Is restlessness causing you to lose sleep? A possible cause is Restless Legs Syndrome (RLS). RLS (also known as Willis-Ekbom Disease - WED) is a neurologic sensorimotor disorder that causes a strong urge to move the legs, often associated with sleep complaints and uncomfortable sensations such as crawling, tingling, pulling, aching, and itching. RLS symptoms usually begin or worsen during rest and improve with movement. Symptoms also worsen in the evening or at night and can interfere with sleep, causing insomnia or daytime fatigue. Patients may have difficulty falling asleep and/or difficulty staying asleep due to frequent awakenings from unpleasant leg sensations. Interestingly, this can also occur in the arms, though it is less common. Primary RLS may be genetic, in which someone has a family member with RLS. Secondary RLS can be associated with other conditions, including:
- · Iron, folate, magnesium, and vitamin B12 deficiencies
- · Pregnancy
- · Kidney disease
- · Diabetes mellitus
- · Peripheral neuropathy
- · Parkinson’s disease
- · Certain autoimmune disorders
- · Medication side effects.
It is important to see a healthcare provider to establish a diagnosis because the evaluation includes a history, physical examination, and lab work to exclude other conditions.
Treatments should be tailored to the patient, the symptoms, and the cause of RLS. Although prescription medications are available, patients should be educated about all treatment options, including complementary therapies.
Nutritional Counseling:
For patients with iron deficiency, iron replacement is standard of care. Oral and IV iron options may be offered. Nutritional counseling can offer dietary options for iron and ways to increase iron absorption.
Folate, magnesium, and vitamin B12 deficiencies can also be replenished through supplements and dietary changes. The following single-blind study of 75 patients concluded that taking magnesium and vitamin B6 supplements for 2 months can reduce the severity of RLS/WED symptoms and improve sleep quality.
Acupuncture:
Acupuncture has been investigated for its ability to influence neurotransmitter activity, improve circulation, and modulate sensory pathways involved in RLS symptoms, with some studies suggesting improvements in symptom severity and sleep quality. The following analysis of 18 studies with 640 RLS patients concluded that acupuncture is an effective treatment option for RLS.
Massage:
Massage therapy may help reduce muscle tension, promote relaxation, and improve circulation, particularly by improving symptom burden and sleep quality. Since RLS is often associated with kidney disease, the following analysis included 5 studies involving 369 hemodialysis patients with RLS. The results concluded that “Massage may be a preferred treatment modality for hemodialysis patients with RLS because it effectively reduces RLS symptoms, relieves RLS severity, and does not increase the risk of adverse events.”
Complementary medicine may serve as an ideal, adjunctive approach for managing Restless Legs Syndrome (RLS), particularly in individuals who experience persistent symptoms, medication side effects, or prefer nonpharmacologic options.
Sources:
Jadidi, Ali et al. “Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial.” BMC Complementary Medicine and Therapies vol. 23,1 1. 31 Dec. 2022, doi:10.1186/s12906-022-03814-8
Huang, Cheng et al. “Effectiveness of acupuncture in the management of restless leg syndrome: a systematic review and meta-analysis.” Annals of Palliative Medicine Vol. 10, 10 (2021): 10495-10505. doi:10.21037/apm-21-2309
Xia, Min et al. “Clinical Efficacy and Safety of Massage for the Treatment of Restless Leg Syndrome in Hemodialysis Patients: A Meta-Analysis of 5 Randomized Controlled Trials.” Frontiers in psychiatry vol. 13 843263. 11 Apr. 2022, doi:10.3389/fpsyt.2022.843263
