Dosage of CBD for restless leg syndrome

by Apoorva Shivankar, M.D

Restless leg syndrome - Can CBD be a cure?

Dosage of CBD for restless leg syndrome

Are you bothered by a regular creepy-crawling feel in your legs, causing a compulsion to move them all night and thus upsetting your sleep?

Frustrating, isn’t it?

But have you ever paid due attention to it?

Beware, it might be an impending case of Restless Leg Syndrome.

Yes, voluntary leg movement can be a disease too.

It’s difficult to believe but true. 

Restless leg syndrome is a disorder not known to many and even commonly missed by a doctor.

Restless Leg Syndrome (RLS) in-depth

Also known by the nameWillis-Ekbom Disease’, can be categorised under neurological disorders or movement disorders or even chronic sleep disorders. 

What defines RLS are its characteristic features:

  1. An irresistible urge to move legs especially while resting during evening or night time.
  2. Unpleasant sensations over your legs.
  3. Disturbed sleep.
  4. Temporary relief while walking or moving around.
  5. Distinct symptom-free period in the morning.

Restless Leg Syndrome is not a primary sleep disorder with discomfort as an after effect. Instead at its core lies a sensorimotor neurological disorder with secondary involvement of sleep. Thus, sleeping pills cannot be a solution for this condition.

Chronology of symptoms:

It begins with an unpleasant, somewhat annoying sensation which can be described as aching throbbing, pulling, itching, crawling, or creeping almost anything which comes up especially when you lie down for some rest.  This compels you to move your legs for temporary relief. Symptoms recur once the movement stops demanding a continuous action which disturbs sleep.   

Restless leg syndrome prefers

  • Women over men though can affect both.
  • Middle-aged or elderly people over young and kids. It may begin at any age and its symptoms keep intensifying and evolving with age.
  • The Lower part of body (legs) more than the arms, chest and head where the weird sensations are quite less.
  • Can be unilateral or bilateral or alternate between sides.

Can you imagine?

Around 7-10% of U.S population is struggling with Restless Leg Syndrome, but most of them do not even recognise it as a problem in itself. They focus on their disturbed sleep and even consume sleep medications attributing all the discomfort to lack of sleep.  But my dear friends, this attitude could be perilous. RLS needs prompt attention right from the beginning otherwise this said-to-be insignificant regular urge holds potential to land you up in a pathetic situation.

How? Here goes the cascade,

Irritating sensation or pain -->  continuous leg movement --> disturbed sleep 
--> Mental fatigue --> depression, dementia, confusion, altered cognition, loss of concentration, daytime sleepiness, decline in performance and productivity, etc 
--> Physical exhaustion --> diseases like hypertension, heart attack, stroke, diabetes, obesity and much more --> poor quality of life.

Though, RLS won’t threaten actual life, the way it declines your quality of life is really worrisome. So, it is better to start the management process with the very first hint of RLS.

For prompt Management, let’s dig out the root cause first.

Mostly multifactorial, search for the exact aetiology is still going on. Some possible causes include

Iron deficiency-

As per studies, iron deficiency (in the brain) stands out as a key player to make you kicking. So, iron supplements are the most popular treating modality for RLS. RLS can be seen in presence of normal blood but deficient brain iron levels.

Other potential causes include:

  • Lower dopamine levels
  • Folate deficiency
  • Underlying vein issues 
  • Peripheral neuropathy
  • Pregnancy
  • Medications such as antidepressants and anti-nausea medications
  • Chronic illnesses including iron deficiency anaemia, kidney diseases, fibromyalgia, Parkinson’s disease etc.
  • Genetics condition -studies show RLS can be passed down the generations via genes wherein it can express at an earlier age.

RLS types based on etiology:

  • Primary Restless Legs Syndrome (idiopathic form): No known cause or precipitating factor.
  • Secondary restless legs syndrome: secondary to above mentioned precipitating causes.

Diagnosis:

Purely on the basis of classical symptoms and history of the patient.

Ways to kick-off Resting Leg Syndrome

  • Treat the basic aetiology.
  • Medications like opiates, anticonvulsants and dopamine agonists show some relief but not in all patients.
  • Pill-free techniques like calf massage, daily exercises, warm and cold compresses, ice packs, warm baths, etc also do their share.

But still, there was no full-proof solution to RLS. Search continued and the latest addition came in the form of

  • Cannabidiol (CBD) – most promising.

Though CBD again is not a cure to the condition, it promises utmost relief from RLS symptoms.

Research and patient reviews strongly backed this claim of CBD.

So, what is this CBD?

CBD (short for cannabidiol) available in the market is an industrial cannabinoid extract of hemp variety of the cannabis plant. Hemp is nothing but a variant of the cannabis plant containing a lesser concentration of THC (<0.3%), the psychoactive component, rendering it safe and legal. A cannabis plant is known to possess more than 100 cannabinoids of which CBD and THC are predominant.

THC is responsible for the world-famous HIGH (psycho-activity) and also the reason for the illegal status of marijuana (THC > 0.3%), other variant of the cannabis plant. Apart from the cannabinoids, the cannabis plant also contains aromatic compounds called ‘terpenes’ and some flavonoids too.

Based on the content, CBD products are divided into 3 subtypes

  • CBD isolate: 99% pure CBD with no other cannabinoids.
  • Broad-spectrum CBD: Contains CBD with most other cannabinoids plus terpenes and flavonoids, but no THC.
  • Full-spectrum CBD: CBD with all other cannabinoids wherein THC concentration is < 0.3%. Terpenes and flavonoids are also present. 

Cannabidiol - a saviour for Restless Leg Syndrome patients

Cannabidiol is well known as a mood relaxant, anxiety reliever, stress buster, pain killer and even a sleep promoter. All these assets of CBD act as a boon for a RLS patient. By using CBD, they are relieved of their symptoms though temporarily and can enjoy a sound, peaceful, undisturbed sleep and fresh morning, the next day.

Moreover, as hemp-derived CBD is free from any major side effects such as psycho-activity and addiction, kudos to meagre THC content, it can easily enter your night time routine without causing any harm.

How does Cannabidiol manage all this?

CBD positively targets one of the most efficient and complicated cell-signalling receptor system of the body – The Endocannabinoid System (ECS)- which itself regulates our perception of certain physiological sensations, such as mood, cognition, stress, hunger, energy level, pain, and sleep, among many others. 

Any deviation from normal such as anxiety, pain, etc are the after-effects of endocannabinoid system deficiency. Exogenous CBD restores this deficiency either by replacing endogenous cannabinoids or by preventing their breakdown. By this, CBD relieves the symptoms and restores the balance.

By virtue of its analgesic effects, relaxant properties, CBD relaxes the restless legs, calms down the nerves and thus, eases the pain, discomfort and the subsequent movements of the legs.

Similarly, by relieving stress and anxiety, it generates a serene mental environment facilitating a nice stretched sleep.

Anti-inflammatory action of CBD products can be beneficial for varicose veins, which itself is a triggering factor for Restless Leg Syndrome.

Guidelines to use Cannabidiol for Restless Leg Syndrome

  1. Dosage of CBD for restless leg syndrome is a crucial determinant of its effectivity. 

    - Response to a particular CBD product varies as per individual experience, body weight, and desired effect. Similarly, dosage also differs.

    - As a thumb rule, it is advised to start with a minimal dosage followed by gradual increase till you get the desired effect.

    - Effects can be seen even with doses as low as 5mg or some individuals may require 30- 50 mg of CBD for a similar effect.

    - Consult a doctor to evaluate apt dosage schedule for you.

  2. CBD is available in different delivery forms with their individual advantages. Which one to choose is totally the patient’s and doctor’s look-out.

    - Using CBD oil is one of the age-old, popular, reliable and affording way.

    - Tinctures offer rapid results.

    - Topical CBD oil deliver targeted results which sounds quite reasonable in RLS management.

  3. Though all the 3 subtypes – CBD isolate, broad spectrum and full spectrum have shown a positive influence on Restless leg syndrome management, full spectrum CBD products should be preferred unless contraindicated as they show superior health effects due to ‘THE ENTOURAGE EFFECT.’

We conclude:

CBD on account of its multiple actions can soothe RLS patients, rip off their symptoms and urge, and eventually the grave after-effects too, but it certainly is not a cure for RLS.

FAQs

What aggravates restless leg syndrome?

certain medications such as

  • anti-nausea drugs (e.g. prochlorperazine or metoclopramide).
  • antipsychotic drugs (e.g., haloperidol or phenothiazine derivatives).
  • antidepressants that increase serotonin (e.g., fluoxetine or sertraline).
  • some cold and allergy medications are known to aggravate RLS.

Do vitamins help restless leg syndrome?

  • Supplementation with iron showed promising results.
  • Vitamin C and E supplements reduced RLS symptoms in patients on haemodialysis.
  • Vitamin D supplements relieved RLS symptoms in vitamin D deficient patients.

Do elevating legs help restless leg syndrome?

  • Yes, as this position soothes the nerves in the legs and prevents compression, reducing the probability of RLS.

Can drinking water help restless legs?

Dehydration can aggravate any condition and RLS is not an exception.

So,

  • Stay hydrated. 
  • Avoiding diuretics such as caffeine, night-time alcohol intake.
  • Drink liberal amounts of sparkling water, filtered water, or decaffeinated teas throughout the day.

Are there any food restrictions for restless leg syndrome patients?

Yes, refined processed foods show links with RLS development. So,

  • soda.
  • fried foods.
  • foods high in sugar.
  • fast foods

should be avoided to prevent symptom precipitation.

References:

 

  1. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet.
  2. Ghorayeb I. More evidence of cannabis efficacy in restless legs syndrome. Sleep Breath. 2020 Mar;24(1):277-279. doi: 10.1007/s11325-019-01978-1. Epub 2019 Dec 9. PMID: 31820197.
  3. Richard Allen et al. “Restless Legs syndrome? Willis-Ekbom disease diagnostic criteria: updated IRLSSG consensus criteria – history, rationale, description and significance”. Sleep Medicine, 2014
  4. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb;4(1):245-59. doi: 10.2147/tcrm.s1928. PMID: 18728714; PMCID: PMC2503660.
  5. de Mello Schier AR, de Oliveira Ribeiro NP, Coutinho DS, Machado S, Arias-Carrión O, Crippa JA, Zuardi AW, Nardi AE, Silva AC. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS Neurol Disord Drug Targets. 2014;13(6):953-60. doi: 10.2174/1871527313666140612114838. PMID: 24923339.
  6. Hampson AJ, Grimaldi M, Axelrod J, Wink D. Cannabidiol and (-)Delta9-tetrahydrocannabinol are neuroprotective antioxidants. Proc Natl Acad Sci U S A. 1998 Jul 7;95(14):8268-73. doi: 10.1073/pnas.95.14.8268. PMID: 9653176; PMCID: PMC20965.
  7. Ghorayeb I. More evidence of cannabis efficacy in restless legs syndrome. Sleep Breath. 2020 Mar;24(1):277-279. doi: 10.1007/s11325-019-01978-1. Epub 2019 Dec 9. PMID: 31820197.
  8. Richard Allen et al. “Restless Legs syndrome? Willis-Ekbom disease diagnostic criteria: updated IRLSSG consensus criteria – history, rationale, description and significance”. Sleep Medicine, 2014
  9. Russo EB. Cannabinoids in the management of difficult to treat pain. Ther Clin Risk Manag. 2008 Feb;4(1):245-59. doi: 10.2147/tcrm.s1928. PMID: 18728714; PMCID: PMC2503660.
  10. 10.de Mello Schier AR, de Oliveira Ribeiro NP, Coutinho DS, Machado S, Arias-Carrión O, Crippa JA, Zuardi AW, Nardi AE, Silva AC. Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa. CNS Neurol Disord Drug Targets. 2014;13(6):953-60. doi: 10.2174/1871527313666140612114838. PMID: 24923339.
  11. 11.Hampson AJ, Grimaldi M, Axelrod J, Wink D. Cannabidiol and (-)Delta9-tetrahydrocannabinol are neuroprotective antioxidants. Proc Natl Acad Sci U S A. 1998 Jul 7;95(14):8268-73. doi: 10.1073/pnas.95.14.8268. PMID: 9653176; PMCID: PMC20965.