Restless legs syndrome (RLS) is a common neurological disorder that creates an overwhelming and often uncomfortable urge to move the legs. This urge is frequently accompanied by unpleasant sensations such as creeping, pulling, or tingling, which often begin or worsen during periods of rest or inactivity, especially in the evening or at night.
These symptoms severely disrupt sleep, leading to chronic fatigue and a significant reduction in the overall quality of life for those affected. Standard treatments primarily involve medications that increase the brain’s dopamine levels, but some patients find these therapies insufficient or experience problematic side effects. This lack of reliable relief has led to a growing interest in exploring the potential of medical cannabis as an alternative treatment option.
Cannabis may help relieve RLS symptoms by influencing the dopamine pathways that researchers believe malfunction in the condition. Additionally, cannabidiol (CBD) and tetrahydrocannabinol (THC) have pain-relieving, antianxiety, sleep-promoting, and muscle-relaxing effects that can directly ease the unpleasant sensations and involuntary movements associated with RLS. Importantly, the sedative qualities of certain cannabinoids also address one of the most critical aspects of RLS, which is the severe disruption of sleep.
Cannabis use may lead to a significant reduction in symptom severity and, in some cases, even a complete resolution of the restlessness. Researchers studying patients with treatment-resistant RLS found that those who used cannabis reported marked improvements in symptoms and overall sleep quality.
One of the primary benefits is that cannabis often improves the core symptoms of RLS, and in some cases, completely resolves them, especially in patients with refractory RLS who don’t respond well to standard medications. This relief likely comes from the pain-relieving properties of type 1 (THC-dominant) or type II (1:1 THC:CBD) cannabis, which directly target the painful or unpleasant sensations that cause the urge to move the legs.
Specifically, the major components of medical cannabis, THC and CBD, contribute to these benefits through different mechanisms. THC, the psychoactive and most critical component for RLS, binds to CB1 receptors in the central nervous system, helping to dull uncomfortable sensations and reduce the restless urge. Furthermore, THC’s sedative effects can help patients fall asleep faster and stay asleep longer by promoting sleepiness, relaxation, and reducing the nocturnal awakenings caused by RLS, thereby leading to significantly improved subjective sleep quality.
CBD helps calm the nervous system and relieve the mental stress and anxiety that often accompany and worsen RLS symptoms, thanks to its antianxiety and relaxing properties. CBD may help ease ruminating thoughts and preserve sleep architecture, so deeper sleep is better protected and achieved than when using THC alone. However, recent clinical trials show that CBD alone (type III cannabis) isn’t sufficient to ease RLS symptoms, and that CB1 activation by THC appears to be more essential based on prior research.
However, leading researchers and medical sources emphasize that while early evidence supports medical cannabis as a possible alternative for patients with refractory RLS, scientists still need to conduct more robust, randomized, and well-controlled clinical trials on different cannabis types to confirm efficacy, determine the optimal dosage, and establish long-term safety for this neurological disorder.
RLS is likely caused by different factors, mostly involving the way the brain functions. The causes are divided into two categories: primary and secondary RLS.
Primary RLS
Occurs when the disorder develops on its own without a known underlying medical trigger. Some major factors in primary RLS include:
Secondary RLS
This condition is either triggered or significantly worsened by an identifiable medical issue or external factor. Some common triggers include:
RLS symptoms can be seen when unpleasant feelings and the urge to move begin or significantly worsen during periods of rest or inactivity. This means symptoms frequently appear when a person is sitting for a long time, such as in a car or movie theater, or when they are lying down to sleep.
These symptoms follow a distinct daily rhythm. They only occur or are noticeably worse in the evening or night compared to the daytime hours.
However, symptoms are partially or completely relieved by movement. Walking, stretching, pacing, or even jiggling the legs will provide temporary relief from the discomfort.
The timing of these symptoms often leads to a significant impact on a person’s life. The evening and nighttime worsening of RLS commonly causes severe difficulties with falling asleep and staying asleep. This chronic sleep disruption can lead to secondary problems, including daytime sleepiness, exhaustion, changes in mood, and difficulty concentrating or maintaining productivity.
Furthermore, most people with RLS also experience a related condition called periodic limb movement of sleep (PLMS). This involves involuntary jerking, twitching, or kicking movements of the legs and sometimes the arms, which can happen every 15 to 40 seconds throughout the night and contribute further to sleep loss.
Each state or county’s specific laws and regulations determine whether RLS is eligible for medical marijuana treatment.
In many jurisdictions, RLS does qualify for medical marijuana use, either by being explicitly named or by falling under broader, approved categories. These categories often include conditions like chronic pain, severe and debilitating neurological disorders, or any condition causing severe, intractable symptoms that conventional therapies have failed to alleviate.
Since RLS is a sensory-motor disorder that causes significant chronic pain and severe sleep disruption, it often meets the criteria for these broader diagnoses.
The most immediate and common side effects include general issues like drowsiness, a feeling of fatigue, dry mouth, dizziness, and nausea, which are typically dose-dependent and manageable but can certainly impact daily function and alertness.
THC interacts with the brain’s already-dysregulated dopaminergic pathways in RLS patients, creating a paradoxical risk-benefit profile. This interaction may theoretically lead to a significant risk of actually worsening RLS symptoms; however, this isn’t what is clinically seen in the small studies we have. This may be because CB1 is known to fuse with many receptor types, including dopamine, changing the way they work.
Furthermore, long-term and frequent use of cannabis, particularly products high in THC, may introduce the risk of developing dependency, tolerance, sleep impairment, and a temporary decline in cognitive functions, which can manifest as impaired memory, concentration, and coordination, all of which are crucial considerations for maintaining safety, such as when driving, working, or caregiving.
It is also important to note that cannabis can interact with other common RLS medications, such as some anticonvulsants, by affecting how the body metabolizes them, which could potentially lead to dangerously altered drug levels. Qualified healthcare providers strongly advise patients to discuss any use of cannabis for RLS thoroughly to minimize potential risks and monitor for adverse reactions.
READ: CBD for Knee Pain
Marijuana may help restless leg syndrome (RLS) symptoms by providing muscle relaxation and pain relief, which improves sleep quality. However, over time, THC may potentially worsen RLS symptoms by disrupting dopamine and deep sleep activity, which is why experts strongly advise patients to seek professional medical guidance, in addition to getting recommended iron studies. While THC helps people fall asleep, CBD helps preserve sleep architecture and promote deeper, quality sleep than THC alone, so a significant quantity should not be missed.
Yes, marijuana can trigger restlessness in two ways: acutely, where high doses of the psychoactive compound THC can induce anxiety and agitation. And chronically, restlessness, along with irritability and sleep issues, is a recognized symptom for regular users experiencing withdrawal.
Drugs that interfere with the dopamine and serotonin pathways are known to worsen RLS. They include: most antidepressants (SSRIs, SNRIs), nearly all antipsychotics (dopamine blockers), sedating antihistamines (in cold or allergy aids), and certain anti-nausea drugs (like metoclopramide). These medications can intensify RLS symptoms or cause them to emerge.
Cannabis may provide modest relief for certain forms of chronic leg pain due to the pain-relieving (analgesic) and anti-inflammatory properties of compounds like THC and CBD. However, patients are advised to consult a physician before using cannabis for pain management.
Certain medications, especially antidepressants, antipsychotics, and sedating antihistamines, often worsen restless leg syndrome. Other major factors include lifestyle choices such as consuming caffeine, alcohol, and nicotine, prolonged periods of inactivity, and the presence of underlying conditions like iron deficiency or pregnancy.
RLS does not reduce life expectancy; however, the condition may be an indirect risk factor due to associated health issues, like the chronic sleep deprivation it causes and its link to an increased risk of cardiovascular disease and cancer mortality.
RLS symptoms occur when a person is resting in bed due to a chemical imbalance in the brain, primarily involving dopamine, the substance that controls movement. Symptoms worsen severely at night because the body’s natural circadian rhythm (the internal 24-hour clock) makes dopamine levels decline in the evening, leading to a noticeable increase in RLS during periods of inactivity or rest.
Secondary factors, such as low body iron or the use of certain medications, frequently intensify this main issue.
Written by Chiagozie Ekemezie
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