Diagnosis

Your doctor will take your medical history and ask for a description of your symptoms. A diagnosis of RLS/WED is based on the following criteria, established by the International Restless Legs Syndrome Study Group:

  • You have a strong, often irresistible urge to move your legs, usually accompanied by uncomfortable sensations typically described as crawling, creeping, cramping, tingling or pulling.
  • Your symptoms start or get worse when you're resting, such as sitting or lying down.
  • Your symptoms are partially or temporarily relieved by activity, such as walking or stretching.
  • Your symptoms are worse at night.
  • Symptoms can't be explained solely by another medical or behavioral condition.

Your doctor may conduct a physical and a neurological exam. Blood tests, particularly for iron deficiency, may be ordered to exclude other possible causes for your symptoms.

In addition, your doctor may refer you to a sleep specialist. This may involve an overnight stay at a sleep clinic, where doctors can study your sleep if another sleep disorder such as sleep apnea is suspected. However, a diagnosis of RLS/WED usually doesn't require a sleep study.

Treatment

Sometimes, treating an underlying condition, such as iron deficiency, greatly relieves symptoms of restless legs syndrome. Correcting an iron deficiency may involve taking iron supplements. However, take iron supplements only with medical supervision and after your doctor has checked your blood-iron level.

If you have RLS/WED without an associated condition, treatment focuses on lifestyle changes, and if those aren't effective, medications.

Medication therapy

Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

  • Medications that increase dopamine in the brain. These medications reduce motion in your legs by affecting the level of the chemical messenger dopamine in your brain. Ropinirole (Requip), rotigotine (Neupro) and pramipexole (Mirapex) are approved by the Food and Drug Administration for the treatment of moderate to severe RLS/WED.

    Short-term side effects of these medications are usually mild and include nausea, lightheadedness and fatigue. However, they can also cause impulse control disorders, such as compulsive gambling, and daytime sleepiness.

  • Drugs affecting calcium channels. Certain medications, such as gabapentin (Neurontin) and pregabalin (Lyrica), work for some people with RLS/WED.
  • Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in high doses. Some examples of these medications include codeine, oxycodone (Oxycontin, Roxicodone), combined oxycodone and acetaminophen (Percocet, Roxicet), and combined hydrocodone and acetaminophen (Norco).
  • Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night, but they don't eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS/WED include clonazepam (Klonopin), eszopiclone (Lunesta), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).

It may take several trials for you and your doctor to find the right medication or combination of medications that work best for you.

Caution about medications

Sometimes dopamine medications that have worked for a while to relieve your RLS/WED become ineffective. Or you notice your symptoms returning earlier in the day. This is called augmentation. Your doctor may substitute another medication to combat the problem.

Most drugs prescribed to treat RLS/WED aren't recommended during pregnancy. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of certain drugs.

Some medications may worsen symptoms of RLS/WED. These include some antidepressants, some antipsychotic medications, some anti-nausea drugs and some cold and allergy medications. Your doctor may recommend that you avoid these medications, if possible. However, if you need to take these medications, talk to your doctor about adding drugs that to help manage your RLS/WED.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Making simple lifestyle changes can help alleviate symptoms of RLS/WED.

  • Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.
  • Apply warm or cool packs. Use of heat or cold, or alternating use of the two, may lessen your limb sensations.
  • Try relaxation techniques, such as meditation or yoga. Stress can aggravate RLS/WED. Learn to relax, especially before bedtime.
  • Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS/WED, so it's important that you practice good sleep hygiene. Ideally, have a cool, quiet, comfortable sleeping environment; go to bed and rise at the same time daily; and get adequate sleep. Some people with RLS/WED find that going to bed later and rising later in the day helps in getting enough sleep.
  • Exercise. Getting moderate, regular exercise may relieve symptoms of RLS/WED, but overdoing it or working out too late in the day may intensify symptoms.
  • Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. Try to avoid caffeine-containing products, including chocolate and caffeinated beverages, such as coffee, tea and soft drinks, for a few weeks to see if this helps.

Coping and support

RLS/WED is generally a lifelong condition. Living with RLS/WED involves developing coping strategies that work for you, such as:

  • Tell others about your condition. Sharing information about RLS/WED will help your family members, friends and co-workers better understand when they see you pacing the halls, standing at the back of the theater, or walking to the water cooler many times throughout the day.
  • Don't resist your need for movement. If you attempt to suppress the urge to move, you may find that your symptoms worsen.
  • Keep a sleep diary. Keep track of the medications and strategies that help or hinder your battle with RLS/WED, and share this information with your doctor.
  • Stretch and massage. Begin and end your day with stretching exercises or gentle massage.
  • Seek help. Support groups bring together family members and people with RLS/WED. By participating in a group, your insights not only can help you but also may help someone else.

Preparing for your appointment

If you have signs and symptoms of restless legs syndrome, make an appointment with your doctor. After an initial evaluation, he or she may refer you to a doctor who specializes in conditions affecting the nervous system (neurologist) or a sleep specialist.

Here's some information to help you get ready for your appointment.

Information to gather in advance

  • Write down your symptoms, including when they started and when they tend to occur.
  • Write down key medical information, including other conditions you have and any prescription or over-the-counter medications you're taking, including vitamins and supplements. Also note whether there's a history of restless legs syndrome in your family.
  • Take a family member or friend along. Someone who accompanies you may remember information you missed or forgot.
  • Write down questions to ask your doctor.

Some basic questions to ask your doctor about restless legs syndrome, include:

  • What is the most likely cause of my signs and symptoms?
  • Are there other possible causes?
  • What tests do I need?
  • What treatment options are available for this condition?
  • I have other health conditions. How can I best manage them together?
  • What self-care steps might improve my symptoms?
  • Do you have educational materials I can have? What websites do you recommend?
  • Where can I find a support group for people with restless legs syndrome?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • Do you get an irresistible urge to move your legs?
  • What words describe your symptoms?
  • Do your symptoms start while you're sitting or lying down?
  • Are your symptoms worse at night?
  • Does movement make you feel better?
  • Have you been told that you kick, shake or otherwise move your legs while sleeping?
  • Do you often have trouble falling or staying asleep?
  • Are you tired during the day?
  • Does anyone else in your family have restless legs?
  • How much caffeine do you have daily?
  • What is your typical exercise program?

What you can do in the meantime

To ease your symptoms, try:

  • Cutting back on or eliminating caffeine, alcohol and tobacco.
  • Massaging your legs while soaking in a warm bath.

Restless legs syndrome care at Mayo Clinic

Dec. 10, 2014
References
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  3. Tarsy D. Treatment of restless leg syndrome in adults. http://www.uptodate.com/home. Accessed Nov. 30, 2014.
  4. Garcia-Borreguero D, et al. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: Evidence-based guidelines and clinical consensus best practice guidance: A report from the International Restless Legs Syndrome Study Group. Sleep Medicine. 2013;14:675.
  5. Silber, MH, et al. Willis-Ekbom Foundation revised consensus statement on the management of restless legs syndrome. Mayo Clinic Proceedings. 2013;88:977.