Figuring out the cause and reducing or eliminating your symptoms of RLS
There are a number of things you can do to figure out what’s causing your restless legs syndrome, alleviate your symptoms, and potentially eliminate them altogether. In addition to the actions listed below, doctors recommend eliminating caffeine, tobacco, and alcohol. Researchers suggest that lifestyle changes should be tried before taking medications due to their efficacy and lack of side effects.
Consider iron supplementation: As a first step, you should get a blood test to find out the level of ferritin in your blood. Dr. John Winkelman, an RLS specialist at Harvard-affiliated Massachusetts General Hospital, recommends treating RLS with a pill form of iron when the ferritin level is 50 mcg/L or lower. He reports that this relieves RLS symptoms substantially in about half of people with ferritin at these levels. As mentioned earlier, levels of iron in the blood and brain are different, so taking an iron supplement may not have a direct or immediate effect on levels of iron in your brain. If you are considering taking an iron supplement, consult your doctor (or ideally, an RLS specialist) to get a blood test and for advice on the correct dosage.
Increasing iron in your diet is also an option, but don’t attempt to do it by increasing consumption of animal products. The iron in animal products is heme iron, which is linked to many serious medical conditions including metabolic syndrome, coronary heart disease, atherosclerosis, stroke, type 2 diabetes, Alzheimer’s disease, Parkinson’s disease, arthritis, and cancer. It is far healthier to obtain dietary iron from whole grains, legumes, dried fruits, nuts, seeds, and dark green leafy vegetables.
Consider vitamin D supplementation: A 2015 study of RLS sufferers who were also vitamin D deficient found that increasing their vitamin D levels through supplementation resulted in a significant reduction in RLS symptoms. Another study done in 2018 found a significant association between vitamin D deficiency and developing RLS. The study authors suggest that “vitamin D may play a role in the pathophysiology of RLS by modulating the dopaminergic system.” If you are considering taking a vitamin D supplement, consult your doctor (or ideally, an RLS specialist) to get a blood test and for advice on the correct dosage. You can also increase your vitamin D levels with sun exposure (in moderation!) and dietary sources including mushrooms and cereals, plant milks, and juices that are fortified with vitamin D.
Address immune system function and inflammation: A 2012 review found that 95% of 38 conditions that are highly associated with RLS are also associated with inflammation and immune system changes. It has also been found that an elevated blood level of C-reactive protein (a marker of systemic inflammation) is associated with increased RLS symptom severity. A small 2008 study found improvements of RLS symptoms with hydrocortisone injections, which decrease inflammation. To learn more about the level of inflammation that could be occurring in your body, talk to your doctor about your current health conditions, get any necessary blood tests done, and consider dietary changes to reduce inflammation.
Address small intestinal bacterial overgrowth (SIBO) and irritable bowel syndrome (IBS): A small 2019 study found that 100% of RLS sufferers tested had SIBO, compared to 6-15% of the general population. Another study found that 69% of RLS patients tested positive for SIBO (compared to 10% of healthy controls), and 28% tested positive for IBS (compared to general population controls). While at first it may sound strange that gut health could be related to RLS, study authors discuss how research has linked gut bacteria to iron deficiency, inflammation, and sleep problems.
Reduce stress: Research consistently shows that chronic stress lowers dopamine levels and has a negative effect on dopamine signaling in the brain. The stress-related disorders of anxiety and depression (both of which involve dysregulation of the dopamine system) are significantly higher among people with RLS. Researchers note this is likely due in part to sleep deprivation in RLS sufferers (see below). RLS sufferers can experience increased symptoms in times of stress, and reduced symptoms when stress is alleviated. Reducing your stress level can be a complex task, but the next five items will help.
Address sleep habits and disorders: Sleep deprivation resulting from RLS symptoms increases risk of anxiety and depression. And, sleep deprivation due to poor sleep habits, sleep apnea, or other sleep disorders can lead to anxiety and depression which in turn can increase the risk of developing RLS. Researchers note that any factors that cause sleep deprivation should be addressed before pharmacological treatment. This includes reducing or eliminating caffeine and alcohol, going to bed and waking at regular times, sleeping in a restful environment, and treating any other sleep disorders like sleep apnea.
Get regular exercise: Exercise has been shown to significantly reduce the severity of RLS symptoms, and lack of exercise is a strong predictor of and risk factor for developing RLS. Researchers suggest that there are several likely reasons why exercise is beneficial for RLS sufferers: increased blood flow (lasting beyond the exercise session), the release of exercise-induced endorphins, and increased release of dopamine. Research also consistently shows that regular exercise improves sleep quality.
Practice yoga: A 2013 study tested the effects of practicing Iyengar yoga for 8 weeks on symptoms of RLS. The participants experienced remarkable reductions in RLS symptoms and severity, and the more often the participants practiced yoga per week, the more their symptoms improved. Their sleep quality, stress level, and mood improved as well. This is not surprising, as research has shown how yoga reduces stress hormones and increases dopamine. And like any form of physical exercise, yoga increases blood flow, releases endorphins, and improves sleep.
Practice meditation and mindfulness: A study of Yoga Nidra meditation found that meditation increased dopamine release by 65%. A small proof-of-concept trial found mindfulness-based stress reduction (MSBR) to be effective for reducing RLS symptom severity, RLS-specific quality of life, sleep quality, and daytime sleepiness. While it doesn’t seem that much other research has been done to directly test the effects of meditation and mindfulness on RLS symptoms, enough research has been done on the effects of meditation on brain function and stress level that it can be considered a worthwhile treatment option for RLS sufferers.
Do anything that reduces your stress, increases dopamine, and improves sleep naturally: This includes spending time outdoors, practicing forms of meditative movement like tai chi and qigong, becoming aware of unnecessary worry and negative thought patterns, and doing anything that brings you joy.