Treating restless leg syndrome

Restless leg sydrome (RLS) is common, affecting about 10% of adults. Fortunately, only about a quarter of all people with RLS are affected seriously enough to require medical attention.

RLS becomes more common as people get older, but it can begin surprisingly early in life. In early childhood RLS is often misdiagnosed as “growing pains” or attention deficit disorder. In all age groups, RLS is more common in females than males.

Help yourself

The first step is to get a general check-up to make sure your overall health is good and to correct any problems your doctor may uncover. In particular, you should review your medications because some drugs may aggravate RLS, including antihistamines, some antidepressants, antinausea drugs like Compazine, calcium channel blockers (used for high blood pressure and angina), and metoclopramide (used for gastric disorders).

If you smoke, stop. It may help relieve RLS, and it will surely help your health.

If you drink alcohol, try stopping to see if it helps take the edge off your RLS. The same goes for caffeine — and that means cola and energy drinks and chocolate, as well as coffee and tea.

Getting moderate exercise during the day may help calm your legs at night; walking is a fine example. Special leg-stretching exercises at bedtime may also help (see figure). Some people find that cold showers are beneficial, but others prefer heat. Finally, some people with mild RLS may be able to get to sleep by simply massaging their calves or stretching their legs in bed. But most people with moderate to severe RLS need medication.

Despite its name, RLS is not a disorder of the legs but of the nervous system. Many experts believe that it’s caused by low levels of dopamine, a chemical that transmits signals between nerve cells. Parkinson’s disease is also caused by a dopamine deficiency, but that disease is more serious since brain cells that produce dopamine are progressively damaged and destroyed. Even though RLS and Parkinson’s disease are very different disorders, some of the best drugs for RLS were originally developed for Parkinson’s.

Some patients with RLS respond well to a simple tranquilizer (such as diazepam, or Valium) at bedtime, and others do well with a pain reliever (such as propoxyphene, or Darvon). But drugs that boost the brain’s supply of dopamine or mimic its effect in the brain appear more effective, especially for moderate to severe RLS.

The first drug that proved useful is levodopa, which is converted by the brain into dopamine. It is usually administered along with carbidopa in a single tablet (Sinemet). Because higher doses and daily therapy can actually make RLS worse, it is wise to reserve Sinemet for patients with occasional RLS who respond to low doses of the drug and need treatment no more than two or three times a week. Other side effects may include nausea, lightheadedness, hallucinations, and insomnia.

A better approach is to use drugs that mimic the action of dopamine. Ropinirole (Requip) and pramipexole (Mirapex) are approved by the FDA specifically for RLS. Doctors often start with a low dose two hours before bedtime and gradually increase the dose if necessary. Side effects are uncommon, especially in the low doses used for RLS, but may include nausea, constipation, nasal stuffiness, and fatigue. A related dopamine mimic, cabergoline (Dostinex), can also relieve RLS, but unlike the preferred drugs, it has been linked to heart valve scarring when used in high doses for Parkinson’s disease.

Certain antiseizure medications present another choice. Gabapentin (Neurontin) is an example. Some patients respond well to as little as 100 to 300 mg at bedtime, but doctors can gradually increase the dose, if necessary. Side effects may include fatigue, sedation, dizziness, and clumsiness.

What treatments have you found help RLS?

Sleep can be as important to your health as diet and exercise, but for many people, falling and staying asleep isn’t easy. The Harvard Medical School Guide to a Good Night’s Sleep lays out a six-step plan to improve sleep and deal with common issues like insomnia, disrupted sleep, sleepwalking, and the many other chronic sleep conditions that affect more than 70 million Americans. Through lifestyle and environment changes, you can finally sleep soundly—without necessarily having to take a pill.

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