@steven46 For at least 10 years, I thought my RLS was a muscular problem. It began while I recovered from a very severe tendon injury and I was forced to sit most of the time for 18 months. I went to physical therapy 4 times over the years, trying to address my symptoms. I kept wondering what I did in the daytime that caused this problem at night.

When it was finally diagnosed, I shifted to thinking about my symptoms as being like a seizure--neurological and beyond my control. Before that, I mentally wanted a cause-and-effect explanation in terms of activities--and wondering drove me crazy...

Once I knew it was RLS, I started to remind myself that brains have both conscious and unconscious. The unconscious plays into my RLS. I was never an anxious person, but RSL made me anxious about sleep (which then made sleeping more difficult). Also, anxiety causes muscular tightness and my legs become tight during RLS episodes. I suspect tight muscles are a RLS trigger for me and maybe this can be very subtle and still set me off.

The physiological piece of the puzzle--the "underlying why"--is a question mark. And, unlike you, it seems that my RLS isn't related to lack of iron (in some particular part of my brain).

I try to focus on the fact that I'm not plagued with something worse. My RLS presents as painful, never much jerking involved. It's like my jerking can't happen (to create a release) and this builds as unbearable pain. On the brighter side, unlike neuropathy, it isn't all day--all the time--pain. It could be something worse.

I discuss the "why" question with my doctor, but he contributes more by successful treatment than conjecture about "why." Maybe there was some internal nuanced "why" in my life that affected my brain--but nothing I picked up on at the time...

Pathophysiology is not part of normal aging, but aging makes us vulnerable to pathophysiology. Maybe, some gene has replicated (in me) incorrectly (due to age) and changed some little "something" in my brain. But, this doesn't explain why several in our forum describe having had RLS for 30 years with much younger onset.

You bring up the profound question of "why." I spent years wondering this myself. Over time, for practical reasons, successful treatment has become my focus, but I agree: there should be a concrete reason and I do wish I understood it.

You are fortunate with your open-minded doctor. I shudder to think of the AI medicine that awaits all of us--virtual doctors cook-booking treatment without the part where someone smart is thinking with an open-mind. Not all doctors are equal and you, it seems, have a good one.