Weighted Blankets for PLMD: Current Evidence
There is insufficient evidence to recommend weighted blankets as a treatment for periodic limb movement disorder (PLMD), and they are not mentioned in current clinical practice guidelines for this condition.
Guideline-Based Treatment Recommendations
The most recent American Academy of Sleep Medicine (AASM) guidelines from 2025 do not include weighted blankets among recommended interventions for PLMD 1. The evidence-based treatments that are conditionally recommended include:
- Triazolam: Conditionally suggested against use (very low certainty evidence) 1
- Valproic acid: Conditionally suggested against use (very low certainty evidence) 1
The guidelines explicitly state there is no evidence found for pediatric PLMD treatments 1.
Limited Research Evidence
Only one case report from 2023 describes weighted blanket use in PLMD 2. This single case involved a 20-year-old female who reported subjective improvement at 6-week follow-up when weighted blankets were combined with sleep hygiene education and lifestyle modifications 2. However:
- This is a single case report without objective polysomnographic follow-up data 2
- The intervention combined multiple non-pharmacological approaches, making it impossible to isolate the effect of the weighted blanket 2
- Case reports represent the lowest level of evidence and cannot establish treatment efficacy
Broader Context on Weighted Blankets
A 2024 scoping review found that weighted blankets show more evidence for adults with various sleep disorders, with improvements in sleep, mood, and medication use, but PLMD was not specifically studied 3. The review noted that sleep outcomes were mixed for children and adolescents, and methodological quality was variable across studies 3.
Clinical Approach to PLMD
Before considering any intervention, confirm the diagnosis requires treatment 4, 5. PLMD diagnosis requires all of the following 4, 5:
- Polysomnography demonstrating repetitive, stereotyped limb movements
- PLMS Index exceeding 15 per hour in adults
- Clinical sleep disturbance or daytime fatigue (this is critical—PLMS without symptoms generally does not require treatment) 5
- Not better explained by another disorder, medication, or substance use 4, 5
If treatment is warranted, address underlying causes first 6:
- Check serum ferritin (supplement if <50 ng/mL) 6
- Review medications, particularly antidepressants (SSRIs, TCAs, venlafaxine, mirtazapine) that exacerbate PLMS 6
- Evaluate for sleep-disordered breathing 6
- Assess for peripheral neuropathy 6
If RLS symptoms coexist (present in up to 90% of PLMD cases), treat the RLS with gabapentin, gabapentin enacarbil, or pregabalin as first-line agents 4, 5.
Bottom Line
Weighted blankets lack evidence for PLMD treatment and should not be recommended as a therapeutic intervention for this condition. Focus instead on guideline-concordant approaches: identifying and treating underlying causes, addressing iron deficiency, and considering pharmacological treatment only when clinically indicated based on objective polysomnographic findings and symptomatic sleep disturbance 1, 4, 5, 6.