Anemia, Iron Deficiency and Sleep Disorders

Sleepless nights are stressful, exhausting and frustrating. Sleep disorders, including snoring, sleep apnea, insomnia, sleep deprivation, and restless legs syndrome are common. Research has shown that restless leg syndrome (RLS), restless sleep or insomnia among infants, children, teenagers, pregnant women and adults is often related to low iron stores.

RLS is characterized by uncomfortable sensations deep in the legs that compel an individual to move. The symptoms are worst at night and sleep disturbance or even insomnia is common.

The National Institute of Neurological Disorders and Stroke estimate that RLS afflicts 10% of the US population. Initially, research focused on the elderly. For example, a 1994 study conducted in an Ireland hospital confirmed that iron deficiency, with or without anemia, contributed to RLS in elderly patients. Iron supplements were found to significantly reduce their symptoms. [1]

Now, it is estimated that 1.9% of children and 2% of adolescents are afflicted with RLS. [2] Typically, early-onset RLS (i.e., before age 45) is linked to genetics, whereas late-onset RLS has a strong relationship with an individual’s iron status. But a 2002 study found that abnormal iron stores (without signs of anemia) or metabolism may result in RLS causing insomnia in teenagers. [3]

Almost one-third of pregnant women suffer from RLS. Researchers recently reported that they surveyed 300 pregnant women in their third trimester and found signs of anemia typical of iron deficiency in RLS-positive respondents, despite higher oral iron supplementation in this group.[4] Unfortunately, sleep disturbance symptoms increase throughout pregnancy and postpartum delivery. [5] [6]

Iron deficiency, with or without anemia, can impact sleep in other ways. A study of 6–18 month-old infants from Nepal and Zanzibar found reduced sleep duration and increased night-waking among infants with iron deficiency anemia [7]. In a 2007 study conducted on 33 autistic children, researchers found that 77 percent had restless sleep at baseline and researchers reported that the children’s restless sleep improved significantly with iron therapy [8].

The underlying metabolic interactions are not clearly understood. Dopamine and serotonin play a role in wake and sleep activities. Iron is also vital to the brain’s dopamine system. But researchers have not been able to ascertain exactly how dopamine, serotonin, and iron interact. [9]    

While there is no known cure for RLS, a physician may recommend sleeping pills, opiates, dopamine-related medications, Alpha2 Delta drugs, or iron (i.e., iron supplements or infusions) to relieve the symptoms. If you, or someone you know, suffer from RLS, consult with a physician to explore treatment options.

*These statements have not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure, or prevent any disease.

[1] S. T. O'Keefe, K. Gavin and J.N. Lavan, Iron Status and Restless Legs Syndrome in the Elderly, Age and Ageing, May 1994, Volume 23, Number 3, Pages 200-203

[2] Matthew A. Picchietti and Daniel L. Picchietti, Restless Legs Syndrome and Periodic Limb Movement Disorder in Children and Adolescents, Seminars in Pediatric Neurology, Volume 15, Issue 2, June 2008, Pages 91-99

[3] Meir H. Kryger, Kazuo Otake, John Foerster, Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers, Sleep Medicine, Volume 3, Issue 2, March 2002, Pages 127-132

[4] Minar M, Kosutzka Z, Habanova H et al, Restless legs syndrome in pregnancy is connected with iron deficiency, Sleep Medicine, May 2015, Pages 589-92.

[5] Ko H, Shin J, Kim M et al, Sleep disturbances in Korean pregnant and postpartum women. Journal of Psychosomatic Obstetrics & Gynaecology, June 2012, Pages 85-90.

[6] Mindell JA1, Cook RA2, Nikolovski J2, Sleep patterns and sleep disturbances across pregnancy, Sleep Medicine. April 16, 2015, Pages 483-8.

[7] Kordas, Katarzyna, et al., Maternal reports of sleep in 6–18 month-old infants from Nepal and Zanzibar: Association with iron deficiency anemia and stunting, Early Human Development, Volume 84, Issue 6, June 2008, Pages 389-398

[8] Cara F. Dosman, et al., Children With Autism: Effect of Iron Supplementation on Sleep and Ferritin, Pediatric Neurology, Volume 36, Issue 3, March 2007, Pages 152-158

[9] “Causes of Restless Leg Syndrome”, John Hopkins Medicine, Neurology and Neurosurgery,; accessed May 22, 2015