Restless Leg Syndrome

Restless Leg Syndrome Treatment


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Restless Leg Syndrome

Restless legs syndrome (RLS) is a nervous system disorder causing an urge in a person to move their legs. It is also considered a sleep disorder because it can interfere with ones sleep. Restless Leg Syndrome Treatment encompasses a wide variety of solutions individualized to each patient.

restless leg syndromeDoes Restless Legs Syndrome Ever Go Away by Itself?

There are some cases of restless legs syndrome disappearing on its own. But this is rare. Instead, for most people symptoms get 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 interferes with daily activities.

Simple self-care steps and lifestyle changes may help you. Medications also help many people with restless legs syndrome.

RESTLESS LEGS 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:Aching Creeping Pulling Throbbing legs

  • Crawling
  • Creeping
  • Pulling
  • Throbbing
  • Aching
  • Itching
  • Electric

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. Sometimes, symptoms disappear for periods of time, then come back.

How Can I Get a Good Night’s Sleep Despite Restless Legs Syndrome?

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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 heat or ice, or soak in a hot bath.

When Should I See a Doctor About Restless Legs Syndrome?

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Some people with RLS/WED never seek medical attention because they worry they won’t be taken seriously. But RLS/WED can interfere with your sleep and cause daytime drowsiness and affect your quality 

of life. Talk with your doctor if you think you may have RLS/WED.

You should see a doctor to confirm the diagnosis of RLS and to exclude other conditions that may resemble RLS. The doctor can treat associated problems like iron deficiency.

If you have RLS, you should also see a doctor if you are:

  • Losing sleep often
  • Feeling depressed or anxious
  • Having trouble concentrating

You don’t have to wait until one of these things happens. If you just want to feel better, see your doctor.

Treatment

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

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Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

  • 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, but they may be addicting if used in high doses. 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. A commonly used sedative for RLS/WED is clonazepam (Klonopin). These drugs are generally only used if no other treatment provides relief.

It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.

Caution about medications

Sometimes dopamine medications that have worked for a while 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 antidepressants, some antipsychotic medications, some anti-nausea drugs, and some 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

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and Support for Restless Leg Syndrome

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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

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  • 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. 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.

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 with 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. For example:

  • 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 level 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 seem to run in the family. Individuals with a genetic connection often show signs of RLS when they are younger.

Fortunately there exist some medical tests that can help uncover some of the preexisting medical conditions that have a link to RLS. Anemia, kidney disease, diabetes and other conditions has a strong correlation with RLS. Your doctor may want to:

  • Run blood tests to examine your hemoglobin and blood cell counts. More test will reveal your basic organ functions (liver, kidney), thyroidhormone levels and body chemistry.
  • If there is any evidence of nerve problems such as neuropathy, your healthcare professional may order a needle 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 exist 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.

What is the first step in treating restless legs syndrome?

Often the first avenue of attack against the irritation of RLS is to prevent it from getting worse. You doctor will tell you to avoid foods or substances that have the potential to cause or worsen the condition. You will need to avoid Stay caffeine, nicotine and alcohol. In may 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.

Preexisting Conditions

vein doctor near meAll 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 and nothing else are all that are needed to relieve sufferers’ RLS symptoms.

Many might additionally benefit from stretching, limb massage, and other in-home treatments. Placing cold or hot packs to the stricken areas, cold or hot baths and/or whirlpool baths may also help. Some report relief by stimulating the toes and feet before bedtime. The stimulation can be done vibratory or electrical. Your doctor may also recommend physical therapy, exercise and/or relaxation techniques. 

Restless Legs Syndrome Medication 

Doctors will likely recommend daily medication only for those people who exhibit restless legs syndrome symptoms more than two nights a week. Remember that medications used to help treat cases of primary RLS cannot cure RLS. They relieve symptoms only. On the other hand, those who have symptoms of RLS that only occur erratically may be given medicine to take only when symptoms appear.

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.

  • The most frequent medicines used to treat RLS are dopamine agonists. This class of drugs replicate the function of the neurotransmitter dopamine on the central nervous system. One of the following medications will likely be the first one prescribed by your doctor; ropinirole (brand name Requip), rotigotine (brand name Neupro), and the pramipexole (brand name Mirapex). Side effects may include nausea, lightheadedness and daytime drowsiness.
  • Another class of commonly prescribed drugs to treat RLS are dopaminergic agents. By increasing dopamine levels in the brain, these drugs may improve leg episodes in RLS. For some, these drugs may have the opposite effect. After daily use, some patients report that their symptoms got worse. Side effects may include involuntary movements (dyskinesias) vomiting, nausea, and hallucinations. A common drug is Sinemet which is a combination of carbidopa and levodopa.
  • Other medications used by doctors are benzodiazepines. Benzodiazepines are sedatives that do not truely relieve the symptoms but they do help you sleep through them. Common medications include alprazolam (brand name Xanax), temazepam (brand name Restoril) and clonazepam (brand name Klonopin).
  • Although are commonly used in treating pain, opiates can additionally alleviate the symptoms of RLS. Because of the highly addictive nature of opiates, they are rarely used unless other drugs have been found to be ineffective. One example is hydrocodone (brand names Vicodin and Norco).
  • Often used in the treatment of epileptic seizures, anticonvulsants agents may also help alleviate some of the symptoms of RLS. It has the added benefit of also treating chronic or nerve pain. Your doctor may prescribe 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 seccion of the nervous system in control of involuntary muscle movements and sensations. Clonidine (brand name Catapres) is a well-known example.

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