What are the natural treatment options for restless leg syndrome and periodic limb movement disorder? Can they help manage the symptoms and improve sleep quality?

Understanding Restless Leg Syndrome and Periodic Limb Movement Disorder

Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) are two similar yet distinct sleep disorders that can significantly impact an individual’s quality of sleep. RLS is characterized by an irresistible urge to move the legs, often accompanied by a burning or tingling sensation. PLMD, on the other hand, is primarily a motor disorder, where the limbs (usually the legs) move involuntarily during sleep.

While there is some overlap between the two conditions, RLS symptoms typically occur before falling asleep or during periods of rest, whereas PLMD episodes occur mainly during the first stages of sleep. RLS appears to be more common in women and can also affect children, while PLMD is often associated with other underlying medical conditions.

Natural Treatment Options for Restless Leg Syndrome

For individuals with mild RLS symptoms (i.e., not painful and occurring less than once a week), natural treatment options may be worth exploring before considering medication. These include:

• Lifestyle changes: Reducing caffeine, alcohol, and tobacco consumption, as well as incorporating regular exercise and leg massages, can help alleviate RLS symptoms.
• Addressing underlying medical conditions: Treating conditions such as mineral deficiencies, kidney disease, thyroid disorders, Parkinson’s disease, neuropathy, diabetes, or varicose veins may help improve RLS symptoms.

For more severe or frequent RLS symptoms, medication prescribed by a healthcare provider may be necessary. It’s crucial to discuss any potential interactions with other medications, vitamins, or supplements, as well as the impact on sleep apnea symptoms.

Natural Treatment Options for Periodic Limb Movement Disorder

Unlike RLS, there is no known cure for PLMD, and the condition is most often treated with prescription medications. However, there are a few natural approaches that may help manage the symptoms:

1. Reduce caffeine intake: Caffeine-containing products, such as chocolate, tea, and coffee (even decaf), can worsen PLMD symptoms and should be avoided, especially at night.
2. Consult with a healthcare provider: As with RLS, it’s essential to discuss any PLMD symptoms with a healthcare provider, who can determine the appropriate treatment plan, including any necessary medications and their potential interactions.

The Importance of Addressing Sleep Apnea

It’s crucial to note that individuals with RLS or PLMD who also have obstructive sleep apnea (OSA) should be especially cautious when considering treatment options. Certain medications used to manage RLS or PLMD can sometimes exacerbate OSA symptoms, leading to an increase in apnea events (AHI). If you notice an increase in apnea events after starting a new medication or supplement, it’s essential to inform your healthcare provider immediately.

Conclusion

Restless Leg Syndrome and Periodic Limb Movement Disorder are two complex sleep disorders that can significantly impact an individual’s quality of life. While there is no cure for these conditions, a range of natural and medical treatment options are available to help manage the symptoms. By working closely with a healthcare provider, individuals can explore the best course of action, taking into account any underlying medical conditions and the potential impact on sleep apnea.

Key Takeaways

• Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) are distinct yet related sleep disorders.
• For mild RLS symptoms, natural treatment options like lifestyle changes and addressing underlying medical conditions may be effective.
• PLMD is primarily treated with prescription medications, but reducing caffeine intake can also help manage the symptoms.
• Individuals with RLS or PLMD who also have obstructive sleep apnea (OSA) should be cautious when considering treatment options, as certain medications can worsen OSA symptoms.
• Consulting with a healthcare provider is crucial to develop the most appropriate treatment plan for managing RLS or PLMD while considering any comorbidities.

FAQs

Can natural treatments completely cure RLS or PLMD?

No, there is no known cure for either RLS or PLMD. However, natural treatments can help manage the symptoms and improve overall sleep quality. For more severe or persistent cases, a combination of natural and medical interventions may be necessary.

How do I know if my RLS or PLMD is being affected by sleep apnea?

If you notice an increase in apnea events (AHI) after starting a new medication or supplement for RLS or PLMD, it’s important to inform your healthcare provider immediately. They can help assess the impact and make necessary adjustments to your treatment plan.

Are there any specific natural remedies that are particularly effective for RLS or PLMD?

While individual responses may vary, some natural remedies that have shown promise in managing RLS or PLMD symptoms include regular exercise, warm baths, leg massages, and addressing any underlying mineral deficiencies or medical conditions. However, it’s essential to consult with a healthcare provider before trying any new treatments.

Restless Leg Syndrome and Periodic Limb Movement Disorder

We explored the causes and symptoms of two similar and serious sleep robbers: restless legs syndrome (a/k/a restless leg syndrome, RLS) and periodic limb movement disorder (PLMD). Now, we’ll review the treatment options for each – and which treatments may be problematic if you also have obstructive sleep apnea (OSA). Talk with your doctor about which treatment(s) are right for you.

RLS treatment options

There is no cure for restless legs syndrome (RLS). But there are several treatment options shown to reduce or even eliminate its symptoms:

Treating your other medical conditions: For those with a mineral deficiency; kidney, thyroid or Parkinson’s disease; neuropathy; diabetes or varicose veins, talk to your doctor about whether treating these conditions could also alleviate your RLS symptoms.¹

Lifestyle changes: If your symptoms are mild (not painful and at most once a week), cutting back on caffeine, alcohol and tobacco products; exercising; massaging your legs and/or taking hot baths before bed may help reduce symptoms. ¹ Talk to your doctor about whether these options might help you.

Medication: Whether your symptoms are mild or moderate/severe (painful and/or 2+ times a week), doctor-prescribed drugs may help reduce your pain and help you sleep easier despite your symptoms. But like with all drugs, these could cause serious side effects – especially when taken with certain other medications. When you talk with your doctor about medication, be sure to discuss:

• Any other medications, vitamins and other supplements you’re taking for any reason, as they may interact dangerously with certain RLS medications.
• How certain medications may affect your sleep apnea symptoms.
• **If your apneas (AHI) increase after taking an RLS medication or any other drug/supplement, tell your doctor right away.**

PLMD treatment options

There is no cure for periodic limb movement disorder (PLMD). But there are several treatment options shown to reduce or even eliminate its symptoms:

Medication: PLMD is most often treated with doctor-prescribed drugs that are very powerful, and can cause various side effects. As with any medication, it’s very important that you discuss with your doctor:

• Any other medications, vitamins and other supplements you’re taking for any reason, as they may interact dangerously with certain PLMD medications.
• How certain medications may affect your sleep apnea symptoms.
• **If your apneas (AHI) increase after taking an PLMD medication or any drug/supplement tell your doctor right away.**

Things to avoid

Caffeine products can worsen PLMD symptoms.² Try to reduce your intake of caffeine products (e.g. chocolate, tea, coffee – even decaf coffee, which still has plenty of caffeine in it) and avoid these foods at night.

Again, talk to your doctor as soon as you think you’re showing PLMD or RLS symptoms and, if diagnosed, what treatment options are best for you.

This blog post contains general information about medical conditions and potential treatments. It is not medical advice. If you have any medical questions, please consult your doctor.

Natural Remedies for Restless Leg Syndrome
– The Rothfeld Apothecary

Years ago, I noticed a curious thing:  my wife kicked me during the night.  Before you suggest that I deserved a good kick from her (I probably did), I  mean that her legs twitched, repeatedly, during the night.  In fact, her legs twitched every 18 seconds, like clockwork, over and over.  It turns out that my wife has something called Periodic Limb Movement Disorder (PLMD), which is considered by many to be an offshoot of Restless Leg Syndrome (RLS).

RLS was first described in the medical literature in 1672.  It is generally defined as the desire or urge to move the limbs (mostly legs), almost always when resting or trying to sleep. Symptoms are frequently associated with burning or tingling, and moving the legs, walking around etc. will usually temporarily relieve it.   RLS    occurs in 5-15% of the population, although it is apparently less common in African Americans than whites.  It appears to be more common in  women than men, and it can appear in childhood although it seems to be worse in older age groups.  

PLMD  was not recognized as a separate disorder until 1953.  Some researchers consider it to be an offshoot of RLS, while others describe it as a distinct condition.  There is definitely some overlap between the two, although RLS frequently includes tingling or other sensations, while PLMD is usually purely a motor phenomenon. 

RLS symptoms occur before going to sleep or after about 15-30 minutes of resting.   PLMD occurs almost exclusively during the first part of the sleep cycle during the first two sleep stages, and frequently is associated with a period of wakefulness or arousal.  This arousal does not have to be enough for the patient to actually be awake, and frequently patients don’t know they have limb movements unless told by their partner (like my wife).  Nevertheless, more than 5 arousals per hour, as measured in a sleep study, warrants intervention.   The periodic movements themselves can last a few seconds, and come every 5 to 90 seconds.   PLMD occurs more frequently with age.   Up to 30% of people over 50 have some form.

No one really knows what causes RLS and PLMD, but it seems to be associated with the circadian rhythm cycle,  the day-night rhythm that is built into our systems.  Specifically, the latter part of the rhythm is disrupted, and the majority of patients experience their symptoms between midnight and 3 AM.  The most studied cause of the disorders is a lack of the neurotransmitter (brain chemical) dopamine.  Dopamine is the neurotransmitter involved in controlling muscle movement, including involuntary movements.  Dopamine levels fall toward the evening and nigh, which matches the rhythm of RLS/PLMD.  The most important illness associated with dopamine deficiency is Parkinson’s Disease.  In fact, Parkinson’s and RLS are thought to be associated because of  this.

Not surprising, then, that Parkinson’s medications are frequently used in these conditions (RLS and PLMD are treated similarly so I’ll just refer to RLS).  Most Parkinson’s medications involve ways of boosting dopamine levels in the brain; they are called dopamine agonists. Common dopamine agonists include rotigitine, ropinirole, and pramipexole and, in fact, these drubs have been found to help RLS in randomized controlled studies.  The problem is the side effects.  Sedation is frequent.  I myself took ropinirole briefly for my Parkinson’s and walked around like a zombie.  Even more alarming is problems with impulse control.   Someone on these drugs could become addicted to gambling, drugs, sex, or even shopping.  Although it’s not been concretely proven, there is evidence of a genetic abnormality in RLS patients involving the gene that produced tyrosine hydroxylase, the enzyme that helps convert L_Tyrosine to dopamine.

Fortunately,  there are other ways of building dopamine in the brain.  Dopamine is made from the amino acid L-DOPA.  L-DOPA in turn is made from the amino acid L-Tyrosine.  Therefore, giving one or both amino acids is an indirect strategy for building dopamine (dopamine itself doesn’t cross the blood-brain barrier, so it has to be built up indirectly).

A decade ago, I ran across work by Dr. Marty Hinz, who was treating Parkinson’s and Restless Leg Syndrome by giving measured doses of L-Tyrosine (along with 5_Hydroxytryptophan or 5-HTP, an amino acid known for helping sleep) and Mucuna, an extract of the castor bean containing high amounts of L-DOPA.  I used his protocol successfully in some patients, but honestly it involved too many pills for a lot of people, and  the high amounts of L-DOPA caused a lot of queasiness and stomach upset.  Since then I’ve modified it to a smaller amount of amino acids, along with antioxidants (usually N-Acetylcysteine) and some vitamin B6.  It doesn’t work all the time, but it’s a lot safer than dragging someone out of a casino.

Another common way of treating RLS is by using anti-seizure drugs.  These medications, like gabapentin and pregabalin, lessen the transmission of nerves, leading to less stimulus to the muscle.  Like the dopamine agonists, they are not without side effects.   Any medication that sedates  nerves is bound to have a sedating effect generally, as anyone who has taken gabapentin for pain can attest.   Again, amino acids come to the rescue.  The amino acid L-Taurine can be an effective in situations where gabapentin is not tolerated.   I have used L-Taurine in patients with spasms, so-called clonic movements, and even seizures where they are not able to take medications.  Taurine has the effect of quieting down neurotransmitters, so it has a calming effect on the body as well.  For RLS and PLMD, I give L-Taurine at night and the L-Tyrosine combination in the morning since it can be stimulating (in fact, sometimes I use this for people who have a hard time waking in the morning).     Mucuna can be used at any time.

There is also evidence that depletion of iron stores in the body contributes to at least some cases of RLS.  These findings are probably not separate from the previous ideas, since adequate iron is necessary for proper function of the dopamine system, which in turn is critical in maintaining the proper circadian rhythm. MRIs have demonstrated less iron stores in the brains of RLS patients, and genetic investigation has suggested an underlying gene abnormality in at least some of  these patients.

Diagnosing iron deficiency can be tricky.  Recently a condition called iron deficiency without anemia, or IDNA, has been described.  In my experience patients with RLS in general are not anemic, and I  have only recently begun to look for IDNA.  However iron therapy can certainly be helpful in treating RLS, particularly in premenopausal women, who have a higher  risk of iron deficiency due to menstrual blood loss.  There have been several small  randomized controlled trials of iron and RLS, and though the results have varied there’s a trend toward iron being helpful in  relieving the condition.

Magnesium is another mineral that’s frequently used to treat RLS.  This is because magnesium generally relaxes nerve and muscle.  In this way it works similar to L-Taurine and , in fact, we use magnesium taurate  (a combination of the two) in situations from cardiac arrhythmia to muscle spasm to anxiety.  In this case magnesium can be used both orally before sleeping, and as a cream or lotion to rub on the feet and legs at night.   Although studies again have been few and far between, this is time-honored treatment for leg spasms of all kinds, and certainly is worth a try.  Interestingly, a study of trace minerals in RLS showed higher than normal levels of magnesium (along with calcium, selenium and copper) in the serum, though magnesium actually does its work within the cell, and high serum levels sometimes can indicate that the magnesium is not going where it’s supposed to.

Melatonin, the hormone responsible for the circadian rhythm, actually inhibits dopamine secretion and vice versa.  Thus, there is a theory that giving melatonin can worsen RLS, and that light therapy (shining bright light, particularly in the eye) can improve it.  A small (8 patient) study seemed to bear this out, and we discourage the use of melatonin in RLS.  Light therapy on its own has been studied, particularly a device giving near-infrared (NIR) light in pulses over the legs, encompassing 57 subjects in total, and the study was positive, the effects even lasting for weeks after the light therapy was ended.

 Antioxidant nutrients  (E, C, CoQ10) have not been clinically studied (except for a small, positive study of Vitamin E in RLS patients with kidney disease).  But, the theory that oxidative stress causes damage to the dopamine-producing cells of the brain has led to a common suggestion that these nutrients be tried in RLS.  More evidence exists for the use of Vitamin D, which is known to protect dopamine-producing neurons against toxins.  Vitamin D deficient patients have a higher rate of RLS ,and in a small study of vitamin D deficiency and RLS, supplementing with Vitamin D improved symptoms.   Not many botanicals have been studied in RLS, but valerian, an herb with Valium-like effects, was studied in a randomized controlled study of 37 RLS patients.    Both valerian and placebo improved the symptoms, but valerian did better.

And my wife?  She still kicks me occasionally, but only when she has a reason.

Bega, Danny, and Roneil Malkani. “Alternative treatment of restless legs syndrome: an overview of the evidence for mind–body interventions, lifestyle interventions, and neutraceuticals.