in research.
The authors concluded venous disease affects more than the legs alone and should prompt doctors to assess sleep problems too.
Researchers also noted that symptoms such as pain, heaviness, swelling, itching and night cramps may help drive this poor sleep.
Could it actually be restless legs syndrome?
Possibly – or it may be confused with it.
Restless legs syndrome (RLS) causes an urge to move the legs, usually in the evening, often paired with crawling, tingling or pulling sensations.
Several studies have explored whether hidden vein disease may explain symptoms in some patients diagnosed with the disorder.
A 2020 study specifically investigated chronic venous insufficiency in patients suffering sleep disturbance due to restless legs syndrome, highlighting growing medical interest in the overlap between the two conditions.
A separate 2025 review described a bidirectional relationship between RLS and chronic venous insufficiency in the context of sleep disorders.
That does not mean all restless legs are caused by veins.
RLS also has established links with iron deficiency, kidney disease, pregnancy, nerve dysfunction and some medications.
But it suggests circulation may be one under-recognized piece of the puzzle for some patients.
The treatment study that improved sleep-related symptoms
One 2023 study in the Journal of Vascular and Interventional Radiology found that treating a specific type of venous reflux was associated with major improvement in patients whose main symptoms were restless legs or night cramping.
Among 90 patients with those symptoms and isolated venous reflux, 100 percent reported significant or complete relief after treatment, according to the paper.
Experts would note this was not a placebo-controlled trial, so it cannot prove cause and effect in every case.
But it is striking evidence that venous treatment may help selected patients.
Another 2023 study found surgery for varicose veins significantly improved sleep quality, daytime sleepiness and restless legs symptoms after treatment.
Again, this does not mean surgery is needed for everyone with aching legs. But it supports the idea that vein disease can have wider effects than appearance alone.
The subtle clues many people miss
Because symptoms of CVI develop slowly, many people normalize them.
Common warning signs include legs that feel heavy in the evening, ankle swelling after work, itching lower legs, night cramps, throbbing calves, visible veins or feeling unable to keep the legs still in bed.
‘The condition often develops gradually, with subtle symptoms like fatigue or mild swelling that are easy to dismiss,’ Dr Lakhanpal said.
‘Many patients don’t seek care until symptoms begin affecting sleep or daily life.’
The root problem is usually weakened or damaged valves inside the leg veins, which allow blood to fall backward and pool in the lower limbs.
Why office workers may be especially vulnerable
Long spells of sitting still reduce activation of the calf-muscle pump that helps return blood from the legs to the heart.
That means desk workers, drivers and frequent travelers may face a higher risk of circulation problems over time.
Pregnancy is another major factor because blood volume rises significantly, placing extra pressure on leg veins.
Dr Sanjiv Lakhanpal, president and CEO of Center for Vein Restoration, told the Daily Mail that ‘early intervention’ is key to preventing further complications from restless legs syndrome
Obesity can have a similar effect, while aging naturally weakens vein walls and the tiny valves that keep blood moving in the right direction.
Family history and previous blood clots can also increase the likelihood of developing CVI.
While age and genetics cannot be changed, specialists say movement is one of the most effective ways to protect circulation.
Regular walking, breaking up long periods of sitting or standing, maintaining a healthy weight and exercising consistently can all help.
Elevating the legs after long days and wearing compression stockings, if advised, may also reduce strain on the veins.
What can happen if you ignore it
Left untreated, CVI can progress.
Swelling may worsen. Skin around the ankles can darken, harden or become irritated as pressure builds in the veins.
In advanced disease, patients can develop venous ulcers – painful, slow-healing sores caused by chronic circulation problems.
And because poor sleep worsens pain sensitivity, mood, weight control and overall health, the effects may snowball.
‘Early intervention is key to preventing these outcomes,’ Dr Lakhanpal said.
Diagnosis usually begins with a physical examination and a review of symptoms, with doctors looking for swelling, skin changes, visible veins and tenderness.
The main test is a duplex ultrasound scan, which can show how blood is flowing through the leg veins and whether valves are leaking.
Treatment depends on severity. Many patients improve with compression stockings, regular walking, weight loss where needed, leg elevation and avoiding long periods of sitting or standing.
Doctors may also recommend anti-inflammatory pain relief or, in some cases, medications that help improve vein tone and swelling.
If symptoms persist or complications develop, minimally invasive procedures such as sclerotherapy, laser treatment or ablation may be considered before more traditional surgery.
What may help tonight
Doctors often recommend more daytime movement, avoiding long sedentary spells, walking breaks, weight loss where appropriate, compression stockings and elevating the legs in the evening.
‘Even light movement or stretching before bed can improve circulation and reduce nighttime discomfort,’ Dr Lakhanpal said.
‘Establishing a nighttime routine that includes leg elevation or gentle stretching can also help improve comfort and sleep quality.’
Simple exercises can help activate the calf-muscle pump and ease heaviness before bed. Specialists often recommend a brisk ten to 15-minute walk in the evening, repeated heel raises while holding a chair for balance, ankle circles, and gently flexing the feet up and down to encourage blood flow.
Calf stretches against a wall and lying on the floor with the legs raised against a wall for several minutes may also help reduce pooling and swelling after a long day.
When to seek urgent help
Sudden swelling in one leg, redness, warmth, severe calf pain or breathlessness needs urgent medical review, as these may signal a blood clot.
Persistent night pain, swelling or sleep disruption should also be discussed with a doctor.
