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What is restless legs syndrome and how do you treat it?

Posted on Dec. 21, 2018 ( comments)

You’ve had a busy day and you’re settling in for the evening, but suddenly you have the uncontrollable urge to move your legs — and it’s only relieved by doing so. It’s affecting your sleep and your ability to relax in general. What’s going on, and can it be treated?

We talked to Suzette Gagnon-Bailey, ARNP, who practices at MultiCare Sleep Medicine clinics in Tacoma, Auburn and Puyallup, for answers.

What is restless legs syndrome?

Restless legs syndrome (RLS) is a common sleep-related movement disorder that mostly occurs in the evening when people are relaxing. They’ll get an uncomfortable urge to stretch or move. Movement temporarily relieves their symptoms, but as soon as the person relaxes the symptoms come back.

Who gets RLS and how common is it?

About 7–11 percent of people in the United States have RLS, and though it occurs in both men and women, it’s more common in women. It can affect any age, but the more severe form most often occurs in middle adulthood, ages 45–60.

What causes RLS?

We don’t know the actual cause, but research supports a possible link to genetics. If someone in your family has RLS, there’s an increased likelihood you’ll have it too.

There’s also considerable evidence that RLS is related to a part of the brain that causes movement and is controlled by a chemical called dopamine. We need dopamine to make smooth movements, so if there’s an interruption in dopamine levels you may make infrequent, involuntary movements, similar to people with Parkinson’s disease.

RLS may also be related to low iron stores, renal disease and hemodialysis.

Pregnancy can increase the likelihood of RLS, especially in the last trimester, but it usually goes away after pregnancy ends.

How is RLS treated?

RLS isn’t curable, but it can be managed with medications, depending on the cause.

If your iron levels are low, then I’d recommend an iron supplement. If your iron levels are normal but you have a family history of RLS, then I’d prescribe other medications. The most common is a class of drugs called dopamine agonists that help promote dopamine and thus lessen the symptoms of RLS.

Other treatment options include medications that treat neuropathy or seizures, because they reduce irritation to the nerves that cause the jiggling sensation of RLS.

For severe cases of RLS, sometimes benzodiazepines or opiates are prescribed, but we try to avoid going that route since those are addictive and habit forming.

A special note about dopamine agonists: Those who take these to treat the symptoms of RLS should monitor their dosage carefully to avoid augmenting. If you start to augment, it means you’re taking so much that your symptoms are actually getting worse rather than being managed.

If this happens, we can take the patient off everything and start with something else, but that’s really a nightmare for everybody. For this reason, it’s best to start with a low dose of dopamine agonist and not increase your dosage without your provider’s blessing.

Dopamine agents can bring out impulsive or obsessive-type behaviors. If you start to notice you’re doing an unusual amount of, say, shopping or gambling, it’s best to talk to your doctor so you can switch medications.

How does RLS impact a person’s day-to-day life?

It can affect a person’s ability to fly, go on long drives or go to the movies. For people who move around during the day, it may only affect them in the evening. But for those who sit a lot during the day, they may have to take medications all day long.

It’s best to take medications before the symptoms occur. So if you know every night at 7pm your legs start bugging you, take the meds at 6pm. Once the symptoms get going, they can be hard to catch up with.

Nicotine, caffeine and alcohol, and certain medications such as antihistamines, antidepressants and cold/allergy meds, can worsen the effects of RLS. Sometimes a person will take an antihistamine to help them sleep, thinking that it will resolve the symptoms of RLS, but it actually makes it harder to sleep because the urge to move becomes stronger.

When should you see a doctor?

It depends. Some people may only experience symptoms of RLS once every few weeks and may not require medication or any intervention. For others it may be happening every night and impacting their sleep. We recommend seeing your primary care provider first if you’re concerned. They can prescribe a medication or, if they’re not comfortable treating it, refer you to a specialist, such as a sleep medicine provider.

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