Restless Leg Syndrome - Treatment Approaches
by: Heidi Fritz, MA, ND
Bolton Naturopathic Clinic
64 King St W, Bolton, Ontario L7E 1C7
Restless leg syndrome (RLS) is a condition that affects the part of the nervous system that causes an urge to move the legs. It usually interferes with sleep, so it can also be considered a sleep disorder. RLS can be quite troubling depending on the intensity of the symptoms. Symptoms include itching, burning, aching, and a desire to move the legs (for no apparent reason). RLS affects up to 10% of the population and affects all genders, but is more common in women and also in children.
The causes of RLS are often unknown. There may be a genetic link, as many people with RLS have a family member who also has it. Other factors that may contribute include certain medical conditions like iron deficiency, kidney failure, diabetes, and peripheral neuropathy. Sometimes, treating the underlying conditions can improve RLS. Some medications also increase the risk of RLS; these include antiemetics, antipsychotics, antidepressants, and antihistamines. Discontinuing these medications (although obviously not recommended without the use of medical supervision), may also provide some symptom relief. A number of women experience RLS during pregnancy, especially in the last trimester. The reasons why are not entirely clear, but as many as 26% of women experience it in the last trimester of pregnancy. It may be related to hormonal fluctuations, mineral deficiencies, or an imbalance of dopamine. (For this population, the symptoms usually go away soon after the baby is born.) Finally, lifestyle factors like sleep deprivation and alcohol or tobacco use may worsen symptoms.
The diagnosis of RLS is not made using any particular lab tests, but medical tests may be used to rule out other conditions. The four basic criteria for diagnosing the disorder are:
- Symptoms that are worse at night and absent in the morning;
- A strong need to move the affected limbs;
- Sensory symptoms triggered by rest, relaxation, or sleep;
- Sensory symptoms that are relieved with movement;
Doctors usually focus on the individual symptoms as well as the triggers and relieving factors. A neurological exam is likely indicated to rule out other potential conditions. Lab tests can be used as well. The potential detection of things like iron deficiency may be useful, but is not diagnostic. In some cases, especially if severe enough, a sleep study might be recommended. This may detect an underlying issue such as sleep apnea, which may impact how management of the disorder is approached. Diagnosis in kids may be difficult depending on how they describe their symptoms. This article will evaluate the treatments for RLS, with a focus on natural therapies.
Treatments for RLS
The first attempts at treatment should focus on potential underlying causes or aggravating factors. We mentioned that sleep deprivation, tobacco, and alcohol can all worsen RLS. So in that regard, smoking cessation (or tobacco cessation, especially near bedtime) may be helpful. Even if this means management of the condition will require a long-term approach, if a causative agent is removed, this could be the most important piece of the puzzle. Alcohol should be reduced or eliminated, at least for a trial period to see if its removal provides any improvements to the symptoms.
Exercise programs can possibly be helpful. This ensures that the muscles are being utilized regularly, and that an increase in circulation is helping with the elimination of waste and the replenishment of nutrients. Leg massages (especially near bedtime) can be helpful for some people. A heating pack or ice pack applied to the legs, or some form of hydrotherapy, can also be beneficial. Alternating hot and cold promotes circulation. Contrast showers can be advised for a trial period (these involve ending your showers on cold—it’s not pleasant, but it can be effective at improving circulation and overall health).
Establishing regular sleeping patterns is an important recommendation in almost all cases. Good sleep habits can help by letting your body know what to expect. Our bodies are very good at getting used to things we do on a regular basis. Going to bed at the same time every day and waking up at the same time every day, even if difficult at first, can be health-promoting over the long term. Any other lifestyle changes that improve sleep quality can also be incorporated; this includes making sure the room used for sleeping is quiet and dark, and that the bed is comfortable and relaxing.
There are some medications that can be helpful in managing RLS. No single medication is useful for all individuals. Medications taken regularly may also lose their effect over time, so sometimes they are rotated or changed at regular intervals. Drugs that are used to treat Parkinson’s disease are commonly used. These are called dopaminergic drugs, as they increase the neurotransmitter dopamine. They are usually well-tolerated but can sometimes cause gastrointestinal side effects or dizziness. With extended use, it may require higher doses over time. Typically, the higher the dose goes, the higher the risk of experiencing side effects.
Benzodiazepines are muscle relaxants and can also be used to treat anxiety. They are also a possible choice for treating RLS. However, they often can be sedating, which means they are best used at night. Anticonvulsants are another class of drugs that can be considered, and these can especially help with the sensory feelings (the itching, burning, creepy crawling feelings).
Supplements that correct deficiencies should be considered first, so if an iron deficiency is detected, an iron supplement is likely a good option. Typical iron supplements provided by allopathic physicians are at a very high dose (300 mg). Iron is very poorly absorbed, and giving such a high dose commonly aggravates or causes constipation. Naturopathic doctors typically use supplements that have a much lower total dose (30 mg or thereabouts), but without side effects. Usually, these low-dose iron supplements can be taken in divided doses, so the overall end result in terms of amount of iron absorbed is the same.
Other possible deficiencies include folate or vitamin B12; these can both be tested for and are very easily corrected. Vitamin B12 can be provided via a sublingual tablet, or given by intramuscular injection if quick results are desired.
One of the most common deficiencies considered in RLS is a magnesium deficiency. Magnesium comes in a number of forms, but these forms are simply related to its ability to be absorbed. Sometimes different forms will be used for different purposes, but any form is likely acceptable. One of the most absorbable forms is called magnesium citrate, so if this form is available to you, it may be worth consideration. Magnesium can be taken alone or in combination with calcium on a trial basis to see if improvements are seen. The other item to consider with magnesium is that it may not be deficient, but a high amount may still have therapeutic benefit. This would be a situation where a nutritional supplement is used in a way similar to a drug. In this instance, magnesium can be tried with capsules and taken orally at incrementally higher doses to see if an effect is seen. The side effect of magnesium is diarrhea—so if too much is taken, you will know! Some practitioners will also recommend opening the capsules (or using powder) and applying the magnesium directly onto the tongue, with apparently good results for RLS.
RLS can be a debilitating disorder depending on the intensity of symptoms. It impacts women and children, including pregnant women in the last trimester, more than other populations. The causes are often unknown, but if it is significantly impacting quality of life and sleep, it is worth trying multiple treatments. In this article, we identified several lifestyle factors that can have an impact on RLS. A regular sleep routine, exercise, hydrotherapy, and tobacco and smoking cessation are almost always healthy modifications to consider. From a pharmaceutical perspective, there are a number of drugs available that work in different ways, but these are often accompanied by the risk of side effects. We discussed a few nutritional supplements that may be beneficial. All supplemental recommendations should be done on a trial basis to see if they actually help. There are also a number of other natural treatments that can be effective (including acupuncture and botanical medicine) that were not discussed, but that have similar actions to the lifestyle factors or supplemental recommendations. As always, please consult your naturopathic doctor before proceeding with any treatments to ensure they are right for you.