8 Tips to Treat Restless Legs Syndrome (RLS)
The House Call Doctor explains the confusing and frustrating symptoms of RLS and gives 8 treatment options so you can stop counting sheep and get a good night’s sleep.
Have you been told by your spouse that you “fidget” in the middle of the night? Or have you noticed your legs or feet may have a mind of their own when you’re trying to fall asleep? Do you have an urge to move your legs a lot at bedtime? You may very well be one of the many people who remain undiagnosed with the condition called Restless Legs Syndrome, or RLS.
For those who have never experienced RLS, it may seem like a very odd and peculiar phenomenon. But if you’ve ever had these symptoms, you may be surprised to learn that this is an actual medical condition. Maybe you’ve already mentioned it to your doctor, or maybe you never realized it was real until now. Either way, let’s find out more about Restless Legs Syndrome and how it’s treated.
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What Is RLS?
I’ve actually discussed RLS in a previous episode on insomnia, and you may want to revisit that episode before moving on to this one. But in a nutshell, here are the symptoms that up to 10% of the American population are estimated to be suffering from:
- An urge to move or kick the legs or feet
- A creepy-crawly or strange sensation in the legs that’s felt deep inside, under the skin
- Occurs only at rest
- Relieved by movement temporarily
- Worse at nighttime, especially bedtime
- Usually felt in both legs equally
RLS can be genetic. If you ask your family members if they experience any of these symptoms, their answers may very well surprise you. Some people live with this all their lives and never mention it to anyone, especially if the symptoms are mild and infrequent.
It also tends to affect women twice as much as men, and the prevalence seems to increase with age (more and more people get diagnosed the older they get). Most people report experiencing their very first symptom sometime between the ages of 11 and 20.
Also, those with diabetes, anemia, kidney disease, other neurologic conditions (such as Parkinson’s or multiple sclerosis), and those who are pregnant can be more predisposed to RLS. But most people with RLS don’t suffer from any of these other conditions.
Treatment of RLS
Whether or not treatment is necessary is really dependent on the patient and how severe their symptoms really are. For some patients, treatment may not be necessary at all. And for others, the quality of life may be so impaired (and include insomnia and daytime fatigue) that treatment may be a lifesaver.
Here is a list of available treatment options for RLS:
- Stretch. Do some calf stretching exercises for 5 minutes prior to bedtime. Make sure you really feel the stretch in the back of your lower legs to relax and loosen the muscles.
- Sleep routine. Sleep deprivation has been shown to worsen RLS (and can also be a symptom of it). Maintain a sleep schedule routine, go to sleep at the same hour ever night and awake at the same hour every morning.
- Avoid medication triggers. Certain classes of medications have been known to exacerbate RLS, including antihistamines, some antidepressants, some anti-nausea medication, and certain anti-seizure meds. If you take any of these, ask your doctor for potential alternatives.
- Avoid known triggers: Alcohol, nicotine, and caffeine are all known triggers. Avoid them.
- Treat iron–deficiency. Ferritin is a measure of the iron stores in your body. If your ferritin level is below 50, a trial of iron supplementation may be considered by your doctor.
Try dopamine agonists. First-line treatment for people diagnosed with RLS is typically a drug in this group that stimulates dopamine receptors in the brain, such as pramipexole and ropinirole. These two drugs start working about 1.5 to 2 hours after intake. Side effects of these drugs are typically mild and self-resolve within a couple of weeks, and include fatigue, nausea, and lightheadedness. Less common side effects of impulsive behavior (such as gambling and promiscuity) can be more common in some patients. Overall worsening of RLS symptoms is a risk if you take these drugs daily and for long periods of time – this is known as “augmentation.” Your risk of augmentation is low if you take the drug intermittently on an as-needed basis.- Try gabapentin. Gabapentin and its extended-release version are also alternative drug therapies that are FDA approved for RLS. These are drugs that calm down the nervous system by modulating overly excited nerves. Side effects are drowsiness, dizziness, and weight gain, and they too improve with time for most. If impulse control is an issue, or a patient with Parkinson’s who suffers from RLS is already being treated with a dopamine agonist, gabapentin may be considered as an alternative.
Try benzodiazepines and narcotics. For most patients, if symptoms are mild and infrequent, these groups of drugs may work. But they should be avoided by people with more chronic RLS symptoms due to drug dependence and tolerance, as they are habit-forming (along with having some other unwanted side effects).
Try dopamine agonists. First-line treatment for people diagnosed with RLS is typically a drug in this group that stimulates dopamine receptors in the brain, such as pramipexole and ropinirole. These two drugs start working about 1.5 to 2 hours after intake. Side effects of these drugs are typically mild and self-resolve within a couple of weeks, and include fatigue, nausea, and lightheadedness. Less common side effects of impulsive behavior (such as gambling and promiscuity) can be more common in some patients. Overall worsening of RLS symptoms is a risk if you take these drugs daily and for long periods of time – this is known as “augmentation.” Your risk of augmentation is low if you take the drug intermittently on an as-needed basis.
Do you suffer from RLS? Share your experience with us on the House Call Doctor’s Facebook and Twitter pages!
And check out more on QDT’s Restless Legs Syndrome homepage: quickanddirtytips.com/rls
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
All images courtesy of Shutterstock.
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About the Author
Dr. Sanaz Majd is a board-certified Family Medicine physician who graduated from Drexel University College of Medicine in Philadelphia. Her special interests are women’s health and patient education.
