Treatment for Restless Legs Syndrome

Restless legs syndrome (RLS) is a disorder that causes people to feel an uncontrollable, and sometimes uncomfortable, urge to move their legs. While there is no known cure for RLS, researchers have identified promising treatments that may reduce the severity of RLS symptoms, improve quality of life, and promote restful sleep.  

Most often, people with RLS experience symptoms during times of inactivity and in the evening when they are either sitting or lying down. Restless legs syndrome can lead to trouble falling asleep and sleep disruptions. In fact, people with RLS often name disturbed sleep as their most bothersome symptom. 

People with restless legs syndrome may be able to alleviate symptoms with lifestyle changes, medications, or treatments for related illnesses. Medical providers often determine how to treat RLS based on the frequency and severity of symptoms, whether a person has another health condition, and age.

Most people who have restless legs syndrome report that lifestyle changes can help reduce their symptoms. 

• Movement: Most people with RLS receive some immediate, short-term relief by moving their legs, such as by walking or stretching. 
• Sleep improvement: Not getting enough sleep can worsen RLS symptoms, so working on healthy sleep habits may help. Experts recommend that adults get at least seven hours of sleep per night. Identifying and treating any sleep disorders causing disrupted sleep, like sleep apnea, may also help relieve RLS symptoms.
• Sensory stimulation: Activating the physical senses may also temporarily relieve uncomfortable sensations associated with RLS. For example, a person may rub their legs, put pressure on them, or immerse them in hot or cold water in order to feel relief.
• Mental stimulation: Similarly, stimulating the mind may help alleviate RLS symptoms. Doing a crossword puzzle or reading during times of less activity may reduce symptoms or provide a distraction. 
• Regular exercise: Following a consistent exercise routine has been shown to improve symptoms of restless legs syndrome and improve sleep quality. 
• Avoiding or limiting certain medications: Some medications may increase RLS symptoms. These medications include certain antidepressants, antipsychotics, antihistamines, and medications that treat nausea. That said, people with RLS should not stop or reduce any medications without first discussing it with a doctor.
• Limiting caffeine and alcohol intake: Caffeine is known to aggravate RLS symptoms, and both caffeine and alcohol may negatively impact sleep quality. Experts suggest people with RLS limit the caffeine and alcohol they consume to find out if doing so may alleviate discomfort associated with the disorder. 
• Taking a bath: Soaking one’s legs in a bath may help improve symptoms of restless legs syndrome. Taking a bath in the evening may also promote relaxation before sleep. 

In people with mild RLS, these therapies may be enough to provide relief, but those with more severe symptoms might require medication in addition to lifestyle adjustments.

When restless legs syndrome symptoms are more frequent or severe and lifestyle changes are not helping, doctors may prescribe a medication. Multiple medications for RLS are available. Some medications may have more side effects than others, so it’s important to talk with a doctor about potential risks and benefits prior to starting medication. 

Gabapentinoids

Gabapentinoids are often the initial treatment for people with chronic RLS. These drugs are primarily used to treat epilepsy or anxiety, though evidence shows that they are also effective in treating restless legs syndrome.

Gabapentinoids don’t worsen RLS symptoms and can be helpful in people with other health conditions such as chronic pain, anxiety, or insomnia. These drugs are also typically used in people who have restless legs syndrome associated with Parkinson’s disease.  

Medications That Affect Dopamine

Medications that affect dopamine were some of the first medications found to alleviate restless legs syndrome. Dopamine is a neurotransmitter that helps send messages throughout the body and plays a role in movement.  

These drugs are still used to treat RLS, but usually only at low doses and for people who do not need to take medication every day. Long-term use of these types of medications may increase a person’s risk for developing more severe symptoms of RLS.

Benzodiazepines

In mild cases of restless legs syndrome, doctors may prescribe a benzodiazepine. Benzodiazepines are a family of sedating drugs that reduce anxiety, muscle spasms, and the frequency of seizures. 

Benzodiazepines may work best for people who have less-frequent RLS symptoms and only need the drug occasionally, rather than for regular, ongoing use. These medications can be habit-forming and may cause long-term side effects that can negatively impact the sleep cycle.

Certain medical issues can impact symptoms of RLS and treatment recommendations. 

• Kidney disease: Conditions that affect the kidneys increase the risk for RLS and include chronic kidney disease and those on dialysis. People on dialysis tend to have more severe RLS symptoms.
• Neuropathy: When nerves are damaged in the body, causing pain, tingling, or numbness in the hands or feet, it’s called neuropathy. RLS is more common in people who have neuropathies that come from underlying causes like diabetes, alcohol abuse, and pinched nerves. 
• Spinal cord disease: Certain conditions and injuries to the spinal cord can trigger RLS symptoms. Anesthetic procedures involving the spinal cord can also exacerbate RLS.
• Multiple sclerosis: This condition affects the brain and spinal cord, resulting in muscle weakness, challenges with balance, numbness and tingling in the body, and memory issues. Research shows that those with multiple sclerosis have an increased risk for developing a more severe case of RLS.   
• Parkinson’s disease: This neurological disorder impacts functioning, movement, and coordination. Having Parkinson’s disease brings an increased risk for restless legs syndrome, but symptoms may be less severe and less likely to cause daytime sleepiness. 

Iron Deficiency and Restless Legs Syndrome 

People with restless legs syndrome often have low levels of iron. Iron helps oxygen flow throughout the body and plays a role in motor control. If iron levels are depleted, research shows that involuntary motions can occur. 

Iron deficiency is a common issue among pregnant people. Studies also show that people assigned female at birth are more likely to have restless legs syndrome. When considering treatment options for pregnant people with RLS, most experts recommend holistic and therapeutic approaches instead of prescription medication.

When deciding the most appropriate treatment plan for restless legs syndrome, a doctor might check levels of ferritin, which is a protein in the body that contains iron. If the levels are low, they might recommend iron supplements.

Limited research has found that medical devices can effectively treat restless legs syndrome, and there are a couple of prescription devices that have been approved by the FDA as treatment options for RLS. 

• Lower leg and foot pressure wrap: This device applies ongoing pressure to the lower leg and foot intended to provide relief by stimulating specific muscles. Pressure is applied by applying foam pressure pads to the feet and wrapping them with cloth. Velcro keeps the wrap in place, and the pads push into the bottoms of the feet.
• Vibrating counter-stimulation device: To use this device, a person places a foam pad covered in cloth beneath their legs before sleep. The pad vibrates at a pre-programmed intensity level for a 35-minute period that can be repeated once. This stimulation may help a person with RLS sleep better.

Both RLS medical devices are considered relatively low-risk. People with RLS interested in considering a medical device to treat their symptoms should talk with their health care provider.