Lifestyle changes, medication help restless legs relax

Q. I'm a 55-year-old man with restless legs syndrome for the past several months. The condition is making it impossible for me to get a good night's sleep. What can I do?

A. Restless legs syndrome (RLS) is a neurological condition that causes uncomfortable sensations in the legs. In describing these odd sensations, my patients use words such as “tingling,” “prickly,” “crawling,” “pulling” and, sometimes, “painful.”

The discomfort of RLS usually comes with an overwhelming urge to move the legs. In fact, moving the legs may actually make them temporarily feel better. RLS also can cause occasional jerking leg movements during sleep. That's why doctors often call it a “movement disorder.”

RLS symptoms tend to worsen when you're inactive, particularly at bedtime. As a result, many people, as you do, find it hard to fall and stay asleep. Then a vicious cycle can set in. Poor quality sleep makes you feel generally worse and may make the unpleasant sensations worse as well.

Treatment will depend on how severe your symptoms are. If they are mild, then exercising, stretching or massaging your legs or taking a hot bath may bring relief.

Lifestyle changes may also help. Follow a balanced diet and avoid caffeine, alcohol and smoking cigarettes.

If your doctor hasn't checked the iron levels in your blood, that's worth doing, too. People with iron deficiency are particularly prone to getting RLS. If you do turn out to have iron deficiency, then your doctor needs to find out why. Iron deficiency is unusual in men. Menstruating women sometimes develop iron deficiency because they lose iron in their blood each month, but there is no similar common cause of blood loss in men.

Incidentally, taking an iron supplement may also help, even if the tests show you don't have iron deficiency.

Many experts also recommend mentally challenging activities to reduce symptoms. These include crossword puzzles or video games. No one is sure why this works; it might just be a matter of distraction.

If these strategies don't work, medication might. Drugs for RLS may be taken alone or in combination.

Dopaminergic agents usually relieve discomfort and improve sleep quality.

Benzodiazepines are sedatives that improve sleep quality.

Anticonvulsants are especially useful in patients whose symptoms are painful.

Opioids are narcotics, such as codeine and oxycodone. They relieve pain and suppress symptoms. Opioids are generally reserved for people with severe, unrelenting symptoms that do not respond to other treatments.

Talk to your doctor about your symptoms and medical history. Together, you can determine which medications would be most appropriate for you to try.

Getting a good night's sleep may seem like a dream right now, but with the right combination of lifestyle changes and medication, it's a dream within reach.

• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: AskDoctorK.com.