Restless Leg Syndrome Treatment
Restless legs syndrome (RLS) is a nervous system disorder that causes the urge in a person to move their legs. It is also considered a sleep disorder because it can interfere with sleep. Restless Leg Syndrome Treatment encompasses a wide variety of solutions individualized to each patient.
Does Restless Legs Syndrome Ever Go Away by Itself?
In rare cases, Restless Legs Syndrome can disappear on its own. For most people Restless Leg Syndrome gets worse over time.
For people with RLS symptoms caused by a medical condition, treatment of that condition can improve their RLS.
What is Restless Leg Syndrome?
Restless legs syndrome (RLS) is a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. Moving eases the unpleasant feeling temporarily.
Restless legs syndrome, now known as restless legs syndrome/Willis-Ekbom disease (RLS/WED), can begin at any age and generally worsens as you age. It can disrupt sleep, which then interferes with daily activities.
Simple self-care steps and lifestyle changes may help the symptoms. Medications also help many people with restless legs syndrome.
Restless Leg Syndrome Symptoms
The chief symptom is an urge to move the legs. Common accompanying characteristics of RLS/WED include:
- Sensations that begin after rest. The sensation typically begins after you’ve been lying down or sitting for an extended time, such as in a car, airplane or movie theater.
- Relief with movement. The sensation of RLS/WED lessens with movement, such as stretching, jiggling your legs, pacing or walking.
- Worsening of symptoms in the evening. Symptoms occur mainly at night.
- Nighttime leg twitching. RLS/WED may be associated with another, more common condition called periodic limb movement of sleep, which causes your legs to twitch and kick, possibly throughout the night, while you sleep.
People typically describe RLS/WED symptoms as abnormal, unpleasant sensations in their legs or feet. They usually happen on both sides of the body. Less commonly, the sensations affect the arms.
The sensations, which generally occur within the limb, rather than on the skin, are described as:
Sometimes the sensations are difficult to explain. Affected people usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move their legs.
It’s common for symptoms to fluctuate in severity. Symptoms sometimes disappear for periods of time, then come back.
How Can I Get a Good Night’s Sleep Despite Restless Legs Syndrome?
Experts agree that simply changing your behavior can often help you sleep if you have restless legs syndrome. For people with mild to moderate RLS, these steps can reduce or prevent symptoms:
- Cut down on caffeine.
- Cut down on alcohol.
- Stop smoking, or at least cut back.
- Go to bed and get up at the same time each day, including weekends.
- Exercise regularly, but moderately (heavy exercise can worsen symptoms).
- Apply hot or cold packs to the area, or cold or hot baths and/or whirlpool baths
- Stretching and massaging the limbs
- Some report relief by stimulating the toes and feet before bedtime. The stimulation can be vibratory or electrical.
- Your doctor may also recommend physical therapy, exercise and/or relaxation techniques.
When Should I See a Doctor About Restless Legs Syndrome?
Some people with RLS/WED never seek medical attention because they worry they won’t be taken seriously. Restless Leg Syndrome can interfere with your sleep and cause daytime drowsiness and affect your quality of life. It is important to talk with your doctor if you think you may have RLS/WED.
A doctor can confirm the diagnosis of RLS and exclude other conditions that may resemble RLS. If there are associated problems, like iron deficiency, the doctor can treat them.
Restless Leg Syndrome can cause:
- Frequent loss of sleep
- Feeling depressed or anxious
- Having trouble concentrating
RLS usually progresses over time. Talking with your doctor if you believe you may have Restless Leg Syndrome is the first step to feeling better.
Treatment for Restless Leg Syndrome
The first step in treating Restless Leg Syndrome is to prevent it from getting worse. Your doctor will tell you to avoid foods or substances that have the potential to cause or worsen the condition. You will need to avoid caffeine, nicotine, and alcohol. In many cases, these steps will relieve or reduce the symptoms. Additionally, take an inventory of all the drugs or supplements you are taking. Talk to your healthcare provider to see if any of your substances could be the cause of the problem.
Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of Restless Legs Syndrome. Correcting an iron deficiency may involve receiving iron supplementation orally or intravenously. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.
If you have RLS/WED without an associated condition, treatment focuses on lifestyle changes. If those aren’t effective, your doctor might prescribe medications.
Medication for Restless Leg Syndrome
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. Medications used to help treat cases of primary RLS cannot cure RLS. They relieve symptoms only. Patients who have RLS symptoms only occasionally may be given medicine to take only when symptoms appear.
- Medications that increase dopamine in the brain. These medications affect levels of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS/WED. Short-term side effects of these medications are usually mild and include nausea, lightheadedness, and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.
- Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin), gabapentin enacarbil (Horizant) and pregabalin (Lyrica), work for some people with RLS/WED.
- Opioids. Narcotic medications can relieve mild to severe symptoms. Because of the highly addictive nature of opiates, they are rarely used unless other drugs have been found to be ineffective. Some examples include codeine, oxycodone (OxyContin, Roxicodone), combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and acetaminophen (Norco, Vicodin).
- Muscle relaxants and sleep medications. Known as benzodiazepines, these drugs help you sleep better at night, but they don’t eliminate the leg sensations, and they may cause daytime drowsiness. Common medications include alprazolam (brand name Xanax), temazepam (brand name Restoril) and clonazepam (brand name Klonopin). These drugs are generally only used if no other treatment provides relief.
- Anticonvulsant agents may also help alleviate some of the symptoms of RLS. It has the added benefit of also treating chronic or nerve pain. Examples include gabapentin enacarbil (brand name Horizant) or gabapentin (brand name Neurontin).
- Alpha2 agonists agents are effective in stimulating the alpha2 receptors located in the brain stem. By doing so, nerve cells send a message that mutes the section of the nervous system in control of involuntary muscle movements and sensations, clonidine (brand name Catapres) is a well-known example.
It may take several trials for you and your doctor to find the right medication or combination of medications that works best for you. Talk to your doctor about the right treatment for you. There are several medications common in the US to treat RLS. They may be prescribed alone or in conjunction with others, depending on the case.
Caution about medications
Sometimes dopamine medications that have worked to relieve your RLS/WED become ineffective, or you notice your symptoms returning earlier in the day. This is called augmentation. Your doctor may substitute another medication to combat the problem.
Most drugs prescribed to treat RLS/WED aren’t recommended during pregnancy. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of certain drugs.
Some medications may worsen symptoms of RLS/WED. These include some types of antidepressants, antipsychotic medications, anti-nausea drugs, and cold and allergy medications. Your doctor may recommend that you avoid these medications, if possible. However, if you need to take these medications, talk to your doctor about adding drugs to help manage your RLS/WED.
Clinical trials for Restless Leg Syndrome
Coping and Support for Restless Leg Syndrome
RLS/WED is generally a lifelong condition. Living with RLS/WED involves developing coping strategies that work for you, such as:
- Tell others about your condition. Sharing information about RLS/WED will help your family members, friends and co-workers better understand when they see you pacing the halls, standing at the back of the theater or walking to the water cooler many times throughout the day.
- Don’t resist your need for movement. If you attempt to suppress the urge to move, you may find that your symptoms worsen.
- Keep a sleep diary. Keep track of the medications and strategies that help or hinder your battle with RLS/WED, and share this information with your doctor.
- Stretch and massage. Begin and end your day with stretching exercises or gentle massage.
- Seek help. Support groups bring together family members and people with RLS/WED. By participating in a group, your insights not only can help you but also may help someone else.
Preparing for your appointment
If you have signs and symptoms of restless legs syndrome, make an appointment with your doctor. After an initial evaluation, he or she may refer you to a doctor who specializes in conditions affecting the nervous system (neurologist) or a sleep specialist.
Here’s some information to help you get ready for your appointment.
Information to gather in advance
- Write down your symptoms, including when they started and when they tend to occur.
- Write down key medical information, including other conditions you have and any prescription or over-the-counter medications you’re taking, including vitamins and supplements. Also, note whether there’s a history of Restless Legs Syndrome in your family.
- Take a family member or friend along. Someone who accompanies you may remember information you missed or forgot.
- Write down questions to ask your doctor.
Some basic questions to ask your doctor about Restless Legs Syndrome include:
- What is the most likely cause of my signs and symptoms of Restless Legs Syndrome?
- Are there other possible causes of Restless Legs Syndrome?
- What tests do I need?
- What treatment options are available for Restless Legs Syndrome?
- I have other health conditions. How can I best manage them together?
- What self-care steps might improve my Restless Legs Syndrome symptoms?
- Do you have educational materials I can have? What websites do you recommend?
- Where can I find a support group for people with Restless Legs Syndrome RLS/WED?
Is RLS/WED heredity?
It is not uncommon for RLS/WED to run in the family. This is especially true for individuals with early-onset RLS/WED. If the condition is diagnosed before the age of 40, it is more likely that another family member also has RLS/WED. Gene research has pinpointed locations on the chromosomes where the RLS/WED genes might be present.
How does pregnancy affect RLS/WED?
Pregnancy, as with other hormonal changes, may have a temporary effect on the signs and symptoms of RLS/WED. Most report that their RLS/WED gets worse during pregnancy. In some cases, women get RLS/WED for the first time while pregnant. It seems to be most likely to occur during the last trimester. Fortunately, the signs and symptoms of RLS/WED typically vanish after delivery.
Home Remedies For Restless Leg Syndrome
Although the exact origin of RLS is unknown, experts are aware that lifestyle choices have an impact on how frequently symptoms arise. You can alter certain aspects of your lifestyle to help your symptoms feel better.
A balanced diet helps support restful sleep. Caffeine and alcohol should be consumed in moderation, and they should not be consumed right before bed. You can also stay away from any items that you are aware may keep you up at night.
Smoking can disrupt sleep and make the body feel uneasy. Consider reducing your smoking or giving it up altogether.
What are the risk factors for RLS/WED?
RLS/WED is a medical disorder that can develop at any age. Although the condition is more common in those of advancing age, it can develop during childhood. Women are diagnosed with RLS/WED more often than men.
Restless legs syndrome typically is unrelated to any serious pre-existing medical condition. Nevertheless, RLS/WED is sometimes accompanied by other medical problems.
- Spinal cord conditions like spinal cord lesions have been linked to RLS/WED. If you have ever received anesthesia to the spinal cord, for example, a spinal block, your risk of developing RLS/WED is higher.
- Iron deficiency can cause or worsen your RLS/WED signs and symptoms with or without anemia. You may have an iron deficiency if you typically have heavy menstrual periods, routinely donate blood, or have a past experience of bleeding from your bowels or stomach.
- Kidney failure can cause low levels of iron. When kidneys are not functioning properly, iron levels in your blood can drop. If you are experiencing kidney failure, you might additionally have an iron deficiency, accompanied by anemia. These and other body chemistry changes might worsen or cause RLS/WED.
- Peripheral neuropathy is permanent damage to the nerves in the hands and feet. It can be caused by chronic illnesses like alcoholism and diabetes.
Risk Factors for Restless Leg Syndrome
There is substantial evidence linking restless leg syndrome (RLS) and genetic causes. In a high percentage of cases, RLS seems to run in the family. Individuals with a genetic connection often show signs of RLS when they are younger.
Fortunately, medical tests can help uncover some of the preexisting medical conditions that have a link to RLS. Anemia, kidney disease, diabetes, and other conditions have a strong correlation with RLS.
Your doctor may want to:
- Run blood tests to examine your hemoglobin and blood cell counts. Other tests will reveal your basic organ functions (liver, kidney), thyroid hormone levels and body chemistry.
- If there is any evidence of nerve problems such as neuropathy, your healthcare professional may order an electromyography and/or nerve conduction study.
- Sleep testing (polysomnography) may be used to determine the cause of your sleep disturbances and diagnosis if you demonstrate limb movements periodically. This is particularly valuable for patients that continue to experience considerable disturbances to their sleep even after the symptoms of RLS lessen with treatment.
While there are currently no cures for Primary Restless Legs Syndrome (RLS), there exists a variety of treatment options that can often relieve disruptive symptoms. If you suffer from secondary restless legs syndrome (or RLS that is caused by another underlying medical condition), your treatment will focus on addressing the underlying cause.
All possible pre-existing medical conditions should be discussed and treated. These include, but are not limited to, nutritional deficiencies, diabetes, kidney disease, varicose veins, thyroid disease, Parkinson’s disease or anemia. Make sure to share your full medical history with your doctor. Your doctor might recommend taking nutritional supplements to correct any deficiencies in your vitamin or mineral levels as determined by your blood tests. For many patients, these simple interventions are all that is needed to relieve RLS symptoms.