Restless Legs Syndrome Foundation Blog

Yuqing Li, PhD, 2015 RLS Foundation Grant Recipient, Awarded NIH Funding

The National Advisory Neurological Disorders and Stroke Council (NANDSC), a division of the National Institutes of Health (NIH), awarded a grant to Yuqing Li, PhD, a professor of Neurology and Neuroscience at the University of Florida. Dr. Li and his team will further investigate the genetic mechanisms that are involved in the development of restless legs syndrome.

Dr. Li will build on his previous research concerning the role of the MEIS1 gene in RLS, which was made possible with an RLS Foundation grant he received in 2015. Li’s work involved exploration of an animal model in which he and his team performed a detailed analysis of MEIS1 mutant mice to determine whether they showed RLS symptoms. They also examined the brain’s dopamine system to identify areas affected by the MEIS1 mutation.

“I want to take this opportunity to express my gratitude for the Foundation grant in 2015,” said Li, who published three papers on MEIS1. “The funding allowed us to collect the necessary preliminary data to apply for this NIH grant.”

Li says the Foundation grant allowed him to identify changes in the dopamine and cholinergic systems in the brains of the mutant animals, which suggests that they could be important in causing RLS.

“With the NIH grant award, we are going to develop animal models with MEIS1 altered only in dopaminergic or cholinergic systems,” said Li. “This will allow us to determine the relative importance of the two systems in causing the RLS. We may find out that both systems are important, or one is crucial and leads to the changes in the other. This kind of knowledge will allow us to have a better understanding of how RLS can develop in patients and develop better-targeted therapies for RLS patients.”

The support of the Foundation members has led to the funding of 48 grants totaling over $1.8 million in funding. “The RLS Foundation is excited by the news of this NIH award to Dr. Li. This study will help to expand our knowledge and understanding of the disease leading to development of targeted therapies and, hopefully, a cure,” said Dzienkowski, RLS Foundation executive director. To support the RLS Foundation Research Grant Program go to www.rls.org/donate.

Are Sleep Trackers Accurate? Here's what researchers currently know

An estimated one in three people report regular sleep complaints. So it’s hardly surprising people are more concerned than ever about getting enough sleep. This blossoming interest has seen an explosion of sleep trackers which measure how many hours of sleep you get each night.

As we sleep, we go through cycles of “deep”, “light” and “rapid eye movement” (REM) sleep. The “deep” portion of our sleep is mainly what leaves us feeling refreshed the next day. Most sleep trackers are a watch worn on the wrist, and work by monitoring your body movements as you sleep to determine how much time you probably spent awake versus asleep. Some devices also look at heart rate changes during sleeping to estimate how much time you spent in each sleep cycle.

Despite their popularity, only a few studies have investigated how accurate sleep devices are. So far, research has found that compared to polysomnography tests – which experts use to diagnose sleep disorders – sleep trackers are only accurate 78% of the time when identifying sleep versus wakefulness. This accuracy drops to around 38% when estimating how long it took participants to fall asleep.

Polysomnography tests are the most accurate because they track a person’s brain waves, heart rate, breathing, blood oxygen levels, and body and eye movements during sleep through electrodes attached to the skin and scalp. Analysing brain wave patterns is the only definitive way of knowing whether someone is awake or asleep, and to know what stage of sleep they’re in.

But since sleep trackers are worn on the wrist, they make their estimates of nightly sleep by measuring body movement and sometimes heart rate data. As we move frequently during all stages of sleep, movement provides few clues about what sleep stage we’re in. Many sleep devices also fail to differentiate one stage of sleep from another based on motion alone.

Given many consumer sleep devices haven’t been compared against polysomnography tests, it’s difficult to determine their accuracy rate. Furthermore, the algorithms which companies use to make predictions about sleep are unknown, making it difficult for scientists to identify whether the assumptions made by the sleep devices are valid.

Studies also show sleep devices underperform in people with insomnia. People with insomnia tend to remain very still in bed in an attempt to fall asleep. But as sleep trackers only measure movement, one study found watches were unable to differentiate sleep from wakefulness in people with insomnia.

Watches that incorporate heart rate data tend to be slightly more accurate when measuring sleep duration because heart rate fluctuates during different sleep stages. However, even in devices that do track heart rate, many experts are still uncertain of their accuracy because of the limited research on them, and because of the differences between each device. For example, one study of heart rate sleep trackers showed that two consumer devices tended to underestimate the amount of deep sleep wearers obtained by as much as 46 minutes.

Sleep anxiety

Ultimately, this leads to the question of whether knowing about our sleep is actually beneficial to us. After all, one of the best ways to stay awake is to try really hard to go to sleep. It sounds counterintuitive, but we see this clinically in patients with chronic insomnia, for whom excessive pre-occupation with sleep causes anxiety and low mood over sleep loss – leading to further sleeplessness.

A study published by our research group showed this effect can be worsened by sleep watches. Participants were given sleep watches and asked to complete measures of mood, daytime thinking processes and sleepiness at regular periods throughout the day. However, the “sleep score” given by their watches was manipulated to show either an increased or a decreased quality of sleep. The amount and quality of sleep participants in both groups got was the same.

The study found that those who were told they had a poor night’s sleep showed lower mood, difficulties with daytime thinking processes and increased sleepiness. Those who were told they had a great night’s sleep showed the opposite.

This shows us that data from these sleep trackers could change your emotional state and concentration levels during the day – even if the readings are accurate. Given people who experience poor sleep may be more likely to use sleep tracking devices, this could be a concern as it may potentially worsen mental health issues.

While few studies have examined this link so far, one report highlighted more patients are seeking treatment for perceived sleep difficulties as a result of feedback from sleep trackers. Even when such complaints are refuted by a polysomnography test, watches continue to provide a source of sleep-related anxiety. Since studies have shown overuse of wearable devices (such as those used during exercise) increase health anxiety and depression, there’s concerns sleep devices may have a similar effect.

While sleep devices might be useful for those who have generally good sleep but are interested in tracking or establishing a better routine, people who have poor sleep or mental health conditions may want to avoid them. But the best metric for measuring how good your sleep was is to see how you feel each day. If you’re tired and struggling to concentrate, then going to bed a bit earlier each night may help you feel more rested – no device necessary.

Matthew Reid, Post Doctoral Researcher, Sleep and Circadian Neurosciences, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

"Herbal Alternative?"

In recent years, some people have been turning to kratom in an attempt to control withdrawal symptoms and cravings caused by addiction to opioids and other substances. Some companies market kratom products as a “natural substitute for opium,” but are now receiving warning letters from the Federal Drug Administration (FDA) for making unsubstantiated claims. Seeking a natural or alternative treatment to pharmaceuticals may be of interest to some people with restless legs syndrome, but there is no scientific evidence that kratom is an effective or safe alternative treatment.

The ongoing debate regarding the risks and benefits of kratom centers around reports of its stimulating effects, increased alertness, physical energy, and talkativeness at low doses, as well as its supposed sedative effects at high doses. The chemical substances, mitragynine and 7-a- hydroxymitragynine, found in the kratom leaf, interact with opioid receptors in the brain, causing sedation, pleasure and decreased pain when consumed in large amounts. Instances of psychosis with symptoms of hallucinations, delusions and confusion have also been reported. Because kratom acts on the brain in ways that are like the effects of morphine, it exposes users to the risks of addiction, abuse and dependence, according to the FDA.

Kratom – a tropical tree native to Southeast Asia – may appeal to those who are seeking an herbal alternative to traditional medical treatment. Opium is similarly considered as an “herbal” product since it is made from poppy flowers. The leaf of a kratom tree is usually chewed, brewed or crushed into powder. In the US, kratom tends to be sold in a processed form (e.g., pills, capsules or extracts). However, there is no uniformity of strength, and similar mg doses from different sources may contain vastly different amounts of active drug, making it difficult to know how much a person is actually taking.

Also, processed kratom is not regulated by the FDA and may contain other harmful substances. In 2019, the FDA conducted laboratory testing of 30 different kratom products from a variety of sources and found significant levels of lead and nickel at concentrations that exceed safe exposure for oral, daily drug intake. Long-term use could lead to heavy metal poisoning, including nervous system or kidney damage, anemia, high blood pressure and/or increased risk of certain cancers.

Although kratom remains a legal substance, it is not legally marketed in the US as a drug or dietary supplement. The FDA warns the public not to use kratom, and the Drug Enforcement Administration (DEA) has listed kratom as a Drug and Chemical of Concern. Some of the negative side effects as reported by the DEA include nausea, itching, sweating, dry mouth, constipation, increased urination, tachycardia (increased heart rate), vomiting, drowsiness and loss of appetite. Former FDA Commissioner, Scott Gottlieb, stated, “at a time when we face an opioid epidemic of devastating proportions, manufacturers should not be allowed to mislead consumers into believing kratom products are a ‘safe’ alternative to prescription opioids.” Using products with unproven claims may prevent those addicted to opioids from seeking safer, more effective treatments, such as methadone and buprenorphine. The FDA prioritizes reducing the rate of Americans who are addicted to opioids by promoting more widespread innovation and access to opioid addiction treatments, continues to warn against the use of kratom and encourages more research to better understand kratom’s safety profile and long-term health effects.

If you are considering kratom and are experiencing any change in RLS symptoms or are thinking about pursuing any new treatment or supplement, consult with your doctor prior to initiating a change to your current treatment plan.

This article has been reviewed and approved by the RLS Foundation Scientific and Medical Advisory Board. This is offered for information purposes only and should not be considered a substitute for the advice of a healthcare provider. The RLS Foundation does not endorse or sponsor any products or services.