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Treatment for RLS is based on how disruptive the symptoms are. All people should review their lifestyle and see what changes could be made to reduce or eliminate their RLS symptoms. These include: finding the right level of exercise (too much worsens it, too little may trigger it); eliminating caffeine, smoking, and alcohol; changing the diet to eliminate foods that trigger RLS (different for each person, but may include eliminating sugar, triglycerides, gluten, sugar substitutes (aspartame), following a low-fat diet, etc.); keeping good sleep hygiene; treating conditions that may cause secondary RLS; avoiding or stopping OTC or prescription drugs that trigger RLS; adding supplements such as potassium, magnesium, B-12, folate, vitamin E, and calcium. Some of these changes, such as diet (particularly aspartame) and adding supplements are based on anecdotal evidence from RLS sufferers as few studies have been done on these alternatives.

For those who experience RLS infrequently and do not need or want to try medication, in addition to lifestyle changes they can try:

• some form of exercise for several minutes such as walking, stretching, meditation, yoga, etc. at bedtime
• heat or cold, such as a hot or cold bath, a heating pad, or a fan
• soaking one’s feet in hot water just prior to going to sleep
• engrossing the mind in a game, the computer, or figuring something out
• wearing compression stockings, tight pantyhose, or wrapping the legs in ace bandages
• placing a pillow between the knees or upper-legs while lying in bed
• hot green tea can relieve symptoms
• vigorous, deep breathing for one or two minutes

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A study by the Mayo Clinic in Rochester, Minn., suggests that medications used to treat restless leg syndrome (RLS) may trigger compulsive gambling. The study appeared in the Jan. 23 issue of the journal Neurology.It happened with a small group of patients treated with drugs called dopamine agonists. And the greater amount of drug given, the more likely the gambling problem. Doctors consider pathological gambling to be an impulse control disorder. And the drug apparently worsened the disorder, the study said. The gambling problem was reversed when doctors switched patients to a different drug. They recommended screening RLS patients for their gambling habits before prescribing the drugs and monitoring their gambling while on the medication.

Know when to fold: Football fans bet an estimated $4 billion on the most recent Super Bowl, according to an article on the Cleveland Clinic website. But sports betting isn’t nearly as addictive as video poker and slot machines, it says. Those games sometimes are called ‘’the crack cocaine of gambling'’ because they supply such immediate gratification compared to, say, horse racing.

Pathological gamblers sometimes have lower levels of norepinephrine than normal gamblers. The brain chemical is secreted under stress, so such gamblers may gamble to increase their levels of norepinephrine. Since such gamblers are seeking excitement and action rather than money, they sometimes will gamble to lose in the desperation phase of their addiction. Some gamble to the point of neglecting their health or even abandoning their children — ‘’casino kids'’ — in the parking lots of gambling houses, the article says.

– FRED TASKER

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Other features associated with restless legs syndrome may include periodic limb movements in sleep (PLMS) characterized by repeated stereotypic movements of the legs. These movements typically consist of upward extension of the great toe and foot as well as flexion of the ankle, knee, or hip. They occur every 15 to 40 seconds and last for one half of a second up to 6 seconds, usually during periods of lighter sleep (non-REM or NREM sleep). Patients who experience at least five periodic limb movements per hour are said to have PLMS. The number of periodic limb movements seems to increase along with the severity of RLS symptoms. Most people with RLS also have PLMS; however, a specialized sleep study is usually required to confirm PLMS. Large movements associated with PLMS contribute, in some measure, to repeated arousals and awakenings.

Almost all patients with RLS also experience sleep disturbances including difficulty falling asleep as well as problems remaining asleep. Difficulty with sleep onset (sleep latency) may be due to the activation of symptoms upon relaxation. PLMS may also be an important contributing factor to sleep disturbances during the night (sleep maintenance). Fifty percent of patients report that discomfort in the leg(s) prevents them from getting a good night’s sleep. Those with severe symptoms may sleep for only a few hours each night and, as a result, experience excessive daytime sleepiness (EDS). Increasing difficulty falling asleep and maintaining sleep is usually associated with a worsening of RLS symptoms.

While awake and at rest, patients may also experience uncontrolled, sporadic movements of the legs (and, in some cases, the arms). These movements, which may occur during the day or night, may be very rapid (myoclonic) or quite slow and prolonged (dystonic); they usually disappear upon voluntary action. Some researchers think that these movements, which are known as dyskinesias while awake (DWA), may represent a wakeful form of PLMS. About 50% of individuals who seek medical attention for RLS experience DWA.

The symptoms of RLS progress with increasing age; however, medical attention is usually not sought until middle age or later. In addition, a family history of RLS is often noted by patients with primary or idiopathic RLS; about 50% to 60% (or higher in some studies) report close relatives with the disease.

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Restless leg syndrome is a condition marked by unpleasant leg sensations at bedtime. Restless leg syndrome frequency leads to insomnia. The cause of restless leg syndrome is unknown in most patients, but many conditions have been associated with it. Treatment of restless leg syndrome is directed toward any underlying illness, if known. Medications are available for restless leg syndrome.

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For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients.

Physicians also may suggest a variety of medications to treat RLS, including dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. In 2005, ropinirole became the only drug approved by the U.S. Food and Drug Administration specifically for the treatment of moderate to severe RLS.

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As described above, people with RLS feel uncomfortable sensations in their legs, especially when sitting or lying down, accompanied by an irresistible urge to move about. These sensations usually occur deep inside the leg, between the knee and ankle; more rarely, they occur in the feet, thighs, arms, and hands. Although the sensations can occur on just one side of the body, they most often affect both sides.

Because moving the legs (or other affected parts of the body) relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.

Most people find the symptoms to be less noticeable during the day and more pronounced in the evening or at night, especially during the onset of sleep. For many people, the symptoms disappear by early morning, allowing for more refreshing sleep at that time. Other triggering situations are periods of inactivity such as long car trips, sitting in a movie theater, long-distance flights, immobilization in a cast, or relaxation exercises.

The symptoms of RLS vary in severity and duration from person to person. Mild RLS occurs episodically, with only mild disruption of sleep onset, and causes little distress. In moderately severe cases, symptoms occur only once or twice a week but result in significant delay of sleep onset, with some disruption of daytime function. In severe cases of RLS, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function.

Symptoms may begin at any stage of life, although the disorder is more common with increasing age. Sometimes people will experience spontaneous improvement over a period of weeks or months. Although rare, spontaneous improvement over a period of years also can occur. If these improvements occur, it is usually during the early stages of the disorder. In general, however, symptoms become more severe over time.

People who have both RLS and an associated condition tend to develop more severe symptoms rapidly. In contrast, those whose RLS is not related to any other medical condition and whose onset is at an early age show a very slow progression of the disorder and many years may pass before symptoms occur regularly.

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If you have restless legs syndrome (RLS), you may recognize these symptoms:

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RLS affects about 10% of the U.S. population. It affects both men and women and may begin at any age, even in infants and young children. Most people who are affected severely are middle-aged or older.

RLS is often unrecognized or misdiagnosed. In many people the condition it is not diagnosed until 10-20 years after symptoms begin. Once correctly diagnosed, RLS can often be treated successfully.

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Treatment for RLS is based on how disruptive the symptoms are. All people should review their lifestyle and see what changes could be made to reduce or eliminate their RLS symptoms. These include: finding the right level of exercise (too much worsens it, too little may trigger it); eliminating caffeine, smoking, and alcohol; changing the diet to eliminate foods that trigger RLS (different for each person, but may include eliminating sugar, triglycerides, gluten, sugar substitutes (aspartame), following a low-fat diet, etc.); keeping good sleep hygiene; treating conditions that may cause secondary RLS; avoiding or stopping OTC or prescription drugs that trigger RLS; adding supplements such as potassium, magnesium, B-12, folate, vitamin E, and calcium. Some of these changes, such as diet (particularly aspartame) and adding supplements are based on anecdotal evidence from RLS sufferers as few studies have been done on these alternatives.

For those who experience RLS infrequently and do not need or want to try medication, in addition to lifestyle changes they can try:

• some form of exercise for several minutes such as walking, stretching, meditation, yoga, etc. at bedtime
• heat or cold, such as a hot or cold bath, a heating pad, or a fan
• soaking one’s feet in hot water just prior to going to sleep
• engrossing the mind in a game, the computer, or figuring something out
• wearing compression stockings, tight pantyhose, or wrapping the legs in ace bandages
• placing a pillow between the knees or upper-legs while lying in bed
• hot green tea can relieve symptoms
• vigorous, deep breathing for one or two minutes

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