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), more accurately called periodic leg movement disorder of sleep (PLMD), 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, being present in one third of people with CFS and fibromyalgia.
One of the most common and easily treated causes of RLS is simply iron deficiency. Studies show that bringing the ferritin level (the best iron test) up over 60 is helpful. That your iron levels are in the "normal range" (i.e. - over 12) does not mean that you do not have iron deficiency. Rather, ask your doctor to check a blood ferritin level and get the actual result from them. If it is under 60, I would take iron until your blood ferritin level is over 60.
Other nutrients, especially B vitamins and magnesium, can also be helpful for keeping your legs and muscles calm while you sleep. These (though not the iron) are present at optimal levels in the Energy Revitalization System.
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A number of factors contribute to RLS. These include:
inadequate levels of the brain neurotransmitter called dopamine. This is very common in fibromyalgia, and in general, and also contributes to increased pain. Iron is critical for the production of dopamine, although once the ferritin level is over 60, you have received the maximum benefit
medications. These include antidepressants and allergy medications
suboptimal levels of thyroid. Optimizing thyroid often can be very helpful
drops in blood sugar while sleeping. This is a very common problem in fibromyalgia, and can often be helped by simply eating 1 - 2 ounces of protein at bedtime (e.g. - a hard-boiled egg)
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. I recommend that you save yourself $2000 though, and simply start by videotaping yourself sleeping one evening (can use your cell phone). 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).
There are both natural and prescription approaches to calming down your legs at night, so that both you and your legs can get a good night sleep.
Avoid caffeine in the evening.
Because RLS may be associated with low blood sugar, eat a 1-2 ounce protein snack at bedtime.
As noted above, if your serum ferritin score is under 60, take an iron supplement at bedtime. Do not take it within 2-6 hours of thyroid supplements, or you won’t absorb the thyroid. Take 25 - 50 mg of iron and 50-100 mg of vitamin C with it so that you absorb the iron
Ambien, Klonopin, and especially Neurontin can be very helpful for both RLS, and treating fibromyalgia in general. I advise people to adjust the dose to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners.
You can get your 8 - 9 hours of restorative sleep a night!
Jacob Teitelbaum, M.D is the author of the best-selling From Fatigued to Fantastic!, Pain Free, 1,2,3!, The Fatigue and Fibromyalgia Solution, and the popular free Smart Phone app Cures A-Z. He is the lead author of 4 studies on effective treatment for fibromyalgia and chronic fatigue syndrome.