Restless Legs Syndrome Foundation Blog

June 29, 2021

Statement has been endorsed by more than 25 medical, scientific, patient, and safety organizations

A new position statement from the American Academy of Sleep Medicine emphasizes that sleep is a biological necessity, and insufficient sleep and untreated sleep disorders are detrimental for health, well-being, and public safety.

Published online in the Journal of Clinical Sleep Medicine, the statement notes that sleep is vital for health and well-being in children, adolescents, and adults. While awareness of the value of sleep has risen in the last decade, there is a significant need for greater emphasis on sleep health in education, clinical practice, inpatient and long-term care, public health promotion, and the workplace.

“Healthy sleep is as important as proper nutrition and regular exercise for our health and well-being, and sleep is critical for performance and safety,” said AASM President Dr. Kannan Ramar. “It is the position of the AASM that sleep is essential to health, and we are urging educators, health care professionals, government agencies, and employers to prioritize the promotion of healthy sleep.”

The statement was written by the members of the 2020 – 2021 AASM board of directors, comprising 11 sleep medicine physicians and a clinical psychologist. In recognition of sleep’s significant and multi-faceted connections to health and chronic disease, the authors outlined the following positions:

• Sleep education should have a prominent place in K-12 and college health education, medical school and graduate medical education, and educational programs for other health professionals.
• Clinicians should routinely inquire about sleep habits and symptoms of sleep and circadian rhythm sleep-wake disorders during patient encounters, and hospitals and long-term care facilities should optimize sleep conditions.
• Healthy sleep should be targeted by public health and workplace interventions to improve health-related outcomes, and behaviors that help people attain healthy sleep should be actively promoted.
• More sleep and circadian research is needed to further elucidate the importance of sleep for public health and the contributions of insufficient sleep to health disparities.

“Education about sleep and sleep disorders is lacking in medical school curricula, graduate medical education, and education programs for other health professionals,” said Ramar. “Better sleep health education will enable our health care workforce to provide more patient-centered care for people who have common sleep disorders such as obstructive sleep apnea and insomnia.”

According to the authors, chronic insufficient sleep and untreated sleep disorders are linked to increased health and safety risks such as cardiovascular disease, diabetes, obesity, workplace accidents, and motor vehicle crashes. Data from surveys conducted by the Centers for Disease Control and Prevention and the Maternal and Child Health Bureau show that 34.1% of children, 74.6% of high school students, and 32.5% of adults in the U.S. fail to get a sufficient duration of sleep on a regular basis. Therefore, helping people get enough sleep is one of the goals of Healthy People 2030, which provides 10-year, measurable public health objectives for the U.S.

The AASM position statement declaring that sleep is essential to health has been endorsed by more than 25 medical, scientific, patient, and safety organizations:

• Alliance of Sleep Apnea Partners
• American Academy of Cardiovascular Sleep Medicine
• American Academy of Dental Sleep Medicine
• American Academy of Neurology
• American Academy of Otolaryngology—Head and Neck Surgery
• American Academy of Physician Assistants
• American Association of Clinical Endocrinology
• American Association of Sleep Technologists
• American College of Preventive Medicine
• American Geriatrics Society*
• American Society for Metabolic and Bariatric Surgery
• American Society of Addiction Medicine
• American Society of Anesthesiologists*
• American Thoracic Society
• Circadian Sleep Disorders Network
• International REM Sleep Behavior Disorder Study Group
• National Safety Council
• National Sleep Foundation
• Obesity Action Coalition
• Project Sleep
• Restless Legs Syndrome Foundation
• Sleep Research Society
• Society for Research on Biological Rhythms
• Society of Anesthesia and Sleep Medicine
• Society of Behavioral Sleep Medicine
• Start School Later
• Wake Up Narcolepsy
• World Sleep Society

*The American Geriatrics Society supports the general principles in the document and believes it is of general benefit to its membership. The American Society of Anesthesiologists’ Administrative Council approved support for the position statement with qualifications; since the document has neither been presented to nor approved by either the ASA Board of Directors or House of Delegates, it is not an official or approved statement or policy of the Society. Variances from the recommendations contained in the document may be acceptable based on the judgment of the responsible anesthesiologist.

June 14, 2021

Magnesium and RLS

By Maddie Lionberger, RLS Foundation Research Coordinator

Magnesium is a naturally occurring mineral in our bodies that plays an essential role in a diverse array of biochemical processes, including protein synthesis, muscle and nerve function and blood glucose control. Deficiencies in magnesium can lead to muscle contractions, cramps and problems with conduction of electric signals along nerves. Because of magnesium’s important function in the nervous system, considerable attention has been given to using magnesium supplements to relieve the symptoms of restless legs syndrome (RLS). However, the evidence behind magnesium as an RLS treatment is largely anecdotal. To assess whether taking a magnesium supplement could benefit you, consider the normal values and functions of magnesium and the research as it pertains to RLS.

Magnesium Intake

According to the Office of Dietary Supplements of the National Institutes of Health (NIH) the adult body contains about 25 milligrams (mg) of magnesium. Total magnesium level is tightly regulated by the kidneys, which excrete about 120 mg of magnesium in the urine per day. The Food and Nutrition Board of the National Academy of Medicine recommends an average daily intake of about 240 to 420 mg for men and 240 to 320 mg for women. These recommendations vary by age and sex and are higher during pregnancy. Most people can obtain daily recommended magnesium levels through diet alone – for example, by eating dark green, leafy vegetables such as spinach and kale; nuts and seeds; fish like mackerel and tuna; beans and lentils; avocados; bananas and low-fat or nonfat dairy products. Consuming caffeine, on the other hand, can decrease magnesium levels. Magnesium is also present in dietary supplements and in some medicines, such as antacids and laxatives.

Overall magnesium status is difficult to assess, with 50% to 60% of magnesium present in the bones and the rest mostly in the blood and soft tissues. The most common method for assessing magnesium is by measuring serum magnesium concentration. Normal serum magnesium concentrations range between 0.75 and 0.95 millimoles per liter (mmol/L). Other methods for assessing magnesium status include measuring concentrations in erythrocytes (red blood cells), saliva and urine. However, no single test is considered sufficient without comprehensive laboratory tests and clinical assessment.

Magnesium Deficiency

Symptomatic magnesium deficiency due to low dietary intake is uncommon. Symptoms of deficiency are more likely to arise from excessive losses of magnesium due to certain health conditions and medications. Early signs of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue and weakness. As deficiency worsens, numbness, tingling, muscle contractions and cramps, seizures and personality changes may develop. In severe cases, magnesium deficiency can result in hypocalcemia (low blood calcium) or hypokalemia (low blood potassium). Individuals more likely to be at risk of magnesium inadequacy include those with gastrointestinal diseases such as Crohn’s disease, celiac disease and enteritis (small bowel inflammation); Type II diabetes; or alcohol dependence. Older adults in general are more at risk because they typically consume insufficient amounts of magnesium in their diets or have medical conditions requiring medications that reduce magnesium absorption in the gut.

Supplementation

In the event of a deficiency, magnesium can be taken as a supplement. There are several different doses and forms available, including magnesium oxide, citrate and chloride. Absorption depends on the type of magnesium. Although magnesium oxide is the most commonly available oral supplement, studies reported by the NIH suggest that magnesium in the aspartate, citrate, lactate and chloride forms is absorbed more completely than magnesium oxide or sulfate. Magnesium sulfate can also be administered intravenously (IV), but that method is generally reserved for more severe cases of hypomagnesemia (low levels of magnesium in the blood). The most common use of IV magnesium sulfate is for the prevention of seizures in pregnant women with preeclampsia, eclampsia or toxemia. The Food and Drug Administration recommends against prolonged use of magnesium sulfate; too much magnesium sulfate, or excessive amounts of any supplement for that matter, can be toxic. It is important to consume plenty of fluids while taking magnesium supplements. Consult your doctor before making any changes to your medication regimen.

One of the main roles of magnesium in the nervous system is to block the calcium channel in nerve cells. In other words, magnesium needs to be removed for signaling to occur. Thus, low magnesium levels or magnesium deficiency can result in an over-excited state and eventually cell death of the neuron called excitotoxicity (a pathological process by which neurons are damaged and killed by overactivation). Abnormal neurotransmission of this kind has been implicated in many neurological disorders, including migraine, chronic pain, Alzheimer’s disease and Parkinson’s disease. In a 2018 analysis, "The Role of Magnesium in Neurological Disorders," by Anna E. Kirkland et al., researchers reviewed literature on the role of magnesium in the prevention and treatment of certain neurological disorders. One study showed that high magnesium concentrations were associated with a reduced risk of Parkinson’s disease. However, research examining magnesium levels in people with Parkinson’s has yielded mixed results overall.

Effective for RLS?

With the similarities that RLS and Parkinson’s disease share in pathologies to the dopamine system, it may seem intuitive to try magnesium as a preventive measure for RLS symptoms. However, there is little to no research to support the use of magnesium for idiopathic RLS. Much of the research addressing magnesium and RLS involves symptoms during pregnancy. It is likely that taking magnesium is perceived as an effective therapy for RLS when magnesium deficiency is a contributing factor, i.e., the supplement provides relief for muscle cramps that are easily confused with RLS symptoms. An existing magnesium deficiency may also explain why some individuals report that caffeine triggers their RLS symptoms. If this is the case, it may be beneficial to test magnesium levels. Despite the lack of any scientific correlation with low magnesium levels and RLS, there are many anecdotal reports of people with RLS benefiting from taking magnesium supplements. However, since there is a very strong placebo response for any potential RLS treatment, it is difficult to determine whether these reports truly reflect a benefit for magnesium supplementation and RLS. Large double-blinded medical trials would be necessary to prove that magnesium would be helpful for RLS symptoms.

If you suspect that a magnesium deficiency may be contributing to a worsening of your RLS symptoms, discuss this with your healthcare provider and follow their recommendations and guidelines before making any changes to your medications or supplements.