Have you ever felt overwhelmed by all the information on how to manage restless legs syndrome (RLS)? Or feel unsure how to make lifestyle changes? RLS can be debilitating, isolating, and frustrating, but you are not alone. This article breaks down the latest research on sleep hygiene, exercise, diet, leg care, and stress management into simple tips to help you find symptom relief. Read on to find out how to finally get the refreshing sleep you deserve.
What is restless legs syndrome?
RLS is a neurological sleep disorder affecting 5-10% of the population.1 It is characterised by an irresistible urge to move your legs, causing pain and unpleasant throbbing, itching or crawling sensations. Affected individuals often experience involuntary, jerking leg or arm movements known as periodic limb movements and suffer from disturbed sleep.2 Around half of the individuals with RLS experience depression and anxiety.3 Symptoms are typically worse at night or during periods of rest and are partially alleviated with movement.
Causes of restless legs syndrome
Research suggests that RLS likely arises from central nervous system (the brain and spinal cord) dysfunction.4 Amongst its diverse roles, the central nervous system regulates movement and sensation by sending commands to various parts of the body via motor neurones (a type of nerve cell). It receives, processes, and responds to sensations, such as touch or pain via sensory neurones.5 This complex system is regulated by neurotransmitters and chemical hormones, such as dopamine and serotonin. The dopaminergic system can be disrupted by several different factors.6
Primary causes
This is where symptoms are not caused by another health condition. RLS does have a significant hereditary component, so it may have been passed down through your family’s genetics.4
Secondary causes
RLS is often associated with another disorder or illness, such as:4,6,7
Other potential secondary causes include:4,6,8,9
- Iron deficiency
- Magnesium deficiency
- Zinc deficiency
- Vitamin B12 deficiency
- Pregnancy
- Psychotropic medication
Treatment for restless legs syndrome
Pharmacological treatments
Treatment of RLS depends on the identified cause. Dopamine agonists, which stimulate dopamine in the brain, are used as first-line medications. These include:
- Pramipexole
- Ropinirole
- Rotigotine
Gabapentin and Pregabalin may also be prescribed as an alternative, while opioid medication may be used to treat associated pain.10 However, medication may increase symptom severity over time, often has associated side effects, and may not be safe to take during pregnancy.11 Ferrous sulphate is often prescribed if iron deficiency is identified as a cause, while vitamins C and E are effective when symptoms relate to kidney dysfunction.10 It is important to work alongside your healthcare provider to discuss the treatment options that are best for you.
Non-pharmacological treatments
Non-pharmacological treatments can improve RLS symptoms, sleep quality, and mental health.12 Treatments may complement or be a suitable alternative to pharmacological treatments.
Research has found that exercise, near-infrared therapy, acupuncture, and compression devices significantly reduce symptom severity. A review found short-term relief was also achieved using:
- Repetitive transcranial magnetic stimulation (rTMS)
- Cryotherapy
- Transcutaneous electric nerve stimulation (TENS)
However, many studies have been small, and larger randomised control trials into interventions such as yoga are needed.13 Pneumatic compression devices have been found to improve daytime fatigue and provide complete symptom relief in around 30% of individuals.14 Home devices, such as compression devices and TENS machines, are widely available and may be used with lifestyle changes or medication to achieve symptom relief.
Lifestyle changes
The good news is that there are several changes that you can make today to reduce symptoms. These include:
Sleep hygiene
It is recommended that adults get 7-9 hours of sleep per night.15,16 Having good sleep hygiene is crucial for managing RLS. Sleep hygiene refers to your bedtime routine, sleep environment, and any behavioural changes, such as caffeine avoidance, during the day.16
A systematic review found that the higher scores of depression and anxiety in individuals with RLS were due to the associated sleep deprivation.17 Therefore, improving sleep quality is a priority for individuals with RLS. Following sleep hygiene advice has been shown to significantly improve sleep quality and RLS symptoms in pregnant individuals and renal patients.18,19
To achieve good sleep hygiene, it is advised to:15,16
- Follow a consistent sleep/wake schedule, even on weekends
- Reduce alcohol and avoid large meals 2 hours before bed
- Eliminate caffeine after midday (including coffee, tea, and dark chocolate)
- Avoid screen time, stimulating activities, or stress before bed
- Maintain a cool temperature in the bedroom (18-20 ℃) and reduce light exposure with black-out blinds or an eye mask
- Reduce noise disturbance with earplugs/white noise
- Regularly exercise in the morning or early afternoon; it is especially helpful to get outdoor natural light during the day to regulate your circadian rhythm
- Avoid naps longer than 30 minutes - 2 hours
- Try breathable clothing and bedding, a supportive mattress, and/or pillow
Balanced diet
Eating a healthy, balanced diet is a great way to reduce RLS symptoms and improve your overall health. Staying hydrated by drinking 6-8 cups of fluid daily is one way to reduce RLS symptoms. Other changes you may consider include:
Iron-rich foods
Iron deficiency is a common cause of RLS. It is thought that a lack of iron may lead to RLS, as iron helps regulate dopamine.4,6,8 Therefore, incorporating foods high in iron may help reduce RLS symptoms. Iron-rich foods include:
- Beans
- Pulses
- Nuts
- Dried fruits
- Red meat
- Oily fish
- Tofu
- Breakfast cereals
Please note, that although liver is also high in iron, consumption should be avoided if you are pregnant.20 If you are concerned about your iron levels, then please consult your GP, as supplements may be advised and a blood test can be arranged.
Magnesium and zinc-rich foods
Magnesium and zinc have been found to be significantly lower in pregnant individuals with RLS.21 Therefore, a diet rich in these may help to alleviate symptoms. Foods high in magnesium include leafy green vegetables, such as:
- Spinach
- Kale
- Legumes
- Pumpkin seeds
- Whole grains
Foods high in zinc include:
- Oysters
- Beef
- Pumpkin seeds
- Oats
However, raw fish should be avoided during pregnancy. It is also possible to take supplements.
Tryptophan and phytonutrients
A diet rich in tryptophan and phytonutrients can improve sleep quality and duration.22 Tryptophan is an essential amino acid that helps regulate serotonin and is found in foods such as:23
- Oats
- Bananas
- Prunes
- Milk
- Tuna
- Cheese
- Chicken
- Peanuts
Meanwhile, phytonutrients are natural compounds found in plants. One recent study found that pine bark, a plant-derived supplement with antioxidant and anti-inflammatory effects, available as Pycnogenol, prevents and relieves RLS symptoms by improving blood flow, oxidative stress, and pain when taken at 150 mg/day.24 However, you can easily increase your consumption of phytonutrients by eating a range of plant-based foods. Remember, a healthy diet should not be an unhappy diet – get creative and eat the rainbow.
Avoid triggers
Another factor in managing RLS is avoiding triggers. Nicotine, alcohol, and stress have been identified as triggers and should be avoided.25 In addition, maintaining a healthy BMI decreases the odds of developing RLS.26 So, if you’re struggling to quit smoking or drinking, it might be time to seek some support.
Regular exercise
A large study found that individuals who are physically active have a lower risk of developing RLS after a 4-6-year follow-up. This may be due to the increased blood flow or endorphin release.26 To relieve current RLS symptoms, it may help to engage in regular, moderate aerobic exercise. For example, one study found that regular cycling (45 minutes three times per week) with progressive strength resistance significantly improved symptom severity, sleep quality, depression, and daytime sleepiness.27 No adverse effects were reported, indicating the benefits of exercise. It is also important to avoid prolonged periods of inactivity, which are associated with worsening symptoms.26
Leg care
Leg care techniques are a great way to ease RLS symptoms such as pain. They can support sleep hygiene or help you manage stress by forming part of a relaxing bedtime routine. A recent study found that using a foot massage device for 30 minutes before bed, in conjunction with heat pads on legs, significantly improved RLS symptom severity and quality of life.28 Leg massages can improve circulation and ease associated muscle cramps. Aromatherapy oils such as lavender, applied with light pressure, can also improve symptoms.29
In addition, stretching can be really helpful. Individuals who performed hip flexors, thigh stretches, and ankle rotations for thirty minutes daily, reported significantly less pain and improved sleep quality after just one week.30 Heat therapy was also found to alleviate symptoms, so a warm bath before bed could be a good idea.
Stress management
Mindfulness-based stress reduction (MBSR) has demonstrated significant reductions in RLS symptom severity, improved sleep quality, and daytime sleepiness after just two hours per week - that’s just 17 minutes per day.31,32 MBSR includes:
- Breathing exercises
- Meditation
- Body scanning exercises
- Yoga
You can find many free MBSR videos, podcasts, and apps.
Summary
Restless legs syndrome is a common, yet debilitating, neurological sleep disorder, with a higher prevalence in individuals assigned female at birth. There are many different causes, so it is important to work with your healthcare provider to ensure you receive the correct diagnosis and treatment. You can adopt various lifestyle changes to alleviate symptoms. These include practising good sleep hygiene, regular aerobic exercise, maintaining a healthy diet, leg care, and stress management (e.g., practising mindfulness).
References
- Khachatryan SG, Ferri R, Fulda S, Garcia‐Borreguero D, Manconi M, Muntean M, et al. Restless legs syndrome: Over 50 years of European contribution. Journal of Sleep Research [Internet]. 2022 Aug [cited 2024 Jun 13];31(4):e13632. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jsr.13632
- Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, et al. Restless legs syndrome. Nature Reviews Disease Primers [Internet]. 2021 Nov 3;7(1):1–18. Available from: https://www.nature.com/articles/s41572-021-00311-z?utm_source=xmol&utm_medium=affiliate&utm_content=meta&utm_campaign=DDCN_1_GL01_metadata#Sec16
- AlShareef SM. The prevalence of and risk factors for restless legs syndrome: A nationwide study. Front Psychiatry [Internet]. 2023 Jan 3 [cited 2024 Jun 13];13:987689. Available from: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.987689/full
- Gossard TR, Trotti LM, Videnovic A, St Louis EK. Restless legs syndrome: contemporary diagnosis and treatment. Neurotherapeutics [Internet]. 2021 Jan [cited 2024 Jun 13];18(1):140–55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1878747923011868
- Thau L, Reddy V, Singh P. Anatomy, Central Nervous System [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://pubmed.ncbi.nlm.nih.gov/31194336/
- Amir A, Masterson RM, Halim A, Nava A. Restless leg syndrome: pathophysiology, diagnostic criteria, and treatment. Pain Medicine [Internet]. 2022 May 4 [cited 2024 Jun 13];23(5):1032–5. Available from: https://academic.oup.com/painmedicine/article/23/5/1032/6353614
- Schattschneider J, Bode A, Wasner G, Binder A, Deuschl G, Baron R. Idiopathic restless legs syndrome: abnormalities in central somatosensory processing. Journal of Neurology [Internet]. 2004 Aug 1 [cited 2024 Jun 13];251(8):977–82. Available from: https://pubmed.ncbi.nlm.nih.gov/15316803/
- Khan M, Robab S, Ahmed A, Rao S, Salem M, Sreedharan J. Prevalence and associated factors of restless leg syndrome. jmhs [Internet]. 2024 Mar 16 [cited 2024 Jun 13];5(1):68–74. Available from: https://al-kindipublisher.com/index.php/jmhs/article/view/6959
- Riaz U, Gohari J. Emergence of restless leg syndrome secondary to psychotropic medications. Psychiatric Annals [Internet]. 2021 Apr [cited 2024 Jun 13];51(4):202–4. Available from: https://journals.healio.com/doi/10.3928/00485713-20210308-01
- Winkelmann J, Allen RP, Högl B, Inoue Y, Oertel W, Salminen AV, et al. Treatment of restless legs syndrome: Evidence-based review and implications for clinical practice (Revised 2017). Movement Disorders [Internet]. 2018 May 14;33(7):1077–91. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/mds.27260
- Anguelova GV, Vlak MHM, Kurvers AGY, Rijsman RM. Pharmacologic and nonpharmacologic treatment of restless legs syndrome. Sleep Medicine Clinics [Internet]. 2018 Jun [cited 2024 Jun 13];13(2):219–30. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1556407X18300079
- Akbaş P, Yaman Sözbir Ş. Non-pharmacological methods used in coping with restless leg syndrome (Rls): A systematic review. Sleep Biol Rhythms [Internet]. 2021 Jul [cited 2024 Jun 13];19(3):215–25. Available from: https://link.springer.com/10.1007/s41105-021-00322-z
- Guay A, Houle M, O’Shaughnessy J, Descarreaux M. Current evidence on diagnostic criteria, relevant outcome measures, and efficacy of nonpharmacologic therapy in the management of restless legs syndrome (Rls): a scoping review. Journal of Manipulative and Physiological Therapeutics [Internet]. 2020 Nov [cited 2024 Jun 13];43(9):930–41. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0161475420301251
- Lettieri CJ, Eliasson AH. Pneumatic compression devices are an effective therapy for restless legs syndrome. Chest [Internet]. 2009 Jan [cited 2024 Jun 13];135(1):74–80. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0012369209600696
- Baranwal N, Yu PK, Siegel NS. Sleep physiology, pathophysiology, and sleep hygiene. Progress in Cardiovascular Diseases [Internet]. 2023 Mar [cited 2024 Jun 13];77:59–69. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0033062023000117
- De Pasquale C, El Kazzi M, Sutherland K, Shriane AE, Vincent GE, Cistulli PA, et al. Sleep hygiene – What do we mean? A bibliographic review. Sleep Medicine Reviews [Internet]. 2024 Jun [cited 2024 Jun 13];75:101930. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1087079224000340
- An T, Sun H, Yuan L, Wu X, Lu B. Associations of anxiety and depression with restless leg syndrome: a systematic review and meta-analysis. Front Neurol [Internet]. 2024 Mar 18 [cited 2024 Jun 13];15:1366839. Available from: https://www.frontiersin.org/articles/10.3389/fneur.2024.1366839/full
- Sönmez A, Aksoy Derya Y. Effects of sleep hygiene training given to pregnant women with restless leg syndrome on their sleep quality. Sleep Breath [Internet]. 2018 May [cited 2024 Jun 13];22(2):527–35. Available from: http://link.springer.com/10.1007/s11325-018-1619-5
- Soleimani F. Effect of sleep hygiene education on sleep quality in hemodialysis patients. JCDR [Internet]. 2016 [cited 2024 Jun 13]; Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2016&volume=10&issue=12&page=LC01&issn=0973-709x&id=8941
- Ondo WG. Restless legs syndrome: pathophysiology and treatment. Curr Treat Options Neurol [Internet]. 2014 Nov [cited 2024 Jun 13];16(11):317. Available from: http://link.springer.com/10.1007/s11940-014-0317-2
- Yıldırım E, Apaydın H. Zinc and magnesium levels of pregnant women with restless leg syndrome and their relationship with anxiety: a case-control study. Biol Trace Elem Res [Internet]. 2021 May [cited 2024 Jun 13];199(5):1674–85. Available from: https://link.springer.com/10.1007/s12011-020-02287-5
- Binks H, E. Vincent G, Gupta C, Irwin C, Khalesi S. Effects of diet on sleep: a narrative review. Nutrients [Internet]. 2020 Mar 27 [cited 2024 Jun 13];12(4):936. Available from: https://www.mdpi.com/2072-6643/12/4/936
- Richard DM, Dawes MA, Mathias CW, Acheson A, Hill-Kapturczak N, Dougherty DM. l -tryptophan: basic metabolic functions, behavioral research and therapeutic indications. International Journal Tryptophan Research [Internet]. 2009 Jan [cited 2024 Jun 13];2:IJTR.S2129. Available from: http://journals.sagepub.com/doi/10.4137/IJTR.S2129
- Belcaro G, Rohdewald P, Cesarone MR, Scipione C, Scipione V, Cornelli U, et al. Restless legs syndrome: prevention with Pycnogenol® and improvement of the venoarteriolar response. Panminerva Med [Internet]. 2022 Jul [cited 2024 Jun 13];64(2). Available from: https://www.minervamedica.it/index2.php?show=R41Y2022N02A0253
- Ohayon MM, Roth T. Prevalence of restless legs syndrome and periodic limb movement disorder in the general population. Journal of Psychosomatic Research [Internet]. 2002 Jul [cited 2024 Jun 13];53(1):547–54. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022399902004439
- 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. Journal of Clinical Sleep Medicine [Internet]. 2016 Feb 15 [cited 2024 Jun 13];12(02):187–94. Available from: http://jcsm.aasm.org/doi/10.5664/jcsm.5482
- Giannaki CD, Hadjigeorgiou GM, Karatzaferi C, Maridaki MD, Koutedakis Y, Founta P, et al. A single-blind randomized controlled trial to evaluate the effect of 6 months of progressive aerobic exercise training in patients with uraemic restless legs syndrome. Nephrology Dialysis Transplantation [Internet]. 2013 Nov 1 [cited 2024 Jun 13];28(11):2834–40. Available from: https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gft288
- Park A, Ambrogi K, Hade EM. Randomized pilot trial for the efficacy of the MMF07 foot massager and heat therapy for restless legs syndrome. Martinuzzi A, editor. PLoS ONE [Internet]. 2020 Apr 2 [cited 2024 Jun 13];15(4):e0230951. Available from: https://dx.plos.org/10.1371/journal.pone.0230951
- Hashemi SH, Hajbagheri A, Aghajani M. The effect of massage with lavender oil on restless leg syndrome in hemodialysis patients: a randomized controlled trial. Nurs Midwifery Stud [Internet]. 2015 Dec 1 [cited 2024 Jun 13];4(4). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733501/
- Shamekh AH, Hassan NZ, Rashwan ZI, Fathalla NF. Effect of stretching exercises versus thermotherapy on restless legs syndrome symptoms, pain, and quality of sleep among pregnant women. ijhs [Internet]. 2022 Sep 29 [cited 2024 Jun 13];11204–20. Available from: https://sciencescholar.us/journal/index.php/ijhs/article/view/13109
- Delshad Z, Aghajani M. The effect of mindfulness-based stress reduction on restless legs syndrome in hemodialysis patients: a randomized clinical trial. Nurs Med J Nursing [Internet]. 2022 Dec 28 [cited 2024 Jun 13];12(3):316–24. Available from: https://ejournal.undip.ac.id/index.php/medianers/article/view/46307
- Bablas V, Yap K, Cunnington D, Swieca J, Greenwood KM. Mindfulness-based stress reduction for restless legs syndrome: a proof of concept trial. Mindfulness [Internet]. 2016 Apr [cited 2024 Jun 13];7(2):396–408. Available from: http://link.springer.com/10.1007/s12671-015-0457-9