For people with Willis-Ekbom Disease, lying down to sleep may be anything but restful. More commonly referred to as “Restless Legs Syndrome” (RLS), these patients experience sensations in the legs along with an urge to move them. Ranging from mildly annoying to painful, RLS typically follows a circadian rhythm and occurs in the evening hours, so it often disrupts sleep.
Some classify RLS as a sleep disorder due to it being triggered by rest and sleep. Others classify it as a movement disorder in that patients have to move to get relief from their symptoms. The National Institute of Neurological Disorders and Stroke (NINDS) asserts that it is best categorized as a neurological sensory disorder in that the symptoms are produced within the brain itself. They estimate that as many as 7%-10% of the US population may experience RLS. When untreated, moderate to severe RLS can lead to a decrease in work productivity of as much as 20%. While both men and women suffer from RLS, women have a higher incidence of it.
RLS symptoms vary widely from person to person and even day-to-day for a given individual. Moderate cases may only occur once or twice a week, but can still cause delay of sleep onset and disruption of daytime function. Severe cases tend to occur more than twice a week, and cause “burdensome interruption of sleep and impairment of daytime function.” While moving may temporarily relieve the symptoms, they often return once that movement stops.
While some people may experience a spontaneous improvement, or remission of symptoms over a period of weeks or months, this typically only happens early in the disease. Overall, the symptoms become more severe over time. While the progression is usually very slow, those with certain other medical conditions tend to progress more rapidly. On the other hand, pregnancy-induced RLS tends to resolve itself a few weeks after the baby is delivered.
With no specific test for RLS, the diagnosis is made based on a doctor’s evaluation. While there is no known cure, RLS can generally be treated by minimizing the symptoms and increasing periods of restful sleep. For those in the early stages, where there is no significant daytime discomfort and the person is able to fall asleep, no treatment is required.
According to the Sleep Foundation, those who seek treatment, are often prescribed medication, with dopamine agonists and anti-seizure drugs being the most common families of pharmaceuticals prescribed. However, there are numerous side effects associated with these medications, including augmentation (progressive worsening) of symptoms. This may take place in the form of symptoms appearing earlier in the day, more intense symptoms, experiencing symptoms in other parts of the body or needing higher doses in order to receive the same relief. Once a patient stops taking the medication, the effects are generally reversed, leaving the patient where they started. Other medications are sometimes used, such as Benzodiazepines and even opioids, however, these carry a high risk of developing tolerance and addiction.
Due to the risks involved with pharmaceutical treatments, there is significant interest in more conservative care. In fact, one study stated that as many as 65% of RLS patients use alternative treatments for symptom relief on a regular basis.
Many cases of RLS have been found to be associated with iron deficiency. So much so, that NINDS recommends a trial of iron supplementation to be among the first treatments.
OTHER NUTRITIONAL SUPPLEMENTS
While evidence is insufficient to solidify the connection between RLS and low levels of magnesium, zinc, vitamins E, C, and D, these may play a role in determining RLS symptoms. Even if these vitamins are not playing a major determining role in RLS, they do affect multiple other bodily systems and functions. Therefore, low levels of these nutrients can have negative effects on the body. Talk to your doctor about possible testing and supplementation of these and other vital nutrients.
There is increasing evidence that a healthy lifestyle can play a role in preventing RLS. A study published in the Journal of Clinical Sleep Medicine followed over 50,000 subjects for 4-6 years. All were free of RLS at the baseline and remained diabetes and arthritis free through the end of the study. Researchers found that subjects of normal weight who were physically active, non-smokers, and had some alcohol consumption had a lower risk of developing RLS. Combining the effects of those factors together revealed a dose response relationship between the increased number of healthy lifestyle factors and a low risk of RLS.
Another 2016 review of available evidence concluded “regular physical activity should be recommended for the treatment of RLS symptoms”. Additional treatments such as yoga, acupuncture, certain types of light therapy, and valerian or Chinese herbs have been suggested by researchers based on preliminary studies. These may be among the possible ways to prevent and treat RLS. However, additional, more in-depth studies are needed to verify this data.
Both the Sleep Foundation and the Restless Legs Syndrome Foundation recommend healthy habits such as a healthy diet and moderate exercise to prevent and/or treat RLS. (Both emphasis “moderate” and also warn to not over-do exercise as it could make RLS worse.) Your doctor can help you determine what exercises will be most appropriate for you.
In recent years, the FDA has cleared 2 medical devices to help treat RLS – a foot wrap that applies targeted pressure to the affected area, and a vibrating pad that utilizes counter-stimulation to mask symptoms and improve sleep. The Sleep Foundation reports both are considered to be safe, though patients should discuss their individual health status, including other underlying health conditions before using the devices. Additionally, some physicians have prescribed a pneumatic compression device to ease symptoms. The thought is that compression of the veins can boost circulation to reduce the sensations.
Your chiropractor can talk with you to help you determine any changes in diet and lifestyle habits that could benefit you as part of an overall treatment plan. They are trained in nutrition and wellness care as well as your musculoskeletal health and can assist you in determining what you can do to improve your overall wellness along with your RLS symptoms. If your case is more severe, then your chiropractor can refer you to another provider to help alleviate your symptoms.
As with many other diseases, maintaining a good healthy lifestyle from the start can help prevent the condition from ever starting. If the condition has already developed, then making positive changes to lifestyle may reduce the symptoms and help you manage it.
Guay, Alexe DC; Houle, Marieve; O’Shaughnessy, Julie, DC, MSc; Descarreaux, Martin DC, PhD; Current Evidence on Diagnostic Criteria, Relevant Outcome Measures, and Efficacy of Nonpharmacologic Therapy in the Management of Restless Legs Syndrome (RLS): A Scoping Review JMPTOnline VOLUME 43, ISSUE 9, P930-941, NOVEMBER 01, 2020 https://www.jmptonline.org/article/S0161-4754(20)30125-1/fulltext
Batool-Anwar S, Li Y, De Vito K, Malhotra A, Winkelman J, Gao X. Lifestyle Factors and Risk of Restless Legs Syndrome: Prospective Cohort Study. J Clin Sleep Med. 2016 Feb;12(2):187-94. doi: 10.5664/jcsm.5482. PMID: 26446243; PMCID: PMC4751426.
Danny Bega, Roneil Malkani,Alternative treatment of restless legs syndrome: an overview of the evidence for mind–body interventions, lifestyle interventions, and neutraceuticals, Sleep Medicine,Volume 17,2016,Pages 99-105,ISSN 1389-9457,https://doi.org/10.1016/j.sleep.2015.09.009
National Institute of Neurological Disorders and Stroke (NINDS) Restless Legs Syndrome Fact Sheet https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet
Pacheco, Danielle https://www.sleepfoundation.org/restless-legs-syndrome/treatment Restless Legs Syndrome (RLS) Treatment Medically Reviewed by Dr. Heather Wright
Restless Legs Syndrome Foundation, Inc. https://www.rls.org/treatment/lifestyle