Something happened to my daughter when she turned fourteen. She moaned, “Mom, I’m tired” and would escape to her room. I thought “this is normal at her age”. Her older brother used to sleep all the time at that age. 

After a few weeks of this behavior, I decided to crack the door of her bedroom open without making a sound. I was sure I would find her on her cell phone flipping through twitter or watching a movie. But no,  she lay sound asleep in the most awkward positions as if she was in the midst of a thought and passed out. I could have played the drums and she would have kept on sleeping.

For months, I attributed her increased need for sleep to puberty. She’s growing and growing fast. Right? The “tiredness” became so intense that she would make excuses to avoid her friends. That’s when I decided that this situation is no longer typical of a teenage girl.

There was another clue that something was amiss. When my daughter had her period, she always worried that her tampon might leak through. It turns out she had good reason to fret. Her menses had become so heavy that she had to change her super-sized tampon every few hours. She even had to put her alarm at night to change her tampon to avoid staining the sheets. I thought this would settle as her hormones stabilized. Nope, it didn’t.

Her gynecologist started her on the pill. I don’t like the idea of non-bioidentical hormones for anyone, let alone my daughter. There were no other options. In my mind, I convinced myself this would be a magic solution. Nope! Her menses began to last over two weeks and cycled every three weeks. Okay, tampons are expensive! She tried a stronger birth control pill. Again no change – still bleeding too much.  A third and even stronger pill made no difference.

At this point, blood tests were ordered and revealed that my daughter had Von Willebrand disease. This had never crossed my mind. What? Yes, this is not a disease, it’s a clotting factor deficiency. That means she bleeds easily. Now that I think back, I remember how she used to regularly wake up with nose bleeds in the middle of the night. I thought it was the A/C.

For over a year, I attributed her fatigue to puberty and heavy menstrual cycles typical of teenage girls. No, my daughter had Von Willebrand disease. There is no treatment. Her monthly bleeding went uncontrolled. Her hemoglobin and iron storage levels kept dropping. Her fatigue persisted. Finally, the gynecologist with the hematologist recommended a progesterone intrauterine device. It worked!

Almost two years later, blood tests demonstrated that my daughter’s hemoglobin level was normal and iron storage level climbing back up to normal range. Yay, but then my daughter started sleeping 15 hours a day and was really dragging. She fell asleep at the dining table. She complained of lightheadedness going up the stairs.

So we schlep back to the doctor’s office. A new series of test show that my daughter has mono. What? She was home for the entire Covid pandemic. She didn’t even go back to in-person classes when school opened up again. There is no treatment for mono, Epstein-Barr virus, except to let her sleep and rest.

I share my story because on so many levels, even as a doctor, I missed the mark. So many factors may contribute to fatigue in teenagers. This isn’t always a medical mystery that’s easy to solve.

Do teens love their sleep? Sure. But pay attention to your constantly fatigued and tired teen to make sure you’re not missing the signs of a deeper health issue.

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Tapping is a self care technique that draws from acupressure and TCM energy medicine to help release stress, pain and anxious thoughts keeping you up at night. The practice is easy: using your fingertips, you simply tap certain energy points on the body as you mindfully release tension.

Want to give tapping a try? Here’s how to do it… 

1. Identify your problem and create a positive affirmation phrase to address it. For example: Even though I feel stressed, I completely accept myself. 

2. Using either your index finger or the fingertips of your right hand, tap the outer “karate chop” part of your left hand (see photo above). Tap long enough to recite your problem and affirmation phrase three times. Repeat using the left fingertips to tap the outer right hand. 

3. Tap other energy points in the following sequence: 
– Eyebrows (Close to the nose where the eyebrow starts.)
– Side of eyes (On the bone bordering the outside corner of the eye.)
– Under eye area (On the bone about 1 inch below your pupil.)
– Under nose 
– Chin (Midway between your bottom lip and bottom of your chin.)
– Collarbone
– Underarm 
– Top of head 

Tap each point seven times. As you move on a new point, recite a reminder phrase to maintain focus on your problem area. For example, say: The stress I feel from work.

After repeating the tapping sequence two or three times, check in with how you feel and rate your intensity level from 0-10. Keep tapping until your intensity level is 0.  

We wouldn’t be telling you about tapping unless we had compelling research to back up its effectiveness, so consider these recent studies… In one, 86% of veterans with PTSD no longer met the criteria for the disorder after only six sessions of tapping; in another, levels of anxiety, depression and cortisol dropped significantly in study participants who tapped!

Get the rest you need with a doctor’s 4 favorite sleep secrets

The post “Tap” your way to less stress and better sleep appeared first on Women's Health Network.

We all know by now how important sleep is in our day-to-day lives. It’s essential to staying mentally sharp and energetic during the day, and getting good, regular, restful sleep also reduces the risk of many serious health issues, from weight gain to diabetes. Sleep even slows biological aging!

But what may be a surprise is just how closely intertwined women’s sleep patterns are with their hormones — one reason why sleep disturbances are so common during and after menopause.

How hormones help with sleep

Many people have heard about melatonin, the “sleep hormone” produced in the pituitary gland in the brain that is crucial to helping us fall asleep. But sleep is a lot more complicated a process than the “add melatonin and stir” perspective allows for. The truth is, falling asleep is just the beginning, and it takes multiple hormones — including estrogen, progesterone, and cortisol — participating in the sleep cycle to keep us asleep.

These hormones do this by helping to bring us in and out of the different sleep stages and promoting wakefulness when morning comes.

Progesterone has a fairly straightforward effect — it’s essentially a sedative. It naturally stimulates receptors in the brain in a manner that’s very similar to the the anti-anxiety medications called benzodiazepines. But it also stimulates breathing and has been used to reduce sleep apnea — short interruptions of breathing that cause the body to awaken from sleep. Sleep apnea is a common contributor to poor sleep in women during and after menopause, and it’s partly due to imbalanced progesterone levels.

Estrogen has a more complicated role — or maybe I should say “roles” — to play. First, it supports slow-wave sleep (SWS), which is what most people call “deep” sleep, and it prolongs rapid-eye-movement (REM) sleep, the stage of sleep in which we dream. REM sleep tends to come right after SWS, and it’s an important transition in our sleep cycle because if you waken after SWS without having gone through REM, you’ll feel groggy and sluggish. In effect, estrogen, by smoothing the way from deep sleep into dreaming, reduces the neurological sludge that slows down the brain in the morning.

But that’s not all it does. It’s a key metabolizer of several important neurotransmitters: serotonin, acetylcholine, and norepinephrine, all of which are involved in different stages of sleep. Acetylcholine is highly active in REM sleep (whereas serotonin and norepinephrine are all but absent) and both serotonin and norepinephrine play key roles in non-REM sleep and circadian rhythms. Estrogen is therefore essential to maintaining the levels of key brain chemicals that regulate different phases of the sleep cycle.

And it does something else: It acts as a booster to two hormones that are vital to both falling asleep and waking up: melatonin and cortisol. In the case of melatonin, it seems to exert a supportive effect that wanes as estrogen levels drop (the relationship isn’t clear, but the fact that women with reduced estrogen have lower melatonin is well-established). It also regulates the normal rise in cortisol that signals the body that it’s time to wake up.

Estrogen has another role that’s not directly implicated in the sleep cycle, but that contributes to restless nights: it’s involved in temperature regulation. If that makes you think “Oh, you mean… hot flashes!” you’re 100% right. As estrogen declines, women experience sudden shifts in body temperature that have nothing to do with how hot or cold the room they’re in might be — and some of these can be intense enough to wake you up out of even a sound sleep (which, if our hormones are shifting, we may not be having anyway).

When you understand how the key sex hormones are also key sleep hormones, it starts to make sense that menopause — the time when women’s bodies start to gradually reduce production of those two hormones — is often accompanied by insomnia and frequent waking.

It matters how fast menopause happens

So what happens when the production of estrogen and progesterone don’t so much “taper off” as “crash” — like when you go through menopause surgically? As you might expect, it means a hard landing — not only do women who have surgical menopause have less satisfying sleep quality, it’s also shorter in duration. In one study, women who underwent surgical menopause were more than twice as likely to have insomnia as women who went through natural menopause. Another study that used data from over 100,000 participants in the Nurses’ Health Studies (I and II) noted that women undergoing surgical menopause are much more likely to develop obstructive sleep apnea.

In general, even if you don’t go through menopause via surgery, having a more rapid transition with greater levels of symptoms like hot flashes and mood changes predicts more frequent sleep disturbances.

It’s no accident that menopause, sleep deprivation, and depression go hand-in-hand — or that all three are much more difficult for women who undergo surgical menopause. Whether the drop in hormones leads to sleep loss, which leads to mood swings, or the hormonal drop leads to mood swings and that, in turn, impacts sleep is an eternal question — but nobody argues that they’re not intertwined. And it makes sense, doesn’t it, given the intertwining of hormones and neurotransmitters that are involved in mood, hot flashes, and sleep.

Why your doctor’s sleeping pill prescription is all wrong

If you’ve shared your sleep issues with your conventional doctor only to walk out of the office with a prescription for a sleep drug like Ambien, I want you to know that taking a prescription sleep drug — at best — is only a band aid. At worst, sleep drugs can be habit forming and carry dangerous short and long term side effects, such as memory issues, depression, sleep walking, sleep hallucinations, and next day grogginess.
The key to getting better sleep in menopause is to listen to your body — and your hormones. As menopause unfolds, you want to really take care that you are doing everything you can to keep your hormones — estrogen, progesterone, cortisol — in balance.
You can take so many steps right now to support your hormones and your sleep:

Don’t wait. If you’re just starting your transition into menopause (or you know that surgical menopause is in your future), don’t wait — take steps now to determine where you might need some support for your hormone balance. You can start by taking our free Menopause Quiz to learn more about hormonal imbalances you may have and how to take steps to correct them.

For most women, natural herbal remedies are an effective way to rebalance hormones. Some women with mild imbalances of progesterone also do well using a bioidentical progesterone. Typically for sleep, oral micronized bioidentical progesterone is preferred for sleep issues because it crosses the blood-brain barrier.

For women recovering from surgical menopause, biodentical hormones can ease your transition. You will want to work with a doctor who is skilled in prescribing biodenticals to get the best match. Please note: biodentical hormones and synthetic hormone replacement therapy are two completely different things. As I tell my own patients, synthetic HRT is toxic to women’s health.

It also helps to support your liver in its job of metabolizing hormones. One easy method: begin each day with a warm glass of lemon water, which offers hydration and a vitamin C boost. And it probably goes without saying that making sure you are eating a wholesome diet, drinking enough water, avoiding caffeine in the afternoon and evening, and generally practicing good sleep hygiene are good ideas.

Guard against hot flashes. Knowing estrogen’s role in temperature regulation, you can take steps to head off hot flashes before they start by avoiding foods that are known triggers, such as spicy foods or wine — and stay away from tobacco and alcohol in general, but especially right before bed. Also, wear loose and breathable PJs; cotton knits (think t-shirt cloth) are usually a good choice, but avoid synthetic blends or heavy, woven fabrics like flannel that hold in heat. If you have a separate thermostat in your bedroom, set it a little cooler and make sure the room is well-ventilated. The National Sleep Foundation suggests keeping a small bucket or bowl of ice and a washcloth next to your bed for a quick cool-down if hot flashes wake you.

Pay attention to your stress levels. I’ve been focusing on sex hormones here, but lurking on the sidelines is cortisol, the key stress hormone in our fight-or-flight response. Cortisol’s circadian rhythm is regulated in part by estrogen, so it makes sense that when there’s less estrogen, there may be some disturbances in how cortisol rises and falls during the day — which can add to sleeplessness, especially if (as many of us are) you’re already producing excess cortisol due to stress. Finding ways to manage stress in menopause is another key to good sleep!

One helpful stress-relief method is gentle exercise — yoga, tai chi, or even just a routine of stretching — an hour or more before bed. Personally, I find the yoga pose “legs up the wall” can be helpful. Try holding the pose for 10-15 minutes. You don’t want to do hard exercise as that will boost cortisol just when you’re trying to quiet it, and you don’t want to do even light exercise too close to bedtime that you can’t cool down.

Listen to your body and give it the self care it needs to feel soothed and rested at the end of the day. I have some other sleep secrets that I want to share with you, so check them out!

A good night’s sleep can make all the difference, and is completely within your reach.

References

Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018; 10: 73–95.
Cho NY, Kim S, Nowakowski S, Shin C, Suh S. Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause. Menopause. 2019 Apr;26(4):357-364. doi: 10.1097/GME.000000000000125

Eichling PS; Sahni J. Menopause related sleep disorders. J Clin Sleep Med 2005;1(3):291-300.
Guida M, Rega A, Vivone I, et al. Variations in sleep associated with different types of hormonal contraceptives. Gynecol Endocrinol. 2019 Jul 17:1-5. doi: 10.1080/09513590.2019.1640204. [Epub ahead of print]

Huang T, Lin BM, Redline S, Curhan GC, Hu FB, Tworoger SS. Type of Menopause, Age at Menopause, and Risk of Developing Obstructive Sleep Apnea in Postmenopausal Women. Am J Epidemiol. 2018 Jul 1;187(7):1370-1379. doi: 10.1093/aje/kwy011

McGinty DT. Serotonin and Sleep: Molecular, Functional, and Clinical Aspects [book review].
Sleep. 2009 May 1; 32(5): 699–700.

The post How you go through menopause affects your sleep appeared first on Women's Health Network.

Our experts

Kate: We are going to be talking today about the importance of sleep and what might help you get a better night’s sleep. I’m joined today by three of our experts. I have Dr. Mary James. She’s a naturopathic physician joining us from North Carolina. We’re also joined by Dr. Julie Schwartzbard, MD. She’s a neurologist and she’s joining us from Florida. Also today we are joined by Dr. Amber Hayden. She’s a DO and she’s joining us from North Carolina.

Why is sleep so important for our physical and mental health?

Kate: Why don’t we jump right into the topic of sleep? Mary, do you want to get it started by telling us why sleep is so important for our physical and mental health?

Dr. James: It’s a great question because I think the value of sleep is really underestimated by so many people in this productivity-driven society.

I think some of the most noticeable benefits are on the brain:

• Actually helping with cognitive function test performance. Students get better grades the next day after getting a good night’s sleep.
• Creativity.
• Emotional intelligence, which may relate to why so many people who have less than say six hours a night of sleep have a high risk of depression. So it makes us better people. It puts us in better moods.

One thing I found really fascinating was a study – an animal study but it might be extrapolated to us – where they found that the brain actually detoxes and cleanses itself of toxins during sleep. The brain is the only organ that’s not part of our lymphatic system so it can’t take advantage of that kind of drainage of toxins. It’s only during sleep that the cell volume changes to allow the cerebrospinal fluid to seep in, gather up the toxins and move them out into the bloodstream.

There are also systemic effects from sleep. Sleep deprivation can increase the risk of immune problems, cardiovascular problems, clotting, inflammation and diabetes. Interestingly, women seem to be much more prone to those problems than men. Not clear why.

How much sleep should you be getting?

Kate: How much sleep should we actually be getting? I know you threw six hours out there, Mary.

Dr. James: Well, that was not a recommended number. That was talking about a study – actually more than one study – where they found that less than six hours a night increased the risk of depression significantly. The average recommended amount is about 7-9 hours but it really should be individualized.

Dr. Hayden: Every adult is different and it really depends on two factors:

• One is the amount of sleep that you optimally can perform at. For some people that is 6-7 hours or for others it might be 8-9.
• But then there’s also the factor of sleep debt where you’re having a couple nights a week where you’re getting less sleep than is optimal for your body’s performance. That can actually accumulate onto your requirements for sleep and really change that number.

On average an adult typically needs 7-8 hours of sleep. But again, for example, I’m on night float right now so I’m getting about 5-6 hours of sleep. And next week I’m probably going to need more like 9-10 hours to get myself back to my baseline.

It really is a debt that you are accumulating. Like Mary said, it can really have negative effects on your health. You can pay it off to an extent. But if you’re chronically getting less sleep than you need, it’s really hard to catch back up. For short periods of time you can really make up that sleep debt, but if you’re doing it over a long period of time it’s much harder.

Dr. James: I just had one thing related to that. It’s been said that not sleeping well for six nights in a row is the equivalent of pulling an all-nighter. So you have to make up that sleep. You can’t not sleep well during the night and then sleep a solid eight hours on the weekend and think that that you’ve had enough. It’s a false sense of recovery and it catches up with you. You begin to show performance deficits as a result.

Dr. Schwartzbard: That’s true. It’s not only the amount of sleep but the way that you’re sleeping. We really want to try to have a regular routine. Trying to fall asleep at the same time and wake up at the same time is really equally as important.

You were talking about night float a few minutes ago, so I was reminded of a study that I was reading in preparation for today looking at medical residents and doctors in training. The study showed that medical residents who were sleep-deprived made about 35 percent more medical errors than those residents who had had a good night’s sleep. And many other studies have shown the incapacity that can develop from lack of sleep.

There was another really interesting study that compared sleep-deprived people to people who have had alcohol. If you are particularly sleep-deprived, your accuracy is going to be slower. Your reaction time is going to be slower and you’re as if you are inebriated.

Are your electronics affecting your sleep?

Kate: One of the reasons I think that some people are missing out on sleep is by tuning in to electronics at night when we should be going to sleep. Or if we wake up in the middle of the night and just roll over and check Facebook.

How does the use of electronics really impact our ability to get a restful sleep? Is that a problem?

Dr. Schwartzbard: It’s a huge problem because anything that’s stimulating is going to make it difficult for someone to fall asleep.

Electronics are terrible in the bedroom. Really the bedroom should be mostly for sleep. If you can’t sleep, the best recommendations are you actually remove yourself from the bedroom if you’re going to perform a quiet activity. But not to do so within the bedroom.

There are even studies that have shown that if you wake up in the night and look at the clock just to check the time that can be stimulating and then get your mind thinking. Facebook and Instagram and Twitter and you know. We could go on and on with the social media. All of those are stimulating activities and they’re going to thwart a person’s ability to get a good night sleep.

Yikes! 95 percent of us check electronic devices within an hour before bed

Dr. James: One survey suggested that 95 percent of us check our electronic devices within the hour before bedtime and it’s probably only growing. It’s way out of control. It’s thought to be the blue light from electronic devices with a 40 Lux short-wavelength radiation that is interfering with melatonin and our ability to sleep.

The interactive devices are a whole lot worse than the passive devices. So if you’re playing video games, you’re texting, you’re working on the internet on your phone, as opposed to watching a movie or reading a book on your device, something passive. The interactive devices are much more disruptive.

But all of them tend to omit this blue light. There are amber-tinted glasses you can wear that shut out the blue light. There are actually apps you can put on your devices if you’re determined to take that thing into bed or during the hour before you go to sleep [to reduce blue light]. There are apps that you can put in your computer and other devices that pay attention to your location and are able to adjust the light on your device so that it’s a softer light when the sun sets and a bright light during the day.

There’s even a company that sells different light fixtures for different parts of your house, like hallway lights or the bathroom lights, or places where you think you’re going to be late at night before bed that also shut out the bright light or the blue light. There are ways around it. But like Julie was saying, really the best thing is to not take your device into the bed with you. Get your work done beforehand and do something passive.

You know even if you read a book in bed at night – which is going to disrupt your sleep a whole lot less than electronic device – try one of those book lights that clips on to the book and comes with the type of light that shuts out other lights. That’s a way to kind of drift into sleep in a nice quiet way without the light interfering with your melatonin production.

What are some tips for better sleep?

Kate: I know Julie had mentioned going to bed at a regular time. And we’ve talked about the electronics. But what are some other things that women can be doing to help have a more restorative sleep?

Dr. Hayden: There’s a couple of ways that you can approach it. When I have a patient that comes in and tells me that she’s having a difficult time sleeping, I first ask the question “are you having trouble falling asleep or staying asleep?” Because that can mean a lot. That’s the pinpoint of where your first aspect of this issue is coming from.

And then we look at lifestyle. There’s caffeine and not only caffeine, but when are you drinking your caffeine. Because everybody has that lull at 3 p.m. And if you have that cup of coffee, it can keep you stimulated until well after you’re supposed to start winding down and go to sleep.

Another aspect is simply how are you taking care of yourself? Are you eating a lot of carbohydrates and sugars that tend to peak you and then go down? Or are you getting into eating good, balanced protein?

Then there’s exercise. Not only if you’re exercising every day but when you’re exercising. We’re busy people and getting exercise in everyday is really important. But the timing can really affect your ability to lie down and fall asleep. More and more people are going to the gym at 8-9-10 o’clock at night. While that’s great for your body, you’re waking yourself up, you’re getting your endorphins going and you simply can’t wind down after exercise.

The final thing is your environment. When you go to sleep, your bedroom should really be reserved for the two purposes of sleep and sex – and maybe reading if you’re able to do it the way Mary had described earlier. But you really don’t want a TV in there. You want it dark. You want a good temperature and comfortable sleep environment. If you’re someone who tends to check their phone at night, that’s going to keep you from falling asleep as well.

How stress keeps us awake at night

Dr. James: Stress comes to mind as being such a huge factor for people. I think that relaxation and good sleep at night go hand-in-hand. We can’t be wound up all day and then expect to just drift right off into sleep as soon as we get into bed. We just can’t shut it off because we haven’t primed our systems to be relaxed during the day so that we’re kind of already in that mode when we get into bed.

One thing a lot of people don’t realize is that cortisol, the stress hormone, is inversely related to melatonin. Melatonin needs to be high at night to help you sleep. Cortisol ideally needs to be at its lowest. And then the opposite in the morning. If those are switched, then the melatonin high in the morning makes us groggy and we can’t really get out of bed or bounce out of bed and start our day. If cortisol is high at night, we can’t really relax. So priming the nervous system to be relaxed during the day is a really important prelude to getting a good night’s sleep.

Also breathing. I think of diaphragmatic breathing. So instead of breathing with the chest going up and down, take that breath down into the abdomen. Make a point of breathing that way as much during the day as we can think; that makes it a lot more likely that we’ll also breathe that way at nighttime. And not get into hyperventilation and sleep apnea and in a light sleep that isn’t really refreshing.

Dr. Schwartzbard: We have patients who come in and they’re doing everything right. They’re getting the right amount of sleep. They’re following all the recommendations you’ve just heard and they’re still waking up feeling sleepy. They’re having daytime sleepiness and that’s really the time that you need to speak with your doctor because that really could be indicative of a problem with the quality of your sleep.

That needs to be investigated with testing and often there’s a simple diagnosis with simple treatments that come from that. But after a good night’s sleep you should wake up feeling well rested. And if you don’t then that’s really a sign to talk to your doctor.

Find out if your sleep issues could be a sign of an adrenal imbalance with our quick quiz.

The post What’s keeping you from your best sleep? appeared first on Women's Health Network.

Research shows that practicing yoga can help insomnia. A small Harvard study showed that just 30-45 minutes of yoga helped people fall asleep 30% faster and reduced their nighttime waking by 35%.

Kundalini is an ancient form of yoga founded on the concept that there is “coiled energy” in the spine which connects to the “subtle body’s” energy centers and channels (chakras and nadis). The scientific community is studying Kundalini techniques, such as alternate nostril breathing, that are currently being practiced to help people manage anxiety, insomnia, and other sleep disorders.

Alternate nostril breathing. People under stress tend to breathe mostly out of their right nostrils, which is connected to the left brain. This activates the sympathetic nervous system, the channel responsible for the classic stress response: dilated pupils, increased core temperature, sweating, and increased heart rate and blood pressure. Check throughout the day to see what’s true for you — are you left- or right-nostril dominant, or is your breath alternating and balanced?

When you want to calm yourself to get to sleep, either before you go to bed, or when you wake up in the night, try gently holding the right nostril closed with your finger, and breathe deeply and slowly through your left nostril for at least 3 minutes. Then release your fingers and breathe normally.

This type of breathing is easy to do, but it may take some practice before you are able to do it for several minutes at a time. (If you have nasal congestion, try again later.) This technique can be very effective and calming.

Meditation. While some forms of meditation can increase alertness, many techniques are calming and relaxing. Try this method used to prepare for meditation: Focus on your breathing. Don’t try to change it — at all — but rather just notice the inhalation and the exhalation, returning to your breath whenever you realize you have become distracted by other thoughts. Over the course of a few minutes, this technique can help clear away worries before bedtime. You can also use it if you wake up and need help getting back to sleep. Though this is a simple exercise, like most breathing methods, it takes a little practice before it feels natural. But you can be rewarded with a sense of calm well-being that can carry you gently into sleep.

The post Yoga techniques for insomnia appeared first on Women's Health Network.

There’s a lot of concerning news out there about tick-borne diseases like Lyme disease that cause fatigue, muscle pain and fever. If they aren’t treated promptly, they can sometimes cause serious, chronic health issues. So if you are suffering from fatigue and you don’t know why, it’s worth considering whether the culprit could be Lyme disease.

What causes Lyme disease?

Black-legged ticks, also known as “deer ticks,” are the prime culprits of carrying Lyme disease, and the infection is most common in the northeastern and north central U.S.

The bacterium that causes Lyme disease, Borrelia burgdorferi, is so widespread in parts of the country that healthcare providers will now test for it — and the other, lesser-known tick-borne diseases, some of which have similar symptoms — in patients complaining of fatigue with no other obvious causes.

How do you know if you have Lyme disease?

The first thing many practitioners recommend — a blood test for Lyme disease — is controversial. That’s because blood tests for Lyme disease don’t actually look for the bacteria that causes Lyme disease, Borrelia burgdorferi. Instead, they look for antibodies to the bacteria. There are problems with this:

• If you’re tested right away, you may not yet have developed enough antibodies for the test to detect.
• Many people who had a Lyme infection in the past carry antibodies for years afterward. Yet they have no active infection.

You need to be cautious because there are a lot of false negatives that happen through this standard testing. If you’re told that you don’t have Lyme disease but intuitively you feel that it’s an issue for you and you’re having symptoms that are unexplained — maybe you’re having neurological issues or memory issues, or you’re having lots of unexplained joint pain and fatigue — you really need to seek a naturopathic physician who works with a lab that provides more specific testing that looks at the cofactors and other ways of evaluating if Lyme actually is an issue for you. 

Diagnosis with a tick bite and Lyme disease symptoms

Some practitioners, knowing that testing isn’t accurate, will diagnose Lyme disease if you have a tick bite and symptoms consistent with Lyme disease. Unfortunately, there are problems with this approach as well:

• The classic “bulls-eye rash” that most people associate with Lyme disease only occurs in 1 in 5 people. And 30% have no rash at all.
• The initial infection may not produce serious (or any) symptoms early on. But a wide range of often debilitating symptoms may develop weeks, months or even years after the tick bite.
• Even when systemic symptoms develop quickly, often they’re so vague and nonspecific that they may get blamed on something else. Especially if no rash appeared after the initial bite.
• The ticks that carry Lyme disease also carry other bacteria that cause diseases with similar symptoms. Some people get multiple infections from the same tick bite.

As you can see, diagnosing Lyme can be very difficult. It definitely pays to be aware of all the questions and issues so you can get the best care possible.

How is Lyme disease treated?

If you’ve had a tick bite and have obvious symptoms, like a rash, you’ll likely be given antibiotics (usually amoxicillin) for up to 21 days. But there are important things to consider when it comes to antibiotic treatment:

• A number of studies show that antibiotic therapy successfully treats localized (early) Lyme if initiated within 2 to 3 weeks after the initial infection. But for those with disseminated (late) Lyme disease, who don’t develop symptoms for weeks to months later — including the 30% who don’t have a rash — antibiotics often don’t work as well.
• Three weeks of antibiotics has a very serious impact on the body, particularly the gut flora. And there’s no guarantee it will cure the infection. Studies have shown that anywhere from 16% to 48% — almost half! — of patients experience continued or recurrent Lyme symptoms after finishing their treatment.
• There’s also the problem of coinfections. For example, black-legged ticks also carry other infectious bacteria, some of which don’t respond as well to amoxicillin. So even if the Lyme is cured, the patient might still have symptoms related to anaplasmosis or babesiosis nonetheless. And think she still has Lyme!

And then there’s chronic Lyme disease…

Chronic Lyme: the disease that “doesn’t exist”

Until recently, the Centers for Disease Control and Prevention (CDC) flatly dismissed the idea of “chronic Lyme disease.” Despite many patients reporting debilitating long-term symptoms after being treated for Lyme disease.

Fortunately, recent studies have verified the existence of post-treatment Lyme disease syndrome. In fact, the CDC now includes information about it on their website.

But many practitioners haven’t gotten the word that there really is a chronic condition related to Lyme infection. Patients with ongoing symptoms of fatigue, joint pain or fuzzy thinking may find themselves facing a skeptical healthcare provider who doesn’t recognize the symptoms’ relationship to Lyme disease.

We still don’t know a lot about Lyme disease or why post-treatment Lyme syndrome occurs. And there is no consensus at all about how to treat it. Retreatment with IV antibiotics isn’t particularly effective and may be harmful.

This leaves many people with chronic symptoms related to Lyme disease in a difficult place. There’s no question that they’re suffering from debilitating symptoms. And they deserve a practitioner who takes their concerns seriously. So do you! If your doctor isn’t open to your questions, I encourage you to find someone who is.

References:

Aucott JN. Posttreatment Lyme disease syndrome. Infect Dis Clin North Am. 2015 Jun;29(2):309-23. doi: 10.1016/j.idc.2015.02.012.

Centers for Disease Control and Prevention. Post-Treatment Lyme Disease Syndrome. Available at https://www.cdc.gov/lyme/postlds/index.html (posted December 1, 2017; accessed July 31, 2018).

Halperin JJ. Chronic Lyme disease: misconceptions and challenges for patient management. Infect Drug Resist. 2015;8:119-128. doi: 10.2147/IDR.S66739.

Maloney, E. L. Controversies in persistent (chronic) Lyme disease. J Infusion Nurs. 2016;39(6): 369–375. DOI: 10.1097/NAN.0000000000000195

Middelveen MJ, Sapi E, Burke J, Filush KR, Franco A, Fesler MC, Stricker RB. Persistent Borrelia Infection in Patients with Ongoing Symptoms of Lyme Disease. Healthcare (Basel). 2018 Apr 14;6(2). pii: E33. doi: 10.3390/healthcare6020033.

National Institute of Allergy and Infectious Diseases. Chronic Lyme Disease. Available at https://www.niaid.nih.gov/diseases-conditions/chronic-lyme-disease (posted September 3, 2015; accessed July 31, 2018).

Partnership for Tick-Borne Diseases Education. Tick-borne diseases overview. Available at https://www.partnershipfortick-bornediseaseseducation.org/tick-borne-diseases-overview/ (accessed July 31, 2018).

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Sleep is integral to our health, both physically and psychologically. While we sleep our bodies repair muscle and tissues, consolidate memory, release hormones for growth and appetite, and much more. In fact, sleep is as important as food and water.

Without regular sleep, the aging process is accelerated, our brains aren’t as sharp, we’re more likely to gain weight and our overall wellness can plunge. We all know how devastating it is to be awake night after night while the rest of the world slumbers. Insomnia is defined as difficulty falling asleep or staying asleep and, unfortunately, the more you don’t sleep the more anxiety you have about it.

What is at the root of your insomnia? Finding this information is an important step because it will determine what the best solution is.

Here are the top five causes of insomnia:

1. Stress and anxiety. Stress and the hormones it releases, cortisol and adrenaline, are major causes of insomnia. Cortisol naturally rises and falls in concert with the circadian rhythm, but a bad day at work, a difficult relationship, or even staring at an electronic screen for hours can cause unhealthy spikes in this “alert” hormone. Long-term stress is especially detrimental for sleep because cortisol rhythm is thrown off, keeping you up at night and leaving you exhausted when it’s time to get up in the morning.

2. Medications or medical conditions. Certain conditions are linked with insomnia and waking in the night, such as indigestion, arthritis, cancer, hyperthyroidism, lung disease and post-traumatic stress disorder. Any condition that causes pain, difficulty breathing or frequent urination can keep you up at night. Some medications can also prohibit sleep, including various antidepressants, allergy treatments, corticosteroids and blood pressure medications. Many over-the-counter pain medications, decongestants and weight-loss pills contain caffeine or other stimulants, which can also block sleep.

3. Food and drink. We all know caffeine keeps us awake (which means chocolate, coffee, cola and certain teas should not be consumed before bed), but alcohol can also disrupt sleep. While drinking alcohol can increase the length of the initial phase of sleep, known as slow-wave sleep, which promotes healing and regeneration, it disrupts REM sleep, so you wake up around 2:00 am or 3:00 am. This early morning sleeplessness is not only frustrating, but prevents important REM activity, such as dreams, memory storage and learning. Eating poorly and yo-yo dieting are also sleep saboteurs, primarily because diets like this often leave out certain key vitamins and minerals that help with sleep. Those who don’t get enough Vitamin C, calcium, magnesium, or B-vitamins may also have trouble with insomnia.

4. Hormonal imbalance. Women are often more vulnerable to insomnia than men due to hormonal shifts during pregnancy, PMS, perimenopause and menopause. Hormonal fluctuation can disturb sleep on its own, but add in hot flashes and night sweats and you can forget about getting a good night’s sleep. Some experts believe that shifting estrogen levels can affect how much melatonin (the sleep hormone) our bodies make and how we respond to it.

5. Bad sleep hygiene. The brain releases sleep hormones like melatonin when we are exposed to darkness, when we are in a comfortable space at the right temperature and when we’re feeling calm. Yet many of our pre-bedtime routines involve bright lights, loud noises, exposure to electronics, rushing to finish chores and staying up past the point of feeling tired. These factors all disturb your body’s ability to prepare for sleep by increasing “alert” hormones like cortisol. Often bedrooms are used as offices or they’re cluttered and noisy, making it even harder for the brain to release its calming sleep hormones. Poor sleep hygiene is a common factor when it comes to insomnia, but it is also the easiest one to fix. For more information, see our article How to sleep through the night.

Insomnia can affect your daily life, your health and how quickly you age. If you are struggling with sleep, our guided at-home approach will help you restore your natural sleep rhythms — for good. With a soothing, easy-to-take herbal product that aids in reducing cortisol, a melatonin supplement, an eGuide packed with helpful sleep tips and phone access to our Advisors, this approach helps you resolve insomnia so you can rest easily every night. Imagine how wonderful it will feel to wake up refreshed and rejuvenated!

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Feeling tired all the time seems to be a given these days. In fact, studies show that nearly 40% of the U.S. workforce struggles with fatigue – affecting productivity at work, time with family, the ability to practice self-care and much more. From what women tell us, we think the real figure is actually much higher, making fatigue a modern day epidemic.

And it’s not just our crazy schedules that are draining us. Fast food, over-use of electronics, sleep deprivation, yo-yo dieting, and other physical and psychological stressors also burden our bodies, making us feel completely exhausted.

These aspects of modern living can, and do, lead to physiologic changes that set us up for a state known as adrenal imbalance. Your adrenal glands perform many important jobs — they manage your stress response, help balance blood sugar, support your sleep-wake cycle and a whole lot more. With adrenal imbalance, your fatigue is likely to get worse — unless you do something about it.

The root source of fatigue: adrenal imbalance

The adrenal glands and the stress hormone cortisol are intimately connected to circadian rhythm — the natural clock our bodies follow that sets the patterns for being asleep and being awake. Cortisol naturally rises in the morning, reaching a peak about 8:00 am — 9:00 am and then gradually declines throughout the day to prepare your body for sleep. Yet adrenal fatigue can turn this rhythm on its head, making it impossible for you to get out of bed in the morning and keeping you wide awake when it’s time to sleep at night.

The fatigue cycle is intensified by consumption of caffeine and sugar, which quickly bring energy levels up but then lets them plunge quickly. Caffeine causes your adrenals to pump out more cortisol and adrenaline, keeping you sharp and awake for a while. But this takes your body out of its natural rhythm and further depletes your adrenal reserves. Sugar raises your blood sugar and insulin, setting you up for an energy crash and subsequent sugar cravings.

Keep in mind there may be other causes contributing to your fatigue, including chronic inflammation, food allergies and chemical sensitivities, and infectious diseases such as Lyme disease, among other factors. And fatigue can also result from the combination of several of these factors. If you aren’t sure what’s behind your fatigue, it’s a good idea to talk over your symptoms with your doctor.

The effects of fatigue on your health

Unfortunately, women often ignore their increasing fatigue until it leads to other disruptive symptoms. By that time, the side effects of fatigue may become nearly constant. They include:

• feeling drained mentally and physically
• inability to bounce back after being sick
• headaches
• joint pain
• depression
• poor short-term memory, confusion, irritability
• food cravings, particularly for sweets/carbs
• weight gain
• a “second wind” after 6:00 pm that interferes with your ability to sleep

The long-term effects of adrenal-related fatigue can include disruptions in sex-hormone balance (making PMS and menopause symptoms even worse) and thyroid-hormone balance (often leading to hypothyroidism or low thyroid). Constant fatigue can also accelerate aging, disrupt blood sugar regulation, contribute to chronic disease and hinder your ability to combat illnesses.

You can get your energy back!

For many conventional doctors the symptom of “fatigue” is too vague to treat. In fact, many of us are told fatigue is just a normal part of aging, so we rely on sugar and caffeine to keep going. But these “crutches” can only work for so long because they worsen adrenal imbalance — and exhaustion. The key to solving ongoing fatigue is to rebalance your adrenal glands.

We can help you do this naturally with minimal impact on your body. Whether your fatigue is mild, moderate or severe, our Adrenal Health Programs can be customized to your symptoms.

Having more energy and effectively supporting your adrenal glands takes a whole-body approach and we’ve helped thousands of women feel better. We can help you too.

For more information on our approach to fatigue, see our article on the Natural cure for your exhaustion.

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It’s time you gave sleep the priority it deserves and you can start tonight. As a busy naturopathic physician, I know that American women are chronically sleep-deprived. In order to have true health — emotionally and physically — we must become highly skilled as sleepers. Science shows that losing just two hours of nighttime sleep decreases attention span and motivation, and increases the risk of obesity. I’ve helped many women reset their ability to sleep and the first step is figuring out the source of their insomnia.

Some have nighttime pain — heartburn and digestive issues, migraine or tension headaches, joint aches and more — that interrupts their sleep, leaving them groggy and unfocused the next day. The National Sleep Foundation says that the average woman sleeps about 6 ½ hours a night during the work week — but many of my patients say they struggle to get even that amount.

Is your body blocking sleep?

My experience shows a hidden health issue or imbalance can fuel insomnia. It may be as simple as low blood sugar — especially if you wake in the night. And because we are women, fluctuating hormones in pregnancy, PMS, during the menstrual cycle itself, and of course, in menopause — can keep us from getting our beauty rest throughout the month and over our entire lifetime.

I, along with many sleep experts, believe that the main cause of short-term sleeping difficulties is the surging cortisol (the “alert” hormone) that accompanies stress, whether it’s from your job, family or marriage problems, the neighbor’s dog barking, a disagreement, or even just a traffic jam. Often, these everyday experiences can keep you up night after night.

Not sleeping — the new normal for American women

Another source of your insomnia may be you. Most women have too many responsibilities, multitasking furiously all day and staying hooked into electronics long into the night. Many women don’t prioritize sleep and leave no time for it in their daily schedule. We’ve simply forgotten how to sleep!

Sleep is as important as food and water — it’s when the parasympathetic nervous system dominates so your body can regenerate, heal and recover. New research shows that sleep clears the brain of toxins, and is a major factor in storing memories, solving problems and paying attention during the day. Good sleep is also associated with losing weight, having better skin, and being happier. Who needs a magic pill/fountain of youth when we have sleep?

What’s the secret to a good night’s sleep?

It’s very important to find the combination of elements that works best for your sleep. You need to know when to sleep, ensuring that the quality and duration of your sleep is good and that you cycle naturally through all the stages of sleep, including REM (rapid eye movement) — or dreaming — sleep. Here are the details:

1. It’s not just any 8 hours — the optimal Sleep Window is from about 10:00pm to 6:00am
We should sleep for eight hours — though your body may feel okay with seven or need as many as nine. You may be able to function with less but, trust me, you’ll suffer in the long run. Ideally, you should fall asleep within five to ten minutes and sleep through the night, waking up without an alarm clock. (The body likes rhythm, so keep to this schedule even on the weekends, only veering from it to stay up for a really rocking event!)

It’s thought that each hour you sleep before midnight is worth two hours of sleep after midnight. Most of us get more restorative, non-dreaming sleep earlier in the sleep cycle. We dream, or have REM sleep, more towards the end of the cycle, and it isn’t the most restful sleep. I invite you to spend a month going to bed at 10:00-10:30pm and waking up at 6:00-6:30am. I guarantee you’ll be happy with your results.

2. Make your bedroom your personal sanctuary — size matters (and so does head placement)
Wear pajamas you love (my personal fave: Hello Kitty) and keep your bedroom clutter-free and cool — most women sleep well at about 65 degrees. Choose linens made of organic cotton or silk and ensure that your mattress is non-toxic and of high quality because you’re going to spend 2,912 hours a year sleeping on it! Think of your bed as the womb — where you go to rest, rejuvenate and escape the demands of your daily life. The bigger the better – give yourself room to stretch literally and figuratively.

Where you place your head can make a difference. Some say that, due to subtle energies and the earth’s magnetic pull, your head should point to the North Pole if you live in the northern hemisphere and vice versa if you live in the southern hemisphere. Both my time in India and what I’ve learned about Ayurvedic medicine suggest that your head should point to the east and your feet to the west — tradition says it helps prevent the body from breaking down before its time. I’ve often been surprised to find that by simply switching my head around I’m off to dream land. Experiment to find what works best for you.

Turn off the TV, computer and cell phone at least one hour — two is better — before bedtime. Use a white noise machine or wear ear plugs if you can hear street noise, or if you sleep with a snorer. Also, block out as much light as possible — darkness activates your brain’s pineal gland, which leads to production of melatonin, the sleep hormone. Without proper melatonin, our sleep quickly suffers. Supplementing with melatonin can help ease this problem as well.

Forget about counting sheep…
having sex can help you sleep.Numerous studies show that you can bring on sleepiness by having sex. Orgasms produce an oxytocin rush that also releases endorphins and helps induce sleep. Try it!

3. Build a better pre-bedtime routine — set the stage for restorative sleep
Going to sleep at 10:00pm does not mean lying down at 9:55 and expecting to be asleep in five minutes. That can cause cortisol to surge instead of decrease. I like to get in bed at 9:00pm with an hour to read, zone out and just enjoy my bed. It’s freeing to know I have nine hours in bed and only need to spend eight of them asleep.

Consider creating a little ritual to get your body in wind-down mode. Reflect on the day by writing in a journal, noting things that inspired you or made you feel grateful. Take a hot bath or drink a cup of non-caffeinated herbal tea but remember no cookies with that tea. Stop eating three hours before bedtime so you’re not digesting food while trying to fall asleep.

Reading is fine as long as the content is uplifting, relaxing, or just plain fun. I like listening to music, too — my favorite lullabies include classical music with harp and melodic Buddhist chants. To help your body chill out or “chillax,” try gazing at a burning candle for a few minutes. Harness the power of aromatherapy with a lavender sachet under your pillow.

4. If you wake in the night — your body is telling you something and it’s time to listen
It’s 3:00am and you’re staring at the clock. Sound familiar? So many women wake on a nightly basis between 1:00am and 3:00am and can’t get back to sleep. In my experience, waking up at this time is a message from your body that your liver needs some TLC. (Traditional Chinese Medicine says this is connected to being stressed or angry). To support your liver, begin each day with a warm glass of lemon water, or apply castor oil packs to your liver 3-4 times a week. Primal scream therapy or journal writing can help you release anger and stress that is holding you back in life.

One of my favorite quotes…

Implementing a plan

First, you need to know your “cutoff time” — for me, it’s 8:00pm. By then, I’m deciding which chores I still have time to do and which ones will wait. I enter wind-down mode when the clock strikes 8:00pm, and by 9:00pm, I stop all tasks, finished or not, so I’m ready to relax and be asleep by 10.

I learned, and teach my patients, to get used to heading to bed with things undone. Don’t let a pile of papers or dirty dishes rob you of this sacred time. We often take sleep for granted and it’s the first thing to go when we get busy, feel overwhelmed, or even when we’re having the proverbial “too much fun.” This is so backwards because we need sleep to heal, so we can handle everything that’s going on in our lives. Bring your body back into balance with sweet, simple sleep. May all your desires be fulfilled beyond your wildest dreams!

For information on natural sleep supplements and herbs, see our article Nature’s sleeping aids.

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Restless legs syndrome is a sleep/movement disorder that keeps you awake with an irresistible urge to move the legs. It’s incredibly frustrating because, night after night, your body keeps you awake — for no obvious reason! Restless legs syndrome affects up to 10% of Americans and is more common in women. It tends to be most severe in people at mid-life or older, although it can occur at any age, even in young children.

Here’s how to know if restless legs syndrome — also known as RLS or Willis-Ekbom disease — could be causing your lack of sleep.

What is restless legs syndrome (RLS)?

Restless legs syndrome is a disorder related to the brain’s use of the neurotransmitter dopamine, which regulates sleep, mood, behavior, cognition and movement. The sleep interruptions that coincide with RLS are why it’s classified as a sleep disorder, and most people are formally diagnosed with RLS through a sleep study.

To see if you might be suffering from RLS, take a look at the five diagnostic criteria that help distinguish it from many other conditions that produce similar effects:

1. You experience an unpleasant sensation of tingling, itching, or pins-and-needles — often described as “creepy crawly” or “electric” — accompanied by a strong urge to move. You most often feel this sensation in your legs (or just one leg), but it can also occur in your arms or other parts of the body. Just having the pins-and-needles sensation isn’t enough. The urgent need to move your legs is the key factor.

2. The tingling sensation and urge to move your legs either starts or worsens when you’re at rest, whether sitting or lying down.

3. You feel almost immediate relief from the tingling sensation upon moving your legs or affected body parts — but the relief doesn’t last after you stop moving, and you may find yourself having to move every 30-60 seconds just to find relief.

4. Your symptoms are nearly always worst in the evening and at night, and they may interrupt or prevent your sleep. If you do get to sleep, it’s common to wake up feeling fatigued because you’ve been moving all night, even though you didn’t wake up — but you won’t necessarily feel sleepy during the day. (Lack of “profound daytime sleepiness” is a hallmark of RLS and a number of other “hyperarousal” syndromes.)

5. No other condition, either medical or behavioral, can account for any of the above considerations (meaning, your condition will be diagnosed as RLS only if you have no other conditions, such as leg cramps, arthritis, obsessive-compulsive disorder, or fibromyalgia, that might be mimicking RLS).

A first-degree relative with RLS is a significant risk factor, so there’s a strong genetic component — but other factors, including iron deficiency, pregnancy, kidney disease, ADHD and even frequent blood donation have also been linked to RLS.

Why can’t I sleep?

Restless legs syndrome happens due to the disruption in your circadian rhythm and dopamine release, which is why you experience it mostly at night. The circadian rhythms of daylight and darkness produce important responses in your brain. As it gets darker, the hormone norepinephrine triggers release of the “sleep hormone” melatonin to ready you for sleep. One of dopamine’s functions is to block norepinephrine so that melatonin levels fall — making it a “wake-you-up” hormone that is usually released at daybreak.

But your circadian rhythm can be disrupted by a lot of factors — stress, poor nutrition, ill health or even staying up too late working or studying (especially if you’re looking at a screen!) — and that can throw off the proper timing of dopamine release. And if you already have some of the underlying factors mentioned earlier, it can initiate (or worsen) RLS symptoms.

For some people, RLS disrupts sleep intermittently — maybe twice a week or less. For others, it’s a chronic problem that interferes with your ability to function and affects your mood. Long-term sleeplessness has also been tied to chronic health problems, so it’s not a problem you should try to just “live with.”

What can I do?

Neurologists specializing in sleep disorders are starting to recognize that using sleep medications is not always the answer for RLS. There are two reasons for that: first, most such medications leave you drowsy during the day (which is actually worse than what you’d experience without them) and second, they don’t address the underlying neurotransmitter dysfunction — so you’d need to use them night after night (and some of them can be habit-forming).

There’s also a trend away from using medications that increase dopamine levels in the brain — medications like pramipexole (Mirapex) or ropinirole (Requip) — as a first option, in part because they can have side effects that include nausea, vomiting, constipation, drowsiness, and mood disorders. For this reason, current guidelines encourage people with RLS — particularly if your symptoms are intermittent — to start with a set of nutritional and lifestyle approaches to try to improve your symptoms before considering medical therapies.

5 ways to improve your restless legs symptoms

1. Start with good sleep hygiene. One of the first steps in addressing any sleep disorder is to make sure you’re setting the stage for sleep even before you lie down. Going to bed at a regular time, turning off electronic devices at least 1 hour before you head for bed, reducing alcohol and caffeine intake, and creating a comfortable, quiet atmosphere in your bedroom are steps that may help anyone with insomnia or sleep disturbances, and RLS is no exception.

2. Exercise daily. Research shows that being sedentary is a significant risk factor for RLS. One study showed that 3 days of aerobic and resistance exercise per week was enough to significantly decrease RLS symptoms, possibly for two reasons: increased blood flow to the lower extremities and exercise-related endorphins that support dopamine release.

3. Get enough iron, folate and magnesium. Iron deficiency has long been known to be associated with RLS, and determining your iron status is one of the first steps recommended. It’s important that you work with a healthcare practitioner to find out what your iron status is, rather than just assuming it’s low. Folate plays a role in dopamine metabolism and sometimes can improve RLS symptoms, and magnesium, which supports nerve impulse conduction and muscle contraction, has been found in some studies to relieve RLS. The B vitamins, particularly B12, support nerve health, and vitamin E may improve peripheral blood circulation — all of which may help RLS symptoms.

4. Try mind-body therapies. While there aren’t many studies to support the effectiveness of natural RLS treatments involving massage, acupuncture, music, and meditation, it’s worth noting that one meta-analysis found that RLS responds particularly well to “the placebo effect” — almost 30% of RLS patients given placebo treatments experienced a positive improvement in symptoms. Our take on this finding is that it shows the power of the mind to achieve healing — so if there’s a mind-body therapy that you enjoy, chances are good that it can be used to quiet your restless legs.

5. Consider adding medication into the mix. For some, especially those with severe symptoms occurring nightly, these options may not be enough, and medications offered by a qualified healthcare provider may be the next step. The typical options used for treatment of RLS include low-dose dopamine agonists such as carbidopa or levodopa, α-2-δ calcium channel ligands such as gabapentin (Neurontin), or nonergot dopamine agonists such as pramipexole or ropinirole. All of these medications have side effects and should be discussed thoroughly with your healthcare provider before deciding on a medication strategy.

However, keep in mind that whatever treatment you decide upon will work best when you take a comprehensive, holistic approach to health. Many of the non-drug approaches may help medication therapy work better, so don’t give up on them!

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