Restless Legs Syndrome and Related Disorders - Treatment

Treatment

The initial approach to a patient who complains of sleeplessness and restless legs syndrome is to try non-drug treatments to improve sleep and eliminate possible causes of RLS. A non-drug approach is a particularly important first step for elderly patients.

• The doctor should first try to treat any underlying medical conditions that may be causing restless legs.
• If medications may be causing RLS, the doctor should try to prescribe alternatives, if possible.
• If the cause cannot be determined, it is best to first try sleep hygiene and relaxation methods. Such approaches provide added benefits, even if drug therapy is later required.

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Helpful Tips

Some people report help or relief from RLS with the following behaviors or devices:

• Hot baths or cold compresses.
• Ergonomic measures. For example, patients might find it useful to work at a high stool, where they can dangle their legs. In meetings or during air travel, it is helpful to obtain an aisle seat.
• Changing sleep patterns. Some patients report that symptoms don't occur if they sleep late in the morning, so, if feasible, changing sleep patterns may also be helpful.
• Avoiding caffeine, alcohol, and nicotine.

Alternative treatments that are sometimes advocated for RLS include acupuncture and massage. These treatments, however, have not been rigorously studied.

Vitamins and Minerals

Some people have reported benefits from:

• Vitamin E (800 - 1200 IU per day)
• Calcium, magnesium, or potassium supplements
• Folic acid supplements for people with folate deficiencies

Dietary Iron

Because RLS is associated with iron insufficiency, people with the condition should be sure they have a diet that provides iron. [For more information, see In-Depth Report #57: Anemia.] Iron found in foods is either in the form of heme or non-heme iron:

• Heme Iron. Foods containing heme iron are the best for increasing or maintaining healthy iron levels. Such foods include (in decreasing order of iron-richness) clams, oysters, organ meats, beef, pork, poultry, and fish.
• Non-Heme Iron. Non-heme iron is less well absorbed. About 60% of the iron in meat is non-heme (although meat itself helps absorb non-heme iron). Eggs, dairy products, and iron-containing vegetables have only the non-heme form. Vegetable include dried beans and peas, iron-fortified cereals, bread, and pasta products, dark green leafy vegetables (chard, spinach, mustard greens, kale), dried fruits, nuts, and seeds.