Restless legs syndrome (RLS) is a disorder of the part of the nervous system that causes an urge to move the legs. Because it usually interferes with sleep, it also is considered a sleep disorder.
Causes of Restless Legs Syndrome
In most cases, doctors do not know the cause of restless legs syndrome; however, they suspect that genes play a role. Nearly half of people with RLS also have a family member with the condition.
Other factors associated with the development or worsening of restless legs syndrome include:
- Chronic diseases. Certain chronic diseases and medical conditions, including iron deficiency, Parkinson’s disease, kidney failure,diabetes, and peripheral neuropathy often include symptoms of RLS. Treating these conditions often gives some relief from RLS symptoms.
- Medications. Some types of medications, including antinausea drugs, antipsychotic drugs, some antidepressants, and cold and allergymedications containing sedating antihistamines, may worsen symptoms.
- Pregnancy. Some women experience RLS during pregnancy, especially in the last trimester. Symptoms usually go away within a month after delivery.
Other factors, including alcohol use and sleep deprivation, may trigger symptoms or make them worse. Improving sleep or eliminating alcohol use in these cases may relieve symptoms.
Treatment for Restless Legs Syndrome
Treatment for RLS is targeted at easing symptoms. In people with mild to moderate restless legs syndrome, lifestyle changes, such as beginning a regular exercise program, establishing regular sleep patterns, and eliminating or decreasing the use of caffeine, alcohol, and tobacco, may be helpful. Treatment of an RLS-associated condition also may provide relief of symptoms.
Other non-drug RLS treatments may include:
Hot baths or heating pads or ice packs applied to the legs
Good sleep habits
A vibrating pad called Relaxis
Medications may be helpful as RLS treatments, but the same drugs are not helpful for everyone. In fact, a drug that relieves symptoms in one person may worsen them in another. In other cases, a drug that works for a while may lose its effectiveness over time.
Drugs used to treat RLS include:
- Dopaminergic drugs, which act on the neurotransmitter dopamine in the brain.
- Mirapex, Neupro, and Requip are FDA-approved for treatment of moderate to severe RLS. Others, such as levodopa, may also be prescribed.
- Benzodiazepines, a class of sedative medications, may be used to help with sleep, but they can cause daytime drowsiness.
- Narcotic pain relievers may be used for severe pain.
- Anticonvulsants, or antiseizure drugs, such as Tegretol, Lyrica, Gabapentin ( Neurontin ), and Horizant.
Although there is no cure for restless legs syndrome, current treatments can help control the condition, decrease symptoms, and improve sleep.
Usual Adult Dose for Restless Legs Syndrome
Gabapentin enacarbil available under the trade name Horizant (R):
600 mg orally once daily with food at about 5 PM
There are several non-pharmacological approaches that may help alleviate the symptoms of restless legs syndrome (RLS), including:
- Regular exercise: Engaging in moderate exercise, such as walking or yoga, on a regular basis may help reduce symptoms of RLS.
- Hot or cold compresses: Applying a hot or cold compress to the legs may help alleviate discomfort and reduce the urge to move the legs.
- Massage: Gentle massage or self-massage of the legs may help relax muscles and improve circulation.
- Compression stockings: Wearing compression stockings or socks may help improve blood flow and reduce symptoms of RLS.
- Relaxation techniques: Practicing relaxation techniques, such as deep breathing, meditation, or progressive muscle relaxation, may help reduce stress and tension in the body, which can exacerbate symptoms of RLS.
- Maintaining a regular sleep schedule: Establishing a regular sleep schedule, including a consistent bedtime and wake-up time, may help improve sleep quality and reduce symptoms of RLS.
- Avoiding triggers: Avoiding triggers such as caffeine, alcohol, and nicotine, as well as certain medications, may help reduce symptoms of RLS.
It is important to note that these approaches may not work for everyone with RLS, and individuals should talk to their healthcare provider before starting any new treatment regimen.
There are several medications that may be prescribed to alleviate the symptoms of restless legs syndrome (RLS), including:
- Dopamine agonists: These medications increase the levels of dopamine, a neurotransmitter that helps regulate movement and sensation, in the brain. Examples include pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro).
- Iron supplements: Iron deficiency can contribute to RLS symptoms, so taking iron supplements may help alleviate symptoms in some individuals.
- Anticonvulsants: Certain anticonvulsant medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), may help alleviate symptoms of RLS by modulating the levels of certain neurotransmitters in the brain.
- Opioids: In some cases, opioids such as oxycodone or hydrocodone may be prescribed to alleviate severe symptoms of RLS, although their use is generally reserved for individuals with severe symptoms who have not responded to other treatments.
It is important to note that all medications carry some risks, and individuals should talk to their healthcare provider about the potential benefits and risks of any medication before starting treatment. In addition, treatment for RLS may need to be adjusted over time, as the effectiveness of certain medications may diminish or side effects may become problematic.