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Your Treatment Options for RLS

Content provided by the Faculty of the Harvard Medical School

Treatments include iron supplements, lifestyle changes, and medications. If your blood ferritin is low (less than 50 ng/mL), you should be evaluated to find the cause, which could be a condition other than RLS or bleeding in the digestive or urinary tract. Because meat, eggs, and other animal proteins are major sources of iron in the diet, people who avoid these foods are also prone to low iron levels.

Dr. John Winkelman, medical director of the Sleep Health Center of Brigham and Women's Hospital and associate professor of psychiatry at Harvard Medical School, recommends that RLS patients with low ferritin levels take 65 mg of elemental iron (about the amount in one 300-mg tablet of ferrous sulfate) once or twice a day on an empty stomach with a glass of orange juice. (The vitamin C in the juice boosts iron absorption.) Iron supplements can cause gastrointestinal distress, including cramps and constipation; if that's a problem, start with a lower dose and gradually increase it to the recommended level. If you're taking iron supplements, you should have your ferritin levels checked at least twice a year, as excess iron can cause other health problems.

Some people find that it helps to avoid caffeine, nicotine, and alcohol. Others get relief by distraction — reading or doing crossword puzzles, for example — but mentally stimulating activities won't work so well when you're trying to get to sleep. You may get some relief around bedtime by rubbing or squeezing the leg muscles, applying cold or warm compresses (or taking a warm bath), and stretching the calf muscles (see the illustration). It may also help to get moderate exercise during the day, such as walking or swimming.

Dr. Winkelman advises his patients with RLS to schedule activities that require prolonged sitting or reclining — airplane flights, beauty appointments, or massage or acupuncture treatments, for example — in the morning rather than the afternoon.

Medications prescribed for RLS, by medication class and side effects

Drug name

Side effects

Comment

Benzodiazepines

diazepam (Valium)

clonazepam (Klonopin)

temazepam (Restoril)

Clumsiness or unsteadiness, dizziness, lightheadedness, daytime drowsiness, headache.

Best for mild or intermittent symptoms. Do not take with alcohol or if you have sleep apnea. May be habit-forming; can trigger withdrawal symptoms if stopped abruptly.

Dopamine agents

cabergoline (Dostinex)

levodopa-carbidopa (Sinemet) pramipexole* (Mirapex)

ropinirole* (Requip)

Nausea, weakness, dizziness, abnormal body movements, cognitive and memory problems. Rare instances of impulse-control behaviors (e.g., obsessive gambling or shopping).

Usually reserved for people with daily symptoms. Long-term use may lead to a worsening of symptoms.

Hypnotics

zaleplon (Sonata) zolpidem (Ambien)

Headache, daytime drowsiness, dizziness, nausea, drugged feelings.

Best for mild or intermittent symptoms. Do not take with alcohol, antihistamines, muscle relaxants, or sedatives.

Opioids

oxycodone (OxyContin, Percocet) tramadol (Ultram, others)

Depressed breathing and circulation, dizziness or lightheadedness, next-day sedation, constipation, nausea, vomiting.

Usually reserved for people with severe symptoms who don't get relief from dopamine agents or benzodiazepines. Low risk of abuse in people with RLS. Do not take with alcohol or if you have sleep apnea.

Anticonvulsants

gabapentin (Neurontin)

gabapentin enacarbil* (Horizant) pregabalin (Lyrica)

Dizziness, fatigue, sleepiness, trouble walking.

Usually prescribed for people in whom dopamine agents no longer work. Can help ease "creepy-crawly" sensations and nerve pain.

*These drugs are FDA-approved to treat RLS. Other medications in this chart are approved for other conditions but have been found to be helpful in treating RLS.

Reference: Sleep Disorders section on Better Medicine


More Information on Restless Legs Syndrome

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A combination of moderate aerobic exercise and lower-body resistance training 3 times per week may reduce symptom severity by about 50%.