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Tonic motor activation (TOMAC) reduces periodic leg movements during sleep and improves sleep reinitiation in adults with medication-refractory restless legs syndrome.

In 20 adults with medication-refractory RLS, 30-minute mid-sleep TOMAC sessions led to rapid sleep reinitiation (median 6.7 minutes) in 82.8% of sessions, with a 47.9% reduction in PLMS/hour and a 70.8% reduction in PLMS associated with arousal/hour. EEG power analysis showed a transition towards deeper sleep during stimulation.

Last updated: Aug 1, 2026•0 RCTs•📖 Read as article →

Evidence Score

Evidence Score34/100
Human RCT☆☆☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. Acute effects of tonic motor activation (TOMAC) on sleep in adults with medication-refractory restless legs syndrome.

observational

Rigot SK, St Louis EK, Baker FC, Alawieh H, Singh H, Ojile J, Tekchandani J, Kolotovska V, Adlou B, Charlesworth JD · Sleep advances : a journal of the Sleep Research Society (2026)

Participants: N/A
Duration: Single night polysomnography with mid-sleep sessions
Intervention: 30-minute mid-sleep TOMAC sessions (high-frequency electrical stimulation to the common peroneal nerve) activated as needed upon awakening with RLS symptoms.
Outcome: Sleep reinitiation latency, sleep architecture (EEG delta and alpha power), PLMS/hour, PLMS associated with arousal/hour.
Effect Size: N/A (median latencies and percentage reductions reported; p values provided)
Population: 20 adults with medication-refractory restless legs syndrome.

Result:

PubMed: 42488517DOI: 10.1093/sleepadvances/zpag060

Mechanism Graph

High-frequency electrical stimulation activates the common peroneal nerve
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Stimulation reduces RLS symptoms and facilitates sleep reinitiation
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EEG changes show increased delta and decreased alpha power, indicating deeper sleep
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Result: Reduced PLMS and improved sleep continuity

Limitations

  • ⚠Cross-sectional design with no control group or sham stimulation
  • ⚠Small sample size (n=20) and limited generalizability to broader RLS populations

Frequently Asked Questions

What is TOMAC and how does it work for RLS?▼

TOMAC (tonic motor activation) delivers high-frequency electrical stimulation to the common peroneal nerve to reduce RLS symptoms and improve sleep.

How quickly did participants fall back asleep after using TOMAC?▼

The median time to sleep reinitiation was 6.7 minutes, with 82.8% of sessions resulting in sleep during the 30-minute stimulation.

Did TOMAC reduce leg movements during sleep?▼

Yes, PLMS/hour decreased by 47.9% and PLMS associated with arousal decreased by 70.8% after mid-sleep TOMAC sessions.

Is this study a randomized controlled trial?▼

No, it is a cross-sectional analysis providing the first objective evaluation of TOMAC during polysomnography, without a control group.

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References

  1. 1.Rigot SK, St Louis EK, Baker FC, Alawieh H, Singh H, Ojile J, Tekchandani J, Kolotovska V, Adlou B, Charlesworth JD. "Acute effects of tonic motor activation (TOMAC) on sleep in adults with medication-refractory restless legs syndrome.." Sleep advances : a journal of the Sleep Research Society, 2026. PMID: 42488517 DOI: 10.1093/sleepadvances/zpag060
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.