Is infrared or near‑infrared light therapy an effective and safe treatment option for a patient with restless‑legs syndrome who cannot tolerate standard medications?

Infrared and Near-Infrared Light Therapy for Restless Legs Syndrome

Infrared and near-infrared light therapy are not recommended for the treatment of restless legs syndrome, as they have no supporting evidence in current clinical guidelines and should not be used in place of proven therapies.

Evidence-Based Treatment Algorithm for RLS

The 2025 American Academy of Sleep Medicine guidelines provide a clear, evidence-based treatment pathway that does not include infrared or near-infrared light therapy 1:

Step 1: Iron Assessment and Repletion

• Check morning fasting serum ferritin and transferrin saturation after withholding iron supplements for ≥24 hours 1
• Initiate iron supplementation if ferritin ≤75 ng/mL or transferrin saturation <20% 1
• IV ferric carboxymaltose 750–1000 mg is strongly recommended for rapid correction (strong recommendation, moderate certainty) 1
• Oral ferrous sulfate 325–650 mg daily or every other day is a conditional alternative 1, 2

Step 2: First-Line Pharmacologic Therapy

• Alpha-2-delta ligands are strongly recommended as first-line treatment (strong recommendation, moderate certainty of evidence) 1, 3, 4:
  • Gabapentin: start 300 mg three times daily, titrate to 1800–2400 mg/day divided TID 1, 4
  • Gabapentin enacarbil: strongly recommended with twice-daily dosing 1
  • Pregabalin: strongly recommended, allows twice-daily dosing with superior bioavailability 1, 4
• Approximately 70% of patients treated with gabapentinoids show much or very much improved symptoms versus 40% with placebo 2

Step 3: Eliminate Exacerbating Factors

• Discontinue medications that worsen RLS: serotonergic antidepressants, dopamine antagonists, centrally acting H1 antihistamines (e.g., diphenhydramine) 1, 2
• Avoid alcohol, caffeine, and nicotine, especially in the evening 1
• Treat untreated obstructive sleep apnea if present 1

Step 4: Refractory Cases

• Extended-release oxycodone 5–10 mg at bedtime is conditionally recommended for moderate to severe refractory RLS (conditional recommendation, moderate certainty) 1, 4
• Alternative low-dose opioids include methadone 5–10 mg daily or buprenorphine 1, 2
• Bilateral high-frequency peroneal nerve stimulation is conditionally recommended as a non-pharmacologic option (conditional recommendation, moderate certainty) 1

Why Infrared/Near-Infrared Light Is Not Recommended

No guideline or high-quality evidence supports infrared or near-infrared light therapy for RLS. The 2025 American Academy of Sleep Medicine guidelines—the most recent and authoritative source—do not mention light therapy as a treatment option 1. Similarly, the 2026 JAMA review of RLS management makes no reference to light-based interventions 2.

The absence of infrared/near-infrared therapy from evidence-based guidelines is significant because:

• RLS guidelines explicitly list treatments with insufficient evidence and recommend against them (e.g., clonazepam, valproic acid, cabergoline) 1
• Light therapy is not even mentioned among rejected or unproven therapies, indicating a complete lack of supporting data 1
• Other unproven therapies (e.g., bone broth, magnesium as monotherapy) are specifically noted as lacking evidence 1

Medications to Avoid

• Dopamine agonists (pramipexole, ropinirole, rotigotine) are NOT recommended for standard use due to a 7–10% annual risk of augmentation—a paradoxical worsening of symptoms 1, 3, 2
• Strong recommendations against: cabergoline, bupropion, carbamazepine, clonazepam, valproic acid 1

Critical Pitfalls to Avoid

• Do not delay evidence-based treatment by attempting unproven therapies like infrared light when effective options exist 1
• Do not assume "normal" ferritin is adequate—RLS requires higher thresholds (≤75 ng/mL in adults, <50 ng/mL in children) than the general population 1, 2
• Do not use single nighttime dosing of gabapentin—three-times-daily dosing is necessary for adequate 24-hour symptom control 1, 4
• Do not start dopamine agonists as first-line therapy given the high augmentation risk and current guideline recommendations favoring alpha-2-delta ligands 1, 3, 2

Clinical Impact of Untreated or Inadequately Treated RLS

Patients with RLS experience significant morbidity, including 2:

• Sleep disturbance in approximately 90% of cases 1
• Elevated rates of cardiovascular disease (29.6%) 2
• Depression (30.4%) 2
• Impaired quality of life and daytime functioning 2

For a patient who cannot tolerate standard medications, the evidence-based approach is to optimize iron status, try alternative alpha-2-delta ligands (if one is not tolerated, another may be), consider bilateral high-frequency peroneal nerve stimulation, or use low-dose opioids for refractory cases—not to pursue unproven therapies like infrared light. 1, 4, 2