Cognitive Behavioral Therapy…for RLS?

Once diagnosed with restless legs syndrome (RLS), you’ll probably be anxious to treat it. After all, sleep disorders are sleep stealers. Who wouldn’t want to reclaim their daytime energy, nighttime sleep, and overall well-being through treatment?

While RLS is chiefly treated with medication, it may still be hard to return to a normal sleeping pattern if you don’t respond right away to therapy. But what if you added cognitive behavioral therapy (CBT) to your RLS treatment regime?

RLS and insomnia: common bedfellows

It’s no surprise that insomnia may materialize for those with RLS. After all, if you desire to fall asleep, but your legs have other plans that include kicking and twitching, this may leave you bound for a sleepless night.

Insomnia is traditionally treated with drugs, but most of these are for short-term use and have concerning side effects. Also, some of these medications can become habituated to (the body develops a tolerance for them and eventually demands a higher dosage to be effective).

For these reasons, the American Academy of Sleep Medicine now designates as its new gold standard the decidedly nonpharmaceutical treatment for insomnia known as CBT for insomnia (CBT-i).1

It wouldn’t be the first time that a form of CBT was applied in a complementary fashion to a sleep disorder. Versions of CBT have already been matched with PAP therapy to treat sleep apnea as a means for boosting cognitive function.2

But what is CBT?

The American Psychological Association defines CBT as

A form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness. Numerous research studies suggest that CBT leads to significant improvement in functioning and quality of life. In many studies, CBT has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.3

With CBT, both therapist and patient collaborate to identify current problematic behaviors interfering with their health and well-being. Typically, these occur as the result of faulty or unhelpful thinking, learned patterns of negative behavior, or a lack of healthy coping mechanisms.

Then, the patient learns how to address these in a way that’s practical and relevant. Research shows proven positive results for CBT; it can bring positive, long-lasting relief without the use of medication.

How is CBT-i different?

This branch of CBT focuses entirely on the challenges of falling asleep at night, as a means for achieving good sleep without the use of drugs.

In 2008, the Chronic Insomnia Task Force of the American Academy of Sleep Medicine published an insomnia treatment standard designating CBT-i as its first line of evidence-based therapy for insomnia.

Why? CBT-i has a proven track record of long-term safety, sustainability, and effectiveness when compared to the use of sleep aids with their associated risks.

Custom approaches to CBT-i include (but are not limited to):4

  • Sleep restriction
  • Stimulus control
  • Stress management
  • Sleep hygiene
  • Maintenance of a nightly sleep diary
  • Relaxation training
  • Reframing techniques
  • Education about sleep and circadian rhythms

CBT for RLS: could it work?

As Régis Langelier, PhD points out at the Restless Legs Syndrome Foundation blog, “Poor sleep is partly learned and partly inherited.”4

In other words, you may have inherited your RLS (it does run in families, after all), but insomnia may be linked to your inability to cope well with these nightly (and sometimes even daily) episodes. Given that the prevalence of insomnia in those with RLS is much higher (48 to 60 percent) when compared to the general population (at about 33 percent), it makes sense to batch CBT approaches with medication for RLS to address both problems.4

Much of insomnia can be addressed by unlearning certain unhelpful behaviors attached to a challenging case of RLS. The coping mechanisms that can work for insomnia can also work for the anxiety and mental health challenges that problematic RLS can bring.

What does research say?

Research seems to bear this out. According to recent data published in Sleep Medicine, scientists running a small study which assigned CBT-i in four sessions found that CBT-i was “effective in RLS patients by improving sleep quality and anxiety symptoms.”5

Also, anxiety linked to RLS was significantly reduced following CBT-i treatment, while the severity of RLS did not significantly change after CBT-i treatment, both sleep quality and anxiety symptoms were improved. The study authors suggest CBT-i could serve as a strong complement to drug therapy for those with both RLS and insomnia.

What could it hurt? If anything, it could do a person with RLS a lot of good, providing relief not only for their restless legs but for anxiety, depression, and sleeplessness.

Have you tried CBT-i for your RLS symptoms? Share your story with the community below.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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