Treatment for Restless Syndrome
Republished with the permission of the National Sleep Foundation
There is no specific diagnostic test for RLS. If you suspect you may have the disorder, talk to your doctor as soon as you can. If possible, bring a diary of your sleep as well as a record of the occurrence and severity of your symptoms with you. Your doctor will conduct tests to rule out factors that may be causing the symptoms such as pregnancy, iron deficiency and end-stage renal failure. You can expect that he or she will ask what time your symptoms occur, when they are most severe, what you were doing before the onset of symptoms, and how much time elapses before you are able to get to sleep due to your RLS. Your doctor will also need a record of your sleep quality and quantity during the time when symptoms appear and whether or not you experienced any pain along with the RLS symptoms.
Until recently, there were no FDA-approved drugs for the treatment of RLS. In May 2005, a drug called Requip® (ropinirole hydrochloride) that is commonly used to treat Parkinson disease was given FDA approval at lower doses for the treatment of moderate-to-severe primary RLS after patients in clinical trials enjoyed more and better quality sleep as early as one week after starting treatment. In 2006, a drug by the name of Mirapex® was also approved by the FDA for the treatment of moderate-to-severe primary RLS. In clinical trials of Mirapex® it was shown that lower doses (than used for Parkinson’s disease) improve RLS symptoms, sleep satisfaction, and quality of life. Both drugs may cause side effects such as nausea and dizziness and may cause patients to fall asleep without any warning, even while doing normal daily activities such as driving.
In addition to Requip® and Mirapex®, there are several drugs approved for other conditions that have been shown to alleviate RLS symptoms. They are:
Dopaminergic agonists – reduce RLS symptoms
Dopaminergic agents – reduce RLS symptoms
Benzodiazepines – allow for a more restful sleep
Opiates – induce relaxation and diminish pain
Side effects may include daytime sleepiness (dopaminergic agonists and benzodiazepines), hallucinations and nausea (dopaminergic agents) or constipation and dependency (opiates). Before taking any medication, discuss the possibility of side effects with your doctor.
In 1996, Drs. Allen and Earley from Johns Hopkins University described a phenomenon called augmentation, in which RLS symptoms are more severe, spread to parts of the body other than the legs, and begin earlier in the evening as a result of taking dopaminergic agents to treat RLS symptoms. If augmentation occurs it can be managed with dose and medication adjustments.
There are also a number of self-directed activities for managing the symptoms of RLS including walking, massaging the legs, stretching, hot or cold packs, vibration, and acupressure. Practicing relaxation techniques such as meditation or yoga have been known to alleviate symptoms. For many people, treating an underlying cause or effective pharmacological treatment of primary RLS and implementation of coping strategies provides relief from most symptoms. However, sometimes medications need to be changed over time or doses adjusted and regular consultation with a physician is recommended.
Reviewed by Richard P. Allen, Ph.D.and Merrill M. Mitler, Ph.D., May 2005.