Restless Legs Syndrome is a condition that results in an irresistible urge to move the legs. This tends to be noticeable on relaxing, particularly in the evening, or lying down trying to fall asleep. It resolves with physical activity. People may find they have to get out of bed and exercise their legs for a long time before they are able to fall asleep.

This condition is most often a primary disorder due to an inherited trait, and runs in families (usually Autosomal Dominant). Sometimes it occurs as a secondary condition as the result of an underlying health problem (e.g. iron deficiency, thyroid dysfunction, vitamin deficiency, or in association with nerve damage in the legs).

Most, if not all the time there is an associated problem during sleep. This is called “Periodic Leg Movements of Sleep” (PLMS) and is a condition that results in the legs twitching, twisting or jumping, every 20 – 30 seconds during the night. These movements can be bad enough to disrupt the deeper stages of sleep, and result in marked daytime fatigue.

Treatment

There are many medications that can aggravate Restless Legs Syndrome and the first step in managing the condition often involves discontinuing such medications (e.g. SSRI anti-depressants).

If the blood levels of ferritin are below 50, supplementation with iron can be very helpful as a treatment.

Other conservative (non-pharmacological) approaches include:

  • Standardizing bed and wake time
  • Soaking the legs in either hot or cold water prior to bedtime
  • Reducing evening exercise and alcohol consumption
  • Leg vibration and massage

Several medications can be used to try to control both Restless Legs, and Periodic Movements of Sleep. These include:

  • Gabapentin or pregabalin (Lyrica)
  • Medications which increase brain dopamine activity: pramipexole (Mirapex), ropinerole (Requip), rotigotine patch (Neupro). Levodopa/carbidopa (Sinemet) should be use with caution, as this medication can cause augmentation (worsening of the severity of symptoms, with earlier onset during the day) in some patients.
  • Clonazepam

High-potency opioids, such as codeine, should only be used as a last resort, and only under the supervision of a qualified medical professional, as these medications can be addictive.

For more information about Restless Legs Syndrome: