Poor sleep is incredibly common for people with multiple sclerosis — and one reason for this is the increased likelihood of developing restless legs syndrome (RLS) and/or periodic limb movement disorder (PLMD).
My father struggled terribly with both RLS and PLMD for years, as have I. The good news is that I am doing much better now, largely because of the steps I’ve taken to improve my sleep and reduce my symptoms. That is what I’ll be discussing today.
People with MS develop RLS at nearly three times the rate of the general population — about 27.5% compared to 8%. And when you have RLS or PLMD, the impact goes far beyond just feeling tired. Research shows people with RLS experience higher rates of depression (30.4%) and heart disease (29.5%), along with significantly lower quality of life.
In this post, I'll walk you through what the research shows about managing these conditions, based on a recent paper titled “Restless Legs Syndrome: A Review.”(1) I’ll also share the specific strategies I use in my clinical practice to help patients finally get the restorative sleep they need.
Understanding RLS and PLMD
Restless legs syndrome is characterized by an overwhelming urge to move your limbs — typically the legs — especially at night. In addition, there may be aching and tingling, or involuntary jerking movements. Some people have RLS alone, while others also develop periodic limb movement disorder (PLMD), which involves repetitive leg movements during sleep.
Symptoms worsen at night or during periods of prolonged immobility, like long car rides or flights. This makes it difficult to fall asleep and stay asleep, which is why RLS has such a significant impact on quality of life.
Certain factors increase your risk of developing RLS, including northern European ancestry and being female (women develop RLS at twice the rate of men). You don't need a sleep study to diagnose these conditions; your doctor can make a diagnosis based on your symptoms and medical history alone.
Iron Deficiency and Medications that Make Things Worse
Because iron deficiency can significantly worsen both RLS and PLMD worse, I recommend testing iron levels with a ferritin test and total iron binding capacity. If you're deficient, iron supplementation can help — the goal is to get your ferritin level up to 100 ng/mL.
It’s also worth noting that some common medications can make RLS and PLMD worse:
- Serotonin-stimulating antidepressants like Prozac
- Dopamine-blocking drugs (like antipsychotics)
- Antihistamines like Benadryl
If you are taking any of these medications and struggling with RLS or PLMD, ask your doctor about any alternative medications that might be used in their place.
Medications That Can Help
Two medications have shown particularly good results for reducing RLS and PLMD symptoms: gabapentin (Neurontin) and pregabalin (Lyrica). In clinical trials, people taking these medications reported about a 70% reduction in symptom severity.
If your restless legs are significantly impacting your sleep and quality of life, ask your medical team whether these medications might be appropriate for you.
Diet, Inflammation, and Their Impact on RLS and PLMD
Diet plays an important role in managing RLS and PLMD and improving overall sleep quality. One observational study that used the Dietary Inflammation Index (DII) — a measure of how much inflammation a diet produces in your body — found that people eating lower-inflammation diets had better sleep scores and less severe RLS and PLMD symptoms.(2)
An important first step toward reducing inflammation is to cut back on added sugar and white flour-based bread, cereal, and pasta. Eliminating these ultra-processed foods from your diet, can significantly reduce inflammation in the body and brain.
Observational studies show following a Mediterranean diet is linked with better sleep quality,(3) as is a ketogenic diet(4). In our own clinical trials, we have seen sleep scores improve for people following a low saturated fat diet or a modified Paleolithic diet, although we’ve only presented these findings at scientific meetings (not published).
The key is to try to improve the quality of your nutrition in whatever way works best for you. Any of the dietary approaches mentioned in this section should help reduce inflammation and improve the quality of your sleep.
Reducing Your Toxin Body Burden
A high toxin load in your body (referred to as the toxin body burden) increases systemic inflammation in your body and your brain, contributing to poor sleep. Here are some practical steps you can take to address this.
Choose organic. Visit ewg.org and check out the consumer guides for the Clean Fifteen and Dirty Dozen lists. These will help you prioritize which foods to purchase organically, and where you can save your money. For conventionally grown produce, soak in two quarts of water with one heaping tablespoon of baking soda for fifteen minutes to reduce pesticide residue.
Filter your water. Use a pitcher filter (like a Brita), an under-the-sink reverse osmosis system, or a whole house water filter.
Clean your air. A HEPA filter or whole house air filter/cleaner can drastically improve the air quality in your home.
Unfortunately, with the Environmental Protection Agency relaxing regulations around water quality, air quality, and pesticide use, toxin avoidance is increasingly falling on individuals. Your best strategy is to minimize exposure wherever possible. If you've had significant toxin exposure, consider taking Dual Phase Detox to support your body's processing and elimination of pesticides, plastics, and solvents.
Physical Interventions: Vibration, Cold, and Heat
Beyond diet and toxin reduction, there are several non-drug interventions that can significantly reduce RLS and PLMD symptoms.
Vibration Therapy
Adding vibration therapy to your legs can reduce the severity of both RLS and PLMD.(5) There are consumer-grade vibration devices designed specifically to reduce anxiety and improve sleep quality, including:
- Apollo Neuro (worn on the wrist or ankle)
- Sensate (worn on the chest)
These devices use vibrations to promote more REM and deep sleep.
Cold Therapy
Research shows that cryotherapy (using supercooled air at -90 degrees Celsius for 2 minutes) significantly reduces symptoms.(5) Cryotherapy sessions are typically done three times a week.
You don't need access to a cryotherapy chamber, though. I tell my patients with RLS or PLMD to do cold therapy at home in their bathtub. Start with cool bath water and add ice as you get used to the cold. For added benefit, mix in Epsom salt or Dead Sea minerals, which are high in magnesium.
Cold plunges and cold baths reduce systemic inflammation and lower your core body temperature, helping you fall asleep faster and sleep more deeply.
Heat Therapy
If cold therapy doesn't appeal to you, try a warm or hot bath with Epsom salt or Dead Sea minerals instead. Your core body temperature will increase while you're in the hot bath, but it will drop when you get out — which leads to falling asleep faster and experiencing more deep sleep.
Supplement Support for Better Sleep
In addition to optimizing your diet, certain vitamins and supplements can help improve both sleep quality and duration.
Research shows that magnesium and pyridoxine (B6) are linked with reduced RLS and PLMD symptoms.(6) Vitamin D supplementation has also been linked with improved sleep scores.(7)
Mitochondrial dysfunction is also linked to poor sleep,(8) and iron is a key mitochondrial nutrient, which may explain why iron deficiency is linked to RLS and PLMD. In general, the most effective way to support the mitochondria is a good multivitamin/multimineral that includes a high dose of B vitamins.
My Recommendations
In my clinical practice, here is what I have patients with RLS or PLMD do:
Check that your prescription medications are not making your sleep issues worse. Talk to your doctor about potential alternatives.
Improve your nutrition with a dietary approach that feels accessible and attainable for you and your family.
Consider trying a vibration device or cold or hot soaks in the evening.
Use targeted supplements and a quality multivitamin/multimineral.
In my practice I have patients take MitoMulti Complete, which includes N acetyl-L -Cysteine, alpha lipoic acid, acetyl -l- carnitine, milk thistle, green tea, broccoli seed extract, resveratrol, huperzine A, shilajit, and bacopa monnieri.
I also recommend D3K2 5000 iu in the morning and Better Brain Mag at night, 30 minutes to an hour before going to bed.
My own sleep has improved dramatically with these interventions, and I've seen the same results in my patients.
Citations
- Winkelman JW, Wipper B. Restless Legs Syndrome: A Review. JAMA. 2026.
- Bazmi S, Pourmontaseri H, Shahraki SFM, Pourmontaseri AR, Askari A, Bagheri P, et al. Association between energy-adjusted dietary inflammatory index and sleep quality disorders: a cross-sectional study on fasa adult cohort. J Health Popul Nutr. 2025;44(1):239.
- Arab A, Lempesis IG, Garaulet M, Scheer F. Sleep and the Mediterranean diet: A systematic review and meta-analysis. Sleep Med Rev. 2025;80:102071.
- Pasca L, Quaranta CA, Grumi S, Zanaboni MP, Tagliabue A, Guglielmetti M, et al. The effects of ketogenic dietary therapies on sleep: A scoping review. J Sleep Res. 2024;33(4):e14073.
- Gupta B, Goel R, Gupta K, Thakor A, Mittal A. Effect of Vibration, Electrical Stimulation and Other Non-Pharmacological Interventions on Restless Leg Syndrome Severity and Sleep Quality: A Systematic Review and Meta-Analysis. Ann Indian Acad Neurol. 2025;28(6):806-16.
- Gonzalez-Parejo P, Martin-Nunez J, Cabrera-Martos I, Valenza MC. Effects of Dietary Supplementation in Patients with Restless Legs Syndrome: A Systematic Review. Nutrients. 2024;16(14).
- Abboud M. Vitamin D Supplementation and Sleep: A Systematic Review and Meta-Analysis of Intervention Studies. Nutrients. 2022;14(5).
- Brunetti V, Della Marca G, Servidei S, Primiano G. Sleep Disorders in Mitochondrial Diseases. Curr Neurol Neurosci Rep. 2021;21(7):30.
