Addressing Restless Legs Syndrome (RLS) and Periodic Leg Movements (PLMs)

Summary

Do your legs kick around a lot at night? Are your sheets and blankets scattered around a lot when you wake up? Does your spouse note that they get kicked around a lot at night or that your legs jump? If so, you probably have restless legs syndrome (RLS) and it is contributing to your fatigue and pain. Although you may be asleep through the night, your legs are running a marathon and you wake up exhausted!

RLS is very common in CFS and fibromyalgia, likely affecting over one third of those suffering with these syndromes. It is getting more media attention, now that there is an expensive new medication , called "Requip," that is being used to address it. I never have prescribed Requip. I do not believe that it is as effective as other natural or even prescription therapies and I'm concerned about safety risks. It's mostly being prescribed because it is expensive and therefore being publicized.

One of the most common and easily addressed causes of RLS is simply iron deficiency. That your iron levels are in the "normal range" does not mean that you do not have iron deficiency. Rather, ask your doctor to check a blood ferritin level. If it is under 60, I would take iron until your blood ferritin level is over 100. In many cases, this will make the RLS go away. Other nutrients, especially B vitamins and magnesium, can also be helpful. These (though not the iron) are present in a good multivitamin powder. Other natural and prescription therapies can also be very helpful, and I find them to be much better than Requip. Are you ready to make your restless legs syndrome go away?

Restless Legs Syndrome and Periodic Leg Movement Disorder

(Used with permission—From Fatigued to Fantastic!)

People with restless legs syndrome (RLS) have the sensation that they need to continually move their legs while sleeping. Occasionally, RLS also occurs during the day. Limb movements tend to be repetitive and most frequently involve the legs. A person will often extend his or her big toe while flexing the ankle, the knee and sometimes even the hip. This can occur with the arms as well and sometimes even with the whole body.

Another pattern consists of a disagreeable leg sensation and sense of restlessness that is brought on by rest and often relieved by movement. It is not uncommon for your bed partner to be very aware that your legs are kicking much of the night or are constantly moving. You may or may not be aware of your own movements. It has been estimated that as many as one-third or more of fibromyalgia patients have RLS. Although the cause of RLS is not clear, experts suspect it comes from a deficiency of the neurotransmitter called "dopamine." RLS can also be aggravated by iron deficiency (having blood ferritin levels less than 60), nerve injuries, vitamin B12 and folic acid deficiency, hypothyroidism, and other problems. In some people, RLS may be associated with hypoglycemia. Some medications, especially Elavil and perhaps lithium, can aggravate RLS.

Diagnosing RLS

If you tend to scatter your sheets and blankets, and especially if you tend to kick your bed partner or if you note that your legs tend to feel jumpy and uncomfortable at rest at night, you probably have RLS. You can also have a sleep study done to look for leg muscle contractions. If contractions occur every twenty to forty seconds and last for about one-half to five seconds each, you have RLS. The sleep study will determine if these leg movements are associated with waking from deep sleep into light sleep to a degree that would be expected to cause daytime fatigue. Leg movements are not considered significant unless one has associated daytime sleepiness—for example, CFS/FMS. You may want to start by simply videotaping yourself sleeping one evening. Leave off your sheets and blankets when you first go to sleep and aim the video camera so you can see both your legs and your face. This way the next day you can watch and look for evidence of either jumping legs (RLS) or snoring associated with stopping breathing (sleep apnea).

Addressing RLS

There are both natural and prescription approaches to addressing RLS. Following are summaries of those that have been found to be most successful.

Natural Therapies

Natural remedies for RLS focus on diet and nutritional supplementation. Avoiding caffeine is important.³⁴ Because RLS may be associated with hypoglycemia, eating a sugar-free, high-protein diet with a protein snack at night may decrease episodes of cramping and RLS at night.³⁵

An estimated 25 percent of RLS patients have low serum iron levels.³⁶ As noted above, if your serum ferritin score is under 60, your doctor should prescribe an iron supplement. I recommend the prescription iron supplement Chromagen Forte, because it also contains folic acid, and vitamin C, which helps the iron to be absorbed. An excellent over-the-counter alternative is an iron supplement that also contains vitamin C. Take iron supplements on an empty stomach or else they won't be assimilated. In addition, do not take iron within six hours of your thyroid dose or thyroid will not be absorbed. Iron can be toxic if too much builds up in the bloodstream, so be sure that your doctor continues to monitor your serum ferritin score while you are taking this supplement to make sure they do not go over 150. Giving your stomach a vacation from the iron several days a week actually increases its assimilation, so feel free to miss a couple of doses every so often.

Vitamin E can also be very helpful, although it takes six to ten weeks of therapy to help.³⁷ Take 400 international units a day, and be sure that it is a natural "mixed tocopherols" form. If you have RLS in which pain, numbness, and lightning stabs of pain are relieved by movement or local massage, taking 5 milligrams of folic acid three times a day (available by prescription) is helpful. However, folic acid does not help cases of RLS where there is no discomfort.³⁸

Finally, a few case reports have suggested that taking the amino acid L-tryptophan can be effective. Because it is hard to get this without a prescription, I recommend using the related compound 5-HTP (can be found under natural sleep aids).

Prescription Therapies

Ambien, Klonopin, Lyrica, Neurontin or Gabitril are the medications I use to address sleep in patients whom I suspect have RLS. These medicines usually do a superb job in suppressing RLS, but are often no longer needed after the iron levels are optimized (though they are still excellent for addressing sleep in those with CFS and fibromyalgia). I tell patients to adjust the dose to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners.

References:

Available in the book From Fatigued to Fantastic!