Restless legs syndrome - Treatment 

Treating restless legs syndrome 

Cardiovascular disease

Research has found that people with restless legs syndrome are twice as likely to develop cardiovascular disease (CVD) than the population at large. It is not known exactly why.

The more severe the symptoms, the greater the increase in risk.

You can take steps to reduce your risk of CVD, such as regularly exercising, maintaining a healthy weight, quitting smoking if you smoke and eating a healthy diet.

Read more about preventing cardiovascular disease.

If your restless leg syndrome (RLS) is known to be linked to an underlying cause, then treating that cause can often cure the condition.

For example, iron deficiency can be treated by taking iron supplements, and restless legs syndrome associated with pregnancy usually goes away on its own within four weeks of the birth.

If no obvious cause can be found, then treatment falls into one of two categories:

  • lifestyle changes
  • medication

Lifestyle changes

A number of lifestyle changes may be enough to ease the symptoms of restless legs syndrome. These include:

  • avoiding evening stimulants, such as caffeine, tobacco and alcohol
  • not smoking - read more about quitting smoking
  • taking regular, daily exercise – but avoid exercising near bedtime
  • establishing a regular sleeping pattern – for example, going to bed and getting up at the same time every day; not napping during the day; taking time to relax before going to bed; avoiding caffeine close to bedtime
  • avoiding medicines that trigger the symptoms or make them worse – if you think your medication is causing your symptoms, continue taking it and make an appointment to see your GP.

During an attack of restless legs syndrome, you may find the following measures helpful in relieving symptoms:

  • massaging your legs
  • taking a hot bath in the evening
  • applying a hot or cold compress to your leg muscles
  • doing activities that distract your mind, such as reading or watching television
  • relaxation exercises such as yoga or tai chi
  • walking and stretching

A small medical trial carried out in 2011 found that a type of osteopathic exercise technique called positional release manipulation (PRM) could be of benefit to people with restless legs syndrome.

PRM involves holding different parts of the body in position that has been found to reduce feelings of discomfort and pain.

Medication

Not all medicines used to treat RLS are licensed in the UK. If a medicine is licensed, it means it has been approved by the Medicines and Healthcare Regulatory Agency (MHRA) as a safe and effective form of treatment.

Unlicensed medicines are not necessarily unsafe. They can be prescribed if a health professional feels that the potential benefit of the medication outweighs any possible risk.

The medicine may be unlicensed because there is not enough commercial interest in marketing it, or because it is awaiting approval for a license. If a medicine is unlicensed, it is up to your GP to decide whether they prescribe it to you.

Dopamine agonists

Dopamine agonists are usually recommended if you are having more frequent symptoms. They include:

These medications can occasionally make you feel sleepy so you should be cautious when driving or using tools after taking them.

Other side effects of these medications include:

  • nausea
  • dizziness
  • headache

Painkillers

You may need to be prescribed a mild opiate-based painkiller such as codeine or tramadol to relieve any pain associated with restless legs syndrome.

Another medication that can be used to both relieve pain and relieve symptoms is gabapentin. Side effects of gabapentin include dizziness and feeling tired and sleepy.

Aiding sleep

If you are having a particularly severe flare-up of symptoms that is disrupting your sleep, it may be recommended that you take a short-term course of medication to help you sleep.

These types of medications are known as hypnotics and include temazepam and loprazolam.

Hypnotics are usually only recommended to be used on short-term basis (typically no longer than week).

You may find you still feel sleepy or 'hungover' the next morning after taking your medication. 

Levodopa

Levodopa may be recommended if you only have symptoms now and again. This is because if you took levodopa every day, there is a high risk that it would actually make your symptoms worse.

Levodopa is available in tablet or liquid form and you should take it once you feel the symptoms of restless legs syndrome coming on.

The medication will make you feel very sleepy, often very suddenly, so you should never drive or use tools or machinery after taking levodopa.

Levodopa can cause nausea, so it is usually combined other medications to reduce the nausea.


Page last reviewed: 18/07/2013

Next review due: 18/07/2015

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Comments

The 20 comments posted are personal views. Any information they give has not been checked and may not be accurate.

douggyFresh said on 24 August 2014

Have developed RLS since being on Prozac. Have been on clonazepam for many years, was perfect and but had the downside of being hard to get up in the morning, once up was fine. Docs said it was addictive, and in terms of getting to sleep, 'I needed it'. Was on the lowest dose, but in time its effectiveness wore off. Tried ropinirole (4x0.5mg tabs), is totally useless.
Others have mentioned Hot baths, as hot as you can stand works well not me to just switch off the pain for a while. Bed time I use the strongest Ibuprofen gel on my ankles, and calf muscles, and take a Ibuprofen tab. Often sleep with my feet out of the bed, and have tried elevating my legs for short term relief. Obviously sleeping with someone else in my bed means no too much of a peaceful night for them. This is one of the upsetting issues with RLS is sleeping apart from your partner.
Will try Amitriptyline next time I can get to a doc.

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douggyFresh said on 23 August 2014

I have been using clonazepam for years. It is additive like you could not sleep with out it, in the morning it was hard to get out of bed, tho once up was ok.
But often lead to lots of Coffee in the morning to make you functional at work - a pill to make you sleep a pill to wake you up risk.
Clonazepam is now getting less effective as I get used to it. Tried a new treatment that is much 'safer' though less effective.
A real Hot bath works wonders, but seems like you need to get the timing right.
Very easy to find that you are still awake at 3am as you wait to the sleepiness to take over. Treatment seems to be a 'black art' will have to try Amitriptyline .

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SarahKH said on 23 July 2014

I was prescribed Amitriptyline for pain, not sure how much it has helped the pains from arthritis but amazed at how it stopped my restless legs. I didn't think anything would help but it is brilliant. Just a small dose every night helped.

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Anern said on 30 May 2014

Has R LS for20years.started clonazepam and at last sleep has come.i take them 2hours befor bed been on them for14years.they have save my sanity.i used to have holes in my sheets with kicking.

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army1 said on 30 August 2013

With regard to using tramadol to treat RLS, this drug has actually done the reverse for me and when I was prescribed it for severe back pain after 6 months of taking the drug and going into withdrawal, weaning slowly off it I now find I have severe RLS (something I have never had in my life) and have not slept for 6 nights, give or take a couple of hours. Please be very careful about taking this drug and check the discussion forums on the internet about how nasty it can be. many GPs seem indifferent to tramadol's addictiveness and how severe the withdrawal can be.

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jasonisherwood said on 29 August 2013

katrina200, i`m fine during the day it`s just when I finish my shift at night i`m done for. I can`t lie in bed, I can`t put my feet up and relax. I`m sat here now with my feet up typing this and my right leg is driving me insane. Please tell me there is some medical or psychological cure or alleviation for this. !!!

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Ferhat said on 25 July 2013

I have suffered with RLS for years (I am 40 now). Two years ago I had to take clonazepam pills for two years. I stopped taking pills since a couple of months ago. Believe it or not I never had any problem during taking the pills. My doctor did not let me take the pills more than 2 years. He prescribed a different medicine. But it does not work. I am aware of clonazepam side effects. But for me it was the only way to get rid of RLS. I am going to see my doctor again and ask him if I can continue taking clonazepam again.

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katrina200 said on 10 June 2013

I have been suffering from RLS for 36 years but i have finally found a solution to sleeping at night. Keep your feet cold. I use a fan pointing at my feet all night. I just wish there was an answer for during the day now!

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stvitis said on 15 April 2013

I'm on Ropinirole for about 9 months, but it does not really work now. I use 5% Ibuprofen gel when the twitches get really bad.

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gypsy63 said on 13 April 2013

I've had RLS since the age of 8 and has gotten worst as i've got older i think personally all the info on this site need a serious up date , I have RLS/WED as it's now known as is now classified as a Disease rather than a syndrome , it sounds very doubtful anyone on your link actually suffers with it because then you'd know it's impossible to keep a regular sleep pattern and as for excerise well that makes it a whole lot worst been there done it ... i have RLS/WED 24/7 in both legs and arms no sooner i sit im up even when bad standing gives no reliefe at times ,
we're all different which is why the meds work differently for each of us i myself can't take meds which are for those with Parkinson's they make my WED/RLS lots worst to the point where i didn't sleep for over a week not even half hour , my Iron level is normal etc! just wish more research could be done to find a cure ,

Restless Leg Syndrome now known as Willis Ekbom Disease

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dorisdevon said on 01 February 2013

Thanks for the excercise tips,I shall definately try them.
My symptoms started after coming off 400mgs Tramadol and 30mgs Amitriptyline a day for back pain
relief(trapped nerve ) I drink the tonic water with quinine as mentioned it doesn't work for me. I would
strongly advise excercise,walking if you can,drugs only cause other problems as I have found to my cost.
Sadly I cannot walk very far,but if you're fit and able get
out there and do it!! Very best of luck to you all.

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Mrs RL said on 21 December 2012

I have suffered from RLS for 50 years and couldn't sit still while visiting friends, go on a a train journey,
visit the cinema or even sleep. It ruled my life. However, the following lifestyle changes have helped me enormously and I can now sleep at night, visit the cinema, go on a plane journey, visit friends in the evenings etc.

1. Elevate your legs on the wall behind your bed before you go to sleep every night. Wait until your legs cool down. This can take between 30 - 60 minutes but better that than tossing and turning all night.
2. Purchase the contraption that hospitals use to keep the bedcovers off your legs. You can put a blanket over the space left at the bottom of the bed. This allows your legs to remain cool.
3. If desperate, go into the shower and spray cold water on your legs until they cool down.
4. On plane journeys try to restrict carbs the day before your journey and place a rucksack under the seat in front and put your feet on it. Raising your legs really helps.

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The Gannet said on 09 November 2012

Just wondering if anyone has pursued the PRM technique that is mentioned above or where can one see the results of the trial ?

It would obviously be wonderful if sufferers could dispense with the need for medication. I discussed with my Physiotherapist but she is not familiar with the technique.

Has anybody consulted an Osteopath or better still had the treatment ?

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kismet35 said on 22 August 2012

I have had since I was a child (now 60) although only since the menopause has it become a real issue.

I take 2mg of Ropinorole and use a 2mg Neupropatch. Although the drugs in no way take away the symptoms they at least hold it at bay until the evening. Without the patch (sometimes it falls off or doesnt adhere 100%) I am jumping around from midday. The patches also bring me out in a rash and sometimes, if the same area has been used too recently, blisters! Urgh!!

All the comments I have read seem to be the problem is at night, but mostly - whether due to medication - I am ok then. It's the afternoons and evenings! I cannot sit down in an armchair or sofa. The kitchen stool seems better (why?) I cannot go to see a film or play or just slob and watch the TV - I would love to. Sometimes I have to stop driving, beause if it is really bad the leg jerk is uncontrollable - not conducive. I work in an office and sometimes can't sit at my desk - I work standing up. As for the journey home on the train ..... It is worse if I feel closed in too.

i had a hip replacement 3 years ago and was worried how I would cope - but they gave me Morphine - OMG what bliss - no RLS :D

When I have been to see the neurologist I just feel guilty as I am waiting amongst people with Parkinsons Desease and Motor Neurone etc. Neupro patch IS a Parkinsons drug. But RLS rules my life and I am so sick of it. Has anyone come up with anything I haven't tried?

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kaoskatt said on 20 April 2012

I have suffered from this for years, especially since I also succumbed to rheumatoid arthristis in 2000. A couple of years ago, a friend who also has issues with RLS suggested I try a glass of tonic water when afflicted - but it had to be Schweppes or similar genuine tonic containing quinine [not ones with just the flavouring]. I now keep diet tonic by my bedside and can report that drinking a small glass of it [under half a pint] subdues my symptoms within 15 minutes. I have no idea why, but it works for me every time.

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greystone said on 16 April 2012

I have suffered with this complaint for the past 30 yrs my father also had it we both used the same system as prevously described by RLSsufferer and Soowhizz and that is the tiptoe stretch but for me after all these years I have to get up to about 100 before the calf muscle tighten's up and the relief comes, I sometimes follow that with some stretching by touching my toes either reaching down to the floor or by siting on the floor and reaching forwards. It only works for me after the symptom's have come on, so at 2am in the morning it's not great but effective ! Over the years I have tried all the pills and potions and this is the only thing that is effective for most of the time , but some nights it's just grit yur teeth and bear it . Hope this helps someone.

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belinda666 said on 05 November 2011

omg i never heard off rls.ive had it getting on for 2yrs and no sleep,it makes you deppresive to,i feel like ime addicted to painkillers,but reading this its time i went to the docs,its an absolute ngtmare,i feel like its taken over my lifeive got it bad i fidget all ngt,i feel exhausted to be honest.i never dreamed other people suffer to,i cant bare the thought off having this the rest off my life,love and best wishes to you all xxxxxxxxxxxx

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tpws said on 19 October 2011

I have had RLS for about 6 years now and it is getting worse I am now taking ropinirole 3 mg just to get through the night.
I take Citalopram for stress which I'm told makes the RLS worse, but as yet no one has come up with an alternative.
If anyone can help out there that would be great.

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Soowhizz said on 11 March 2011

I have suffered with RLS for a number of years now and I do exactly the same as you do to relieve it. I can then get back in to bed and go to sleep!

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RLSsufferer said on 30 June 2010

I have suffered with RLS for nearly 2 years, since I was pregnant. It advises not to exercise just before bed. I have found that my calf muscles feel too active at night and need wearing out. So either just before bed, or after the RL symptoms have started, I stand up on my tiptoes and slowly lower my heels to the floor (like calf raising exercises) 15-20 times. This seems to wear my legs out sufficiently to relieve the symptoms and allow me to sleep. I didnt think anything of what I was doing, until I overheard a pregnant lady complaining of her restless legs. Like me she had tried stretching and it didnt work. I demonstrated the exercises I do to her. She came back to mea week later and told me they work a treat and I should share the advice. So I hope this helps people. I would love to know if they work for anyone else?

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Getting ready for bed

If you have difficulty nodding off, a regular bedtime ritual will help you wind down and prepare for sleep