9 Tips to Treat Restless Legs Syndrome

There Are Ways to Get Relief From RLS Symptoms
By Carole Jacobs, Special to Lifescript

Restless legs syndrome can be debilitating - taxing your job, health and relationships. Here are some tips to reduce RLS symptoms and take back your downtime...

Do friends or family members roll their eyes when you can’t still long enough to watch your favorite TV show, enjoy dinner or take in a movie or play?

“Don’t be dissuaded by people who think that restless legs syndrome is ‘all in your head,’” advises Donald Watenpaugh, Ph.D., director of Sleep Consultants in Fort Worth, Texas, and a restless legs syndrome sufferer.

It’s a real disease with recognizable features and an underlying biological basis, agrees David Rye, M.D., Ph.D., professor of neurology at Emory University School of Medicine in Atlanta, director of the Emory Healthcare Program in Sleep and co-author of a 2007 landmark study that isolated a gene believed to dramatically increase the risk of restless legs syndrome.

About 10% of women suffer from restless legs syndrome (RLS), a neurological sleep and movement disorder that causes painful, crawling sensations in the legs and an irresistible urge to move them.

According to the National Institutes of Health, 2%-3% of adults, or more than 5 million people, have reported moderate to severe RLS symptoms.

Although RLS isn’t curable, you can take many steps to calm symptoms.

“To isolate things that may trigger symptoms, record eating, exercise, medication and sleep habits in a diary and watch for patterns,” says Jacci Bainbridge, Pharm.D., president of the Restless Legs Syndrome Foundation board and a professor of pharmacology and neurology at the University of Colorado in Denver. (For a seven-day diary, visit www.rls.org.)

1. Beware of high blood pressure.
The higher your blood pressure, the worse your RLS symptoms are likely to be, especially if you're middle-aged, according to a 2011 Harvard study of 98,000 women.

Taming hypertension can help reduce RLS symptoms, the study found.

To lower blood pressure, “eat a healthy diet, engage in regular physical activity and maintain a healthy weight,” advises lead researcher Xiang Gao, M.D., Ph.D., assistant professor of medicine at Harvard Medical School and author of several studies on restless legs syndrome.

2. Lose the ab flab.
Obese women with excess belly fat may be more likely to develop restless legs syndrome than those who maintain a healthy weight, according to a 2009 Harvard study conducted on more than 80,000 overweight people with restless legs syndrome.

In the study, women with a body mass index (BMI) of 30 or more were 42% more likely to have RLS than those who were at normal weight or underweight (BMI of less than 23).

The underlying culprit could be decreased dopamine levels in the brains of obese people, says Dr. Gao, lead study author.

“Since decreased dopamine function is believed to play a critical role in restless legs syndrome as well, this could be the link between the two,” he says.

To lose weight and blast belly fat, eat a fat-burning diet with 30% protein, 40% carbohydrates and 30% fat, suggests David Edelson, M.D., a New York-based internist and bariatric surgeon and assistant clinical professor of medicine at Albert Einstein College of Medicine in New York.

That's basically a Mediterranean diet, he says. (For examples of these dishes, read 10 Mediterranean Recipes.)

Add weight training, and you’ll burn more calories and lose more pounds than women who rely solely on diet, according to a 2010 study at the University of Missouri.

But be cautious at the gym, says Michelle Bommarito, an American College of Exercise (ACE)-certified fitness instructor and personal trainer who works with women who have restless legs syndrome.

“Women with restless legs syndrome should avoid weight machines that overstress their legs, such as leg presses, treadmills and elliptical trainers and focus on machines that work their arms, shoulders and abdominal muscles, such as abdominal crunch machines, chest press machines and bicep curl machines,” she says.

3. Find the right amount of exercise.
Engaging in aerobic and lower-body resistance training three times weekly will help decrease RLS symptoms, according to a 2011 study conducted by Brigham Young University in Utah.

In fact, if you avoid exercise completely, your symptoms may increase, according to a 2007 study conducted at the University of Kentucky College of Medicine.

But strike a happy medium.

“Overly strenuous exercise, especially if you’ve never done it before, can also aggravate symptoms by irritating and inflaming leg tissues,” Watenpaugh says.

Stick to low-impact exercises such as walking, low-impact aerobics classes and water aerobics and avoid high-impact activities such as running and long-distance running, Bommarito says.

It’s a real disease with recognizable features and an underlying biological basis, agrees David Rye, M.D., Ph.D., professor of neurology at Emory University School of Medicine in Atlanta, director of the Emory Healthcare Program in Sleep and co-author of a 2007 landmark study that isolated a gene believed to dramatically increase the risk of restless legs syndrome.

About 10% of women suffer from restless legs syndrome (RLS), a neurological sleep and movement disorder that causes painful, crawling sensations in the legs and an irresistible urge to move them.

According to the National Institutes of Health, 2%-3% of adults, or more than 5 million people, have reported moderate to severe RLS symptoms.

Although RLS isn’t curable, you can take many steps to calm symptoms.

“To isolate things that may trigger symptoms, record eating, exercise, medication and sleep habits in a diary and watch for patterns,” says Jacci Bainbridge, Pharm.D., president of the Restless Legs Syndrome Foundation board and a professor of pharmacology and neurology at the University of Colorado in Denver. (For a seven-day diary, visit www.rls.org.)

4. Find the right amount of exercise.
Engaging in aerobic and lower-body resistance training three times weekly will help decrease RLS symptoms, according to a 2011 study conducted by Brigham Young University in Utah.

In fact, if you avoid exercise completely, your symptoms may increase, according to a 2007 study conducted at the University of Kentucky College of Medicine.

But strike a happy medium.

“Overly strenuous exercise, especially if you’ve never done it before, can also aggravate symptoms by irritating and inflaming leg tissues,” Watenpaugh says.

Stick to low-impact exercises such as walking, low-impact aerobics classes and water aerobics and avoid high-impact activities such as running and long-distance running, Bommarito says.

5. Step up your sex life.“Although it’s not clear why, some women with restless legs syndrome find prolonged relief after having an orgasm, whether through sexual intimacy or masturbation,” says Mark Buchfuhrer, M.D., an internist and pulmonary specialist at SomnoMedix Sleep Disorders Center in the Los Angeles area and co-author of Restless Legs Syndrome: Coping With your Sleepless Nights (Demos Medical Publishing).

Having sex at bedtime could help relieve bothersome RLS symptoms that otherwise would keep you awake, he says.

But to avoid triggering symptoms, use positions that don’t overstress your legs and don't get too strenuous during sex, he says.

6. Consume enough iron and folate.
Patients with restless legs syndrome had decreased iron levels in their cerebrospinal fluid, according to a 2007 review of studies of more than 35,000 patients by Durango Natural Medicine in Colorado.

An iron deficiency in central brain neurons is believed to disrupt the brain’s dopamine levels, triggering RLS symptoms, says Rebecca Gray, M.D., an ob-gyn with Baylor Medical Center in Irving, Texas.

About 90% of American women are iron-deficient, the Durango study found.

Folate, a vitamin, is also crucial because it's needed to make red blood cells and prevent iron-deficiency anemia.

To find out if you're deficient in iron, get annual tests that detect levels of the metal in your blood, says midwife Jennifer Hensley, R.N., coordinator of nurse-wifery at the University of Colorado College of Nursing in Denver, and part of the International Restless Legs Syndrome Study Group, which is setting guidelines for treating restless legs syndrome during pregnancy.

To help prevent iron deficiency, eat iron-rich foods, for example, dark green vegetables, liver, wheat germ, kidney beans and lean beef.

To help your body absorb iron, also consume foods high in vitamin C, such as citrus fruits, and fortified cereals and grains, Hensley adds.

Also, get plenty of folic acid, or folate, by eating lentils, leafy greens like spinach, kale and collard greens and asparagus.

7. Distract yourself.
Daytime boredom and inactivity can trigger a restless legs syndrome attack, Buchfuhrer says.

“Activities that increase alertness often improve symptoms [for a few hours] by changing the mental state and activating the body’s motor system (and increasing dopamine levels),” he explains.

Do something to get your mind absorbed in a game or hobby. For example, play a video game, do a crossword puzzle or needlework, play cards or read an interesting book, Buchfuhrer says.

8. Get help for depression.“Restless legs syndrome can lead to depression, which in turn can interrupt sleep and make symptoms even worse,” says Pam Santamaria, M.D., a neurologist at the Nebraska Medical Center in Omaha.

If you’re depressed, antidepressants that don’t trigger symptoms (Wellbutrin, Norpramin, Pamelor) may help relieve anxiety and improve sleep, Buchfuhrer says.

9. Zone out.
Patients with restless legs syndrome who pray, meditate or listen to relaxing music regularly enjoy a temporary reduction in symptoms, according to a 2008 study at Tottori University in Japan.

Practicing a calming ritual known as “progressive muscle relaxation” can also be therapeutic, according to the Restless Legs Syndrome Foundation. Here’s how to do it:

1. Breathe deeply for a few minutes and then tense the muscles in your feet. Hold the tension for a few seconds and then relax.

2. Next, tense your calf muscles. Hold and relax.

3. Do the same with your thigh muscles.

4. Repeat the tensing-and-relaxing pattern, working all the way up your body to your neck and face muscles.

If that technique seems like too much work, get a rub-down.

Patients with restless legs syndrome who received Swedish massage with special attention to their legs twice a week for three weeks enjoyed relief from symptoms for two weeks after treatment, according to a 2011 Brigham Young University study.

10. Ask your doctor about medication.
“If lifestyle changes don’t help reduce RLS symptoms, you may need medication,” Buchfuhrer says.

Medications used to treat restless legs syndrome include:

• Horizant: Similar to an epilepsy drug, Horizant received FDA approval in April 2011 for treating moderate to severe restless legs syndrome.
• Requip: A drug that replaces dopamine, Requip received FDA approval in 2006 for treating moderate to severe restless legs syndrome.
• Benzodiazepines (Valium, Dalmane, Xanax) treat anxiety and insomnia associated with restless legs syndrome.
• Nonbenzodiazepine hypnotics (Ambien, Lunesta, Sonata) treat associated insomnia.
• Narcotics (codeine, morphine, oxycodone) treat associated pain.

Take your medication as prescribed to avoid triggering symptoms, Buchfuhrer says.

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Overview

1. If you have RLS, you’re suffering from a neurological disorder that causes throbbing, creeping and other painful sensations in your legs.

2. Walking is your best bet, but any movement helps. RLS is characterized by an irresistible urge to move your legs, because movement brings temporary relief from the painful sensations. In fact, lying down or sitting makes the symptoms worse. Though a glass of wine seems like a tempting quick fix, the National Institutes of Health says that alcohol may aggravate RLS symptoms.

3. Patients with RLS can experience a temporary remission. The disorder cannot be cured, but treatments are available.

4. Reducing intake of caffeine, alcohol and tobacco can help you experience less unpleasant RLS symptoms. Other potential natural remedies include moderate exercise, leg messages and a warm bath. There are also drugs available that temporarily treat RLS, which work by increasing dopamine in your brain. But health experts say that long-term use of such drugs can aggravate your symptoms in the long run.

5.About 3% percent of U.S. adults are thought to have a moderate to severe form of the disorder, while an additional 5% has a milder form. About 1 million children also suffer from RLS. Kids with RLS are sometimes misdiagnosed as having growing pains.

6. RLS syndrome is sometimes misdiagnosed as stress or nervousness, but the syndrome isn’t a psychiatric condition. There are a number of risk factors for the disorder. RLS can be a side effect from taking allergy, anti-psychotic or anti-nausea medications. It can also be caused by an iron deficiency. If a blood test indicates that you are suffering from an iron deficiency, iron supplements may help you. Pregnancy also increases risk of RLS.

7. New research links increased estrogen levels in a woman’s body during pregnancy to an increased risk of RLS. This link between estrogen and RLS may help researchers find a better treatment for the disorder in years to come.

8. Your arms can be affected by RLS. In very rare cases, you may also feel the unusual RLS sensations in your trunk.

9.Because lying down aggravates the symptoms, RLS typically makes it difficult for you to fall asleep at night, causing insomnia. RLS syndrome may also be a sign of an underlying condition, such as heart disease, neuropathy (damage to the nervous system), diabetes or kidney failures. Researchers do not yet know if or how these chronic conditions cause RLS. A study by Harvard University researchers this year suggests that men suffering from impotence may also be more likely to suffer from RLS.

10. People with RLS tend to have fewer symptoms in the morning and gradually get worse as the day goes on.