How do you treat restless legs syndrome?

DEAR DOCTOR K:

I’ve just been diagnosed with restless legs syndrome. Can you tell me the latest medicines for this condition?

DEAR READER:

Restless legs syndrome (RLS) is a neurological condition that causes uncomfortable sensations in the legs. In describing these odd sensations, my patients use words such as “tingling,” “prickly,” “crawling,” “pulling” and, sometimes, “painful.”

The discomfort of RLS usually comes with an overwhelming urge to move the legs. In fact, moving the legs may actually make them temporarily feel better. RLS also can cause occasional jerking leg movements during sleep. That’s why doctors often call it a “movement disorder.”

RLS symptoms tend to worsen when you’re inactive, particularly at bedtime. As a result, many people, as you do, find it hard to fall and stay asleep. Then a vicious cycle can set in. Poor quality sleep makes you feel generally worse and may make the unpleasant sensations worse as well. That’s because when you don’t get enough sleep, all sorts of bodily sensations — particularly pain — are amplified.

Treatment will depend on how severe your symptoms are. If they are mild, then exercising, stretching or massaging your legs or taking a hot bath may bring relief. In the past, we’ve talked in this space about lifestyle changes that can help to reduce the symptoms of RLS. But you asked specifically about medications.

Several different medicines can improve or even eliminate the bothersome symptoms. The first may surprise you: iron pills. That’s because people who have deficient levels of iron in their body are much more likely to develop restless legs syndrome. Menstruating women sometimes develop iron deficiency because they lose iron in their blood each month, but there is no similar common cause of blood loss in men. If your blood iron levels are definitely low, or even if they are in the low normal range, you should talk with your doctor about iron pills.

The more conventional drugs that are used for RLS include the following, taken alone or in combination:

  • Dopaminergic agents usually relieve discomfort and improve sleep quality. The two most commonly prescribed drugs are pramipexole and ropinirole. A relatively new drug of this type is rotigotine. It is available as a pill and also as a skin patch that you apply for a day, and replace the next morning with a fresh patch.
  • Benzodiazepines are sedatives that improve sleep quality.
  • Anticonvulsants are especially useful in patients whose symptoms are painful.
  • Opioids are narcotics, such as codeine and oxycodone. They relieve pain and suppress symptoms. Opioids are generally reserved for people with severe, unrelenting symptoms that do not respond to other treatments.

As is often true in medicine, you and your doctor may need to try different treatments, in different doses and combinations, to find out which is best for you. But after that period of trial and error, you’re likely to get that good night’s sleep you’ve been dreaming of.

(This column is an update of one that ran originally in July 2012.)