It’s the middle of the night and you’re not sleeping; you’re searching for restless legs syndrome treatments to quell the uncontrollable urges to move your legs. And you’re not alone: Among the 10% of the population with RLS, 2.5% seek medical help. “In some cases it’s so severe that you can’t fall asleep and you feel miserable. It can affect work, school or relationships. You’re tired or irritable or you don’t have the drive to do things. It can be quite troublesome,” says Dr. Erek Lam, chief of sleep neurology and clinical assistant professor at the University of Pittsburgh Medical Center.
Finding relief depends on what’s causing your RLS.
What Is Restless Legs Syndrome?
RLS is neurological disorder, and some experts consider it a sleeping disorder as well. It’s typically a lifelong problem characterized by:
— An urge to move your legs.
— Symptoms that are worse with rest, such as sitting or lying down.
— Symptoms that are worse later in the day, afternoon or evening.
— Symptoms that diminish with movement.
About 15% of the people with the condition experience general leg discomfort that causes leg movement urges; 85% have more specific symptoms. Symptoms range from moderate to severe.
“People describe it in a lot of ways — creepy-crawly, burning or tingling. And sometimes it can’t be described in usual terminology; someone might say it feels like they have Pepsi Cola running through their veins,” says Dr. Arthur Walters, a professor of neurology in the sleep division of Vanderbilt University Medical Center. He’s a pioneer in the field of treatment and diagnosis.
Restless Legs Syndrome Causes
It’s not exactly clear what triggers RLS.
Suspected factors that cause or worsen the condition include:
— Genetics (RLS may be inherited).
— Imbalances in certain brain chemicals, such as dopamine (which regulates muscles) or opiates.
— Certain medications, such as antidepressants.
— Alcohol intake.
— Caffeine intake.
Other theories about potential causes of RLS include cardiovascular disease, chronic inflammation or autoimmune disease. “In our research, we’ve found about 40 conditions associated with restless legs syndrome. About two-thirds of them have either an inflammatory origin or an autoimmune origin, such as multiple sclerosis, celiac disease or hypothyroidism. But we’re still investigating,” Walters says.
Home Remedies for Restless Legs Syndrome
Home remedy types of restless legs syndrome treatments don’t require a doctor’s order, and you can try them on your own. “These aren’t clinically proven, but they seem to help calm symptoms,” Lam notes. For example, you can:
— Change your lifestyle. Stop smoking and reduce alcohol or caffeine intake. All three substances can rouse you from sleep and increase RLS symptoms.
— Work at night instead of the day. “Some people gravitate toward professions that allow them to stay on their feet in the afternoon or evening — when symptoms are worse — like a night nurse,” Walters says.
— Take a warm bath prior to bed.
— Move your legs. “Anything that moves the legs can give patients relief,” Lam says. “You can massage your legs, use a vibration pad that you sleep on or wear compression socks. I have some patients who get up and ride an exercise bike for five minutes when symptoms act up. Then they go back to bed,” Lam says.
Simple Medical Approaches to Restless Legs Syndrome
Some restless legs syndrome treatments are simple approaches that require your doctor’s interpretation and assistance. Your doctor might recommend that you:
— Change a medication. “We look to see if patients are on medications that can trigger symptoms — antidepressants, certain antihistamines or antipsychotic agents,” Walters says. “It may be possible that they can come off the medication or switch to another one. Occasionally, it can be the only cause of restless legs syndrome. A person gets rid of it, and the restless legs syndrome disappears and never shows up again.”
— Take an (oral) iron supplement. A blood test can check for low ferritin levels (a marker of iron stores in the body). Iron supplements are recommended for people with levels below 75 micrograms per liter. “I usually have them start with 325 milligrams daily of ferrous sulfate, and then recheck the iron level in three months. If it’s still low, we can gradually increase it,” Lam says. “For who can’t tolerate iron because it upsets their stomach, we’ll give IV formulations.”
Medications for Restless Legs Syndrome
A number of prescription medications are known to be effective restless legs syndrome treatments. The first line of defense includes:
— Dopamine agonists. These medications — such as ropinirole (Requip), pramipexole (Mirapex) and rotigotine (Neupro) — increase dopamine levels in the brain. They’re the same medications prescribed for people with Parkinson’s disease. The drugs are also FDA-approved to treat RLS.
— Alpha-2 delta calcium channel agents. These medications affect nerve cell activity. “The one that is FDA-approved is a long-acting medication called gabapentin enacarbil (Horizant). Gabapentin (Neurontin) is a short-acting formulation, and we use that commonly,” Walters explains. “The other drug is pregabalin (Lyrica), and it’s a similar agent. The company that makes it never sought FDA approval, so it’s used off-label.”
For people with severe RLS symptoms or those who don’t respond to first-line drugs, other medications may help. These include:
— Opioids. “Opioids may help with the lack of natural opiates, which may be causing RLS. It’s just a theory. We usually start with a shorter-acting drug like codeine,” Walters says. “In severe cases we might try oxycodone (Oxycontin),” Walters says.
— Benzodiazepines. These are first-generation sleeping pills, such as diazepam (Valium) or clonazepam (Klonopin). “These drugs are the least proven to treat restless legs syndrome,” Walters notes. “We usually wait to prescribe them.”
[See: Steps to Fall Asleep Fast.]
Both doctors agree that medications are the most effective restless legs syndrome treatments. But the experts point out that, like all medications, the drugs have potential side effects. For example:
— Lam says some alpha-2 delta calcium channel agents (gabapentin and pregabalin) can increase the risk for depression and also result in increased fluid retention.
— Dopamine agonists can lose their effectiveness and sometimes worsen symptoms. “You’re going along fine, and then there’s a rebound of symptoms that worsen in the daytime. If that happens, we go back to a lower dose,” Walters says.
Can you take restless legs syndrome treatments for a long time? “I have patients who’ve been on the medications for 20 years, and they’re doing fine,” Lam says. “But you need to monitor for side effects and sometimes make adjustments.”
And the best plan isn’t just a single approach but often a combination of several restless legs syndrome treatments — like taking medications, using oral iron supplements and trying a number of home remedies — to give you a better quality of life.
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