How Is Restless Legs Syndrome Treated?

The goals of treatment for restless legs syndrome (RLS) are to:

• Relieve symptoms
• Increase the amount and quality of sleep
• Treat or correct any underlying condition that may cause RLS

Types of treatment include:

• Lifestyle changes and other nondrug treatments
• Medicines

Lifestyle Changes and Other Nondrug Treatments

Lifestyle changes can improve and relieve symptoms of RLS. Lifestyle changes may be the only treatment needed for mild RLS. Some lifestyle changes that may help include:

• Avoid things that can make symptoms of RLS worse:
• Tobacco
• Alcohol
• Caffeine—Chocolate, coffee, tea, and some soft drinks contain caffeine. Although it may seem to help overcome daytime sleepiness, caffeine usually only delays or masks RLS symptoms, and often makes them worse.
• Some medicines—Some types of over-the-counter and prescription medicines can also make RLS symptoms worse. These include:
• Antidepressants (most of them)
• Antinausea medicines
• Antipsychotic medicines
• Antihistamines
• Adopt good sleep habits:
• Keep your bedroom or sleep area cool, quiet, comfortable, and free of unnecessary light.
• Use your bedroom for sleeping, not for watching TV or using computers or cell phones.
• Go to bed every night at the same time and wake up at the same time every morning. Some people with RLS find it helpful to go to bed later in the evening and get up later in the morning. The important thing is to get enough sleep so that you feel rested when you wake up.
• Follow a program of moderate exercise

Other activities that also may help relieve symptoms include:

• Walking or stretching
• Taking a hot or cold bath
• Massaging the leg or arm
• Using heat or ice packs

Medicines

Medicines can help relieve some symptoms of RLS. Doctors prescribe medicines to treat RLS in people:

• With clearly defined symptoms
• Whose symptoms cannot be controlled by lifestyle and nondrug treatments

No single medicine is helpful in all persons with RLS. It may take several changes in medicines and dosages to find the best approach. Sometimes, a medicine will work for a while and then stop working.

Some medicines may not be safe for pregnant women.

Always talk with your doctor before taking any medicines, even over-the-counter medicines.

Specific medicines

Medicines used to treat Parkinson’s disease also are used to treat RLS. Even though these medicines help reduce RLS symptoms, RLS is not a form of Parkinson’s disease. The medicines help reduce the amount of motion in the legs. They include:

• Levodopa (le-vo-DO-pa)
• Is best used to treat mild cases of RLS
• Is short-acting
• Works for a while but does not work long term in most people
• Dopamine agonists (pergolide (PER-go-lid), pramipexole (prah-mih-PEX-ohl), and ropinirole (roh-PIN-ih-roll))
• Are used to treat moderate and severe cases of RLS
• Are used to treat mild cases of RLS if levodopa stops working
• Are long-acting

The U.S. Food and Drug Administration recently approved ropinirole to treat moderate to severe RLS.

Other medicines may be used to treat RLS, including:

• Strong pain-relieving medicines (narcotics).
• Used most often when symptoms are severe
• May be used in people who don’t respond to dopamine agonists
• Sedatives (benzodiazepines (BEN-so-di-AZ-e-pens)).
• Help with falling asleep
• May cause daytime sleepiness
• Are not recommended for people with sleep apnea and for older persons
• Medicines used to treat epilepsy (anticonvulsants: gabapentin (gab-ah-PEN-tin), carbamazepine (kar-bam-AZ-e-pen), and valproate (val-PROH-ate)). These types of medicines are:
• Considered when dopamine agonists fail
• Most effective in persons with daytime and evening symptoms, as well as sleep-onset symptoms, and in those who describe the unpleasant feelings in the legs as painful.
• Iron supplements, if iron deficiency appears to be contributing to RLS. Iron supplements should only be used if recommended by a doctor.