Restless legs syndrome (RLS) is a disorder of the nervous system that, as the name implies, commonly affects the legs but may also affect the arms. It causes an uncontrollable urge to move the extremities and can affect males and females of any age, generally worsening with time. Sensations can include a burning, throbbing pain and a feeling the skin is itching or crawling. Symptoms can vary in intensity and disappear for periods of time. Sleep can be interrupted for hours, making daytime activities difficult to get through. The myriad of symptoms that may vary from person to person often begins following a period of lying down or sitting for extended periods of time.

RLS is an inherited disorder that may be due to an imbalance of dopamine in the brain. Most individuals so diagnosed find it difficult to fall asleep and stay asleep. They suffer from insomnia, since the way to help the non-stop symptoms is to get out of bed and walk, even in the middle of the night.

Diagnosis may be made through four criteria established by the International Restless Legs Syndrome Study Group: the individual will have an irresistible urge to move his or her legs; symptoms begin to exacerbate when the person is resting or beginning to settle down for the evening; symptoms worsen at night; and lastly, they are relieved to some degree by walking, stretching, twisting or wiggling.

RLS may be present without any associated condition but when an underlying cause such as iron deficiency or peripheral neuropathy can be found, treatment will initially focus on controlling the condition(s). Iron deficiency can result in iron deficiency anemia, a condition in which the body’s reserve of iron has been depleted and the body is unable to maintain levels of hemoglobin in the blood. Iron deficiency can be determined through simple lab testing and treatment is accomplished with iron supplements. Peripheral neuropathy results from nerve damage. It may present as a tingling or burning sensation that can result from such things as infection, toxin exposure, metabolic issues, or traumatic injury. Diagnosis may be difficult and may require a full neurological examination, nerve function testing, CT or MRI, lab testing, and more. Treatment may include pain relievers, capsaicin, anti-seizure drugs, electrical nerve stimulation, and a number of other possibilities.

There are a number of medications that might be prescribed for control. Mirapex and Requip have both been approved by the FDA for the treatment of moderate to severe RLS. Sinemet is commonly prescribed for Parkinson’s patients; however it is also prescribed, as is gabapentin and a number of other drugs for the treatment of RLS. It may take a trial and error period before a physician can determine which, if any, drug is right for you; however a drug that appears to work for a period of time may become ineffective, necessitating a review and substitution. Opioids are generally avoided because of their addictive traits.

On the home front, exercise is important, as is incorporating relaxing techniques such as meditation, yoga, tai chi and others. Avoid caffeine, eat a well-balanced diet, reduce alcohol consumption and cut back on the smoking habit if appropriate.

DEAR DR. GOTT: I am a 76-year-old female with RLS for many years. The symptoms have increased in the past 10 years. It begins about two hours after supper and I must walk for some relief. Then it continues (many times with jerking) when I go to bed so I have to get up and walk. I average about four to five hours of sleep every night and don’t nap during the day. I have been on the low-dose generic drug for Mirapex for several years. It worked very well for about seven to eight months, then started lessening.

I now suspect that my ongoing constipation problem, which has increased with aging, is the cause of my RLS. My primary care doctor disagrees but the RLS symptoms seem related to my difficulty with having bowel movements, especially since they occur mostly after supper. Have any studies been done on that possibility?

I have varicose veins and I should mention that before reluctantly agreeing to go on Mirapex, I consulted a vascular surgeon who diagnosed that a valve was not closing properly in my left groin and I was getting overflow. But he concluded that RLS was my primary problem. I had phlebitis after childbirth 40 years ago and have worn 20-30 compression stockings every day since 1970. I also take calcium for osteopenia as well as a daily multi-vitamin, along with fish oil and vitamins C and D.

I hope I have given you enough information and would welcome your comments and advice. Thank you.

DEAR READER: RLS (restless legs syndrome) is a neurological disorder and life-long condition that is believed to affect as much as 10% of the US population. It occurs more frequently in women than in men and can affect people of all ages. Symptoms occur primarily in the evening when a person attempts to relax. Sensations range in severity from person to person. An interesting and unusual aspect of this movement disorder is that rest of the lower extremities exacerbates the symptoms rather than providing relief which is only achieved by movements such as walking, through massage and perhaps warm baths for stress reduction.

Symptoms are generally restricted to the lower extremities between the knees and ankles but there can be an extension into the arms, feet and thighs with an irresistible and uncontrollable urge to move the legs. Aching, tingling, pulling, crawling sensations that can last for an hour or throughout the night are common.

Medications, to include pramipexole (Mirapex) and ropinirole (Requip) have been approved for relief of symptoms. Sleep can be interrupted, which may be a rather bizarre thing for me to say because many individuals spend the entire night walking for relief. Tranquilizers and medications for Parkinson’s may be prescribed by a physician. On the downside, those same tranquilizers and some drugs provided for Parkinson’s can cause daytime drowsiness that continues the cycle of napping during the day and being awake most of the night.

On the home front, my old trick of placing a small bar of soap under your bottom bed sheet where your legs rest has brought relief from leg cramps to thousands of my readers. Or, you might consider drinking pickle juice or eating a pickle before retiring for the evening. Another helpful trick is to stretch the posterior leg muscles. Simply plant your feet on the floor about two feet from a wall and, keeping the body straight, lean forward onto the wall.

Now on to your constipation, a known side effect of Mirapex. Other known issues from this drug include dry mouth, headache, fatigue and stomach upset. Calcium carbonate which you are on for your osteopenia can also cause constipation, so you might consider speaking with your physician regarding the matter. Perhaps you can consider drinking warm prune juice every other day for symptom relief.

I have read “headlines” associating constipation with RLS but cannot find valid, scientific studies that would allow me to tell you there is a direct correlation. A number of large centers have had legitimate recorded trials in the past regarding RLS but none specifically linking the two. Institutions include the Cleveland Clinic, Charlottesville Medical Research, Georgia Health Sciences University and others. In fact, one is ongoing right now at the Sleep Health Center in Brighton, MA for a new investigatory medication for RLS. I don’t know where you reside or what your local resources are so I recommend you contact your nearest major facility for assistance. If that doesn’t prove fruitful, contact the RLS Foundation at www.RLS.org to determine what studies might be available in the near future.

Readers who would like other home remedies for leg cramps and information on other topics can order my Health Report “More Compelling Home Remedies” by sending a self-addressed, stamped, number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

DEAR DR. GOTT: My husband and I are both in our late 40s. He has suffered from restless legs syndrome (RLS) for more than 20 years. He has taken different prescription medications that either have not worked or have left him groggy the next day.

A couple of months ago I had some mild heartburn and my legs had that creepy-crawly feeling, so I got up and took two Tums. Even though my heartburn did not completely go away, the sensation in my legs did. The next night my husband’s legs were bothering him, so I told him to take two Tums. For the past couple of months he has continued to take them every night. If he forgets and his legs start to bother him, he gets up, takes two, and within 30 minutes he is able to rest.

DEAR READER: Calcium has been found to be helpful in relieving nocturnal leg cramps, and some RLS sufferers have also found that it is beneficial in preventing symptoms when taken just prior to sleep. However, many sources don’t list it is a possible remedy.

Other deficiencies, most notably iron, magnesium, folic acid and B vitamins, are known to cause RLS symptoms in some. Some studies have found that diabetes and other diseases may also lead to RLS. Treatment includes supplementation for deficiency, prescription medications and relaxation techniques.

For other sufferers or those interested in learning more, there are several online sources that discuss symptoms, causes and treatment. The most popular of these is the Restless Legs Foundation (www.RLS.org).

As a side note, the Restless Legs Syndrome Foundation has also initiated the process of changing the name of the condition to Willis-Ekbom disease. This is for several reasons, in part because the condition is not limited to the legs, and the word “syndrome” implies a collection of symptoms, rather than a disorder.

DEAR DR. GOTT: I am writing to inquire about a medical condition that I have had for more than 15 years with no diagnosis determined. I’m a 63-year-old African-American female in good health except for allergies. The older I get, the worse the problem.

I have constant cramping in my legs, thighs, toes, hands, rib cage and arms. Lately, most of my cramping is happening at night when I go to bed. Both legs cramp up, and one of my feet twists to one side. These cramps are painful. I can turn over in the middle of the night and catch a cramp. I have had all types of blood work performed, and when my potassium was a little low, I was told to take a potassium pill. I cramped twice as much.

I have gone to internal-medicine doctors, rheumatologists, orthopedic specialists, family medical practitioners, OB-GYNs and cardiologists with no resolution.

I am currently taking Celebrex and magnesium oxide — specifically for cramping — which has helped, but not completely. I also take Singulair, Diovan, Prevacid, a garlic pill and Zocor at night only. In the past, I have taken some cramping medications, such as clonazepam, quinine tablets and others I can’t even remember the names of. Can you shed some light on my medical problem that might assist me with these awful cramps?

DEAR READER: You indicate you are in good health with the exception of your allergies. Let’s review your other medications. Celebrex is a prescription medication used to control the pain, stiffness and swelling of osteo and rheumatoid arthritis. Magnesium oxide and Prevacid are commonly used to relieve symptoms of acid indigestion. Diovan helps control hypertension and is sometimes prescribed for patients with heart failure who cannot take ACE inhibitor medications. Zocor is a statin drug designed to reduce bad cholesterol while increasing the good. Garlic is believed to help symptoms of arthritis and lower high-cholesterol and blood-pressure readings. And, when added to many foods, it simply tastes good. So it appears that you have arthritis, acid indigestion, hypertension and hypercholesterolemia (high cholesterol).

Statins have a bad reputation for causing muscle pain, cramping, fatigue, and muscle tenderness and weakness in some people. You appear to be one of them. I cannot clearly state that this is the cause of your problem, but it’s a good place to start. Speak with your physician to determine whether you can take a different cholesterol-lowering medication that isn’t a statin. Perhaps an over-the-counter such as niacin or an OTC with plant stanols and sterols might be effective. Because of your history, my inclination is to have you refrain from red-yeast-rice products only because they include lovastatin-like substances. Try drinking pickle juice or eating dill pickles for relief from your cramps. Last but not least, place one bar of soap (or more) under your bedsheet near the part of your body that cramps for additional relief.

To provide related information, I am sending you copies of my Health Reports “Understanding Cholesterol” and “Compelling Home Remedies.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

DEAR DR. GOTT: I am a 70-year-old female who began experiencing restless legs at age 20. I understand you have discussed using hawthorn berries for control and would like to know more about this alternative treatment. Thank you for your help.

DEAR READER: Hawthorn berries contain antioxidant properties and improve blood flow to the heart. Readers have also indicated the supplement has helped with the muscle twitches and tremors associated with restless-legs syndrome, Parkinson’s and hypertension.

Check with your primary-care physician before using hawthorn berry, because some herbals can cause unwanted side effects if taken with other drugs. If you choose to continue, be sure to follow the packaging directions for recommended doses.

DEAR DR. GOTT: My 27-year-old granddaughter has restless-legs syndrome, and I can’t remember your home remedy. Can you help?

DEAR READER: There are several remedies that might help your granddaughter. One herbal recommendation is hawthorn berry available in most health-food stores. Nutritional supplements include supplemental vitamin E in the diet, calcium, magnesium and folic acid. Home remedies include an unwrapped bar of soap under the bottom sheet of her bed placed in the area of the lower legs. Smaller hotel bars of soap are ideal because of their size, but the large ones work equally well. Still another possible solution is an over-the-counter topical liniment containing cooling menthol rubbed onto the lower legs and feet before going to sleep.

DEAR DR. GOTT: I always enjoy reading your column. You seem to be well-grounded medically, yet open-minded enough to hear new things. I am writing to let you know my experience with restless-legs syndrome.

I am a 57-year-old female. My height and weight are proportionate, and I am healthy overall. When I get fatigued, or just very tired at the end of the day, I am often bothered by RLS. It is annoying to say the least. Generally, I take an aspirin or two, which helps calm things down, but I already have thin blood and don’t like to take more than is necessary.

One night, I had both a hacking cough and RLS symptoms. I got out of bed and took a spoonful of honey to coat my throat. Minutes after I went back to bed, the RLS symptoms settled down. Just a fluke, I thought. Well, I have learned over time that taking a spoonful of honey has indeed helped the situation. I don’t need it every night, but when I do, it is nice to know that there is something in the house apart from medicine to help me. Oh, and the honey helped to quell my cough, too.

DEAR READER: Restless-legs syndrome is an annoying but harmless condition that causes the sufferer to experience odd sensations in the legs such as tingling, aching, burning, crawling, itching, pain and much more when sitting or lying down. It typically causes an urge to get up and move. In severe cases, these abnormal sensations may be experienced in the upper extremities as well.

Symptoms generally begin during extended periods of inactivity. They may worsen in the evening and throughout the night, causing the legs to twitch — a condition known as periodic limb movements of sleep. These sensations often cause sufferers to have trouble falling or staying asleep. Relief is often found by getting out of bed and moving around.

There is no one cause of RLS, and in many instances, no cause can be found. The current thought is that it may be the result of an imbalance of dopamine, the brain chemical that helps control muscle movement. There is a known hereditary link in approximately 50 percent of all cases. Pregnancy can cause temporary RLS symptoms, but most women experience relief shortly after delivery. Peripheral neuropathy, kidney failure and iron deficiency may also cause or worsen symptoms.

Now, before I am berated by my readers, I will mention sleep apnea. However, the various related departments of the National Institutes of Health, the American Academy of Family Physicians and the Mayo Clinic do not list sleep apnea as a cause of RLS. In fact, I cannot find any scientific studies that show the two conditions are related. However, this does not mean they aren’t. Perhaps researchers need to study this possible connection.

Honey as a remedy to RLS is new to me. Hawthorn berries, magnesium and calcium, soap under the sheets, pickle juice, electrolyte sports drinks and other remedies have helped some of my readers who suffer from RLS. Unfortunately, RLS is often difficult to treat, with few prescription options being available and home remedies being extremely beneficial for one and not at all for another. On occasion, I get a letter from a sufferer who is helped intermittently by one or more home remedies.

So, readers, here is another one to try. This option is admittedly better tasting than pickle juice, but does it work? Try it, and let me know your results. I will print a follow-up article once I receive enough results.

DEAR DR. GOTT: I went to my doctor about my restless-legs syndrome (RLS). He gave me a prescription, but I read the side effects and didn’t take the medicine. Instead, I started rubbing my feet, legs and hips with a topical cooling ointment and put on warm socks before going to bed. I’ve not had a restless night since! This works for me. It seems some of these home remedies really work. It’s just a matter of finding them.

DEAR READER: Pharmacy shelves are lined with a number of topical ointments and alternatives designed to help painful muscles associated with arthritis, simple backache, sports injuries, strains, sprains — and for you, in treating RLS. Some people find relief from ointments containing the warming properties of capsaicin. Others use ointments with cooling properties or with petrolatum menthol salves. I have also received positive reports for symptoms of RLS and leg cramps being treated with pickle juice, hawthorn-berry extract and marjoram mixed with carrier oil, such as olive or castor oil. Then there’s the hot bath, ice pack, heating pad, massage and supplements for low levels of potassium, iron, folate and magnesium.

DEAR DR. GOTT: I have just become aware of your newspaper column, where reference was made to restless legs syndrome. I have suffered for several years with this frustrating condition and have tried numerous remedies, including prescription drugs. Because of side effects, I cannot use the prescriptions and have not had success with the other remedies.
Unfortunately, I did not see your original article recommending the use of hawthorn berries. I have read the testimonials of those who were helped by the product and am interested in trying it. Could you please reprint the article? I have also been taking 250 milligrams of magnesium at bedtime.
DEAR READER: Because I have received so many letters regarding this topic, I have decided to share the information again.
In the original column, the writer described his success using three daily capsules of hawthorn berry to resolve his severe restless legs syndrome. This person also had moderate success using 200 milligrams of calcium and magnesium daily.
To provide related information, I am sending you copies of my Health Reports “Dr. Gott’s Compelling Home Remedies” and “More Compelling Home Remedies.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

DEAR DR. GOTT: I am an 86-year-old widow of a disabled WWII veteran. I am the eldest in a family of 5 girls. I and two of my sisters have restless legs syndrome (RLS). We three also had rheumatic fever. I have often wondered whether there was a connection between the two conditions.

My father also had rheumatic fever but he died at age 46 so I do not know if he would have had RLS.

DEAR READER: Restless legs syndrome is in no way related to rheumatic fever, but as you know, the cause of RLS remains unknown, so the future may tell us more.