Restless Legs syndrome Treatment

Behavioral Therapy

Establish good sleep hygiene by maintaining a consistent sleep-wake schedule, exercising regularly, and decreasing caffeinated beverages, as well as avoiding alcohol and tobacco.

  • A warm bath prior to bedtime may be beneficial.
  • Practice relaxation techniques such as stretching or yoga.
  • You may try to make small changes to your sleep schedule so you may try to sleep when your symptoms are the least pronounced. This is particularly helpful for patients who do not have early morning obligations and who can stay up 1-2 hours later in the evening, going to bed somewhat later when RLS symptoms may subside in some patients.
  • When your symptoms start, walk, or massage your limbs, apply hot or cold packs, or try a warm bath.
Medication Therapy

A number of medications initially FDA approved for diseases other than RLS are also now approved and used to treat RLS. Treatment is administered according to the severity of the symptoms, the level of relief experienced with the drug and the patient’s tolerance for potential side effects. Patients may receive one or a targeted combination of several of the following prescription medications. 

Iron Deficiency Treatment

Low iron can trigger or exacerbate RLS. Of the numerous lab studies used by providers to identify iron deficiency, serum ferritin appears to have the most specific correlation with RLS severity, but this lab test is often not included in routine evaluations for iron deficiency. Unless your provider has specifically requested an evaluation of serum ferritin, it was most likely not checked.

Serum ferritin provides an indication as to how much iron stores are present in the body. Iron can be present in numerous forms, including free iron, but iron supplementation may be helpful in RLS patients even if these routine iron studies appear to be normal. The normal range for serum ferritin has a wide range from approximately 20-380 ng/ml. However, current data demonstrate that supplemental iron can improve RLS symptoms if the serum ferritin is less than 50 ng/ml.

Therefore, patients with RLS who have a serum ferritin less than 50 ng/ml should start on iron supplementation even if all other iron study results are normal. Patients are typically start on ferrous sulfate 325 mg per day. Your provider may recommend you also take 500 mg of vitamin C to aide in the gastrointestinal absorption of the iron. Iron levels generally take months to improve with oral iron. Any patient with chronic low iron should see their primary care physician to evaluate the underlying cause.

Dopaminergic Agonists

Initially used to treat the tremor and other symptoms in Parkinson’s disease patients, Requip (ropinirole) and Mirapex (pramipexole) are very effective in improving RLS symptoms and are FDA approved to treat moderate to severe RLS. These medications act on dopamine receptors in the brain. Some other medications used to treat Parkinson’s have also been used to treat RLS, but are not FDA approved for this condition. These medications include dopaminergic agents (levodopa plus carbidopa known as Sinemet) and older dopaminergic agonists (pergolide,).

Although the same medications are used to treat both Parkinson’s and RLS, there is no evidence to suggest that patients with RLS have a higher risk for later developing Parkinson’s. Side effects from dopaminergic agonists such as Requip and Mirapex include nausea, lightheadedness and sleepiness. Patients are recommended to not drive a motor vehicle after taking dopaminergic agonists until they have some experience taking these medications.

Epilepsy Medications

The extended-release version of Gabapentin Horizant (gabapentin-enacarbil) and Pregabalin are very effective for the treatment of RLS. Neurotin (Gabapentin) is not FDA approved but is sometimes used as an off-label treatment. The anti-seizure medication carbamazepine may also help RLS.

Narcotic Analgesics

RLS symptoms are typically much improved following the administration of narcotic analgesic medications. These include opiates such as propoxyphene, methadone or oxycodone. Potential side effects include excessive sleepiness, hallucinations, nausea, constipation, and risk of addiction. Narcotic analgesics are only used in special cases of severe RLS and require the close supervision of a physician.
Neurostimulation Therapy

Nidra is a wearable device worn around the upper calf at night while the patient is sleeping. It provides the same relief as walking to relieve moderate to severe RLS symptoms through neurostimulation technology. The treatment is personalized for each patient and adjustable.

Nidra uses Tonic Motor Activation (TOMAC) to stimulate a nerve on the side of each leg which sends a neural signal to activate the muscles of the lower legs. Learn more.