What should be avoided in patients with Restless Legs Syndrome (RLS)?

What to Avoid with Restless Legs Syndrome (RLS)

Patients with Restless Legs Syndrome (RLS) should avoid alcohol, caffeine, antihistaminergic medications, serotonergic medications, antidopaminergic medications, and ensure treatment of any underlying obstructive sleep apnea, as these are key exacerbating factors that worsen RLS symptoms. 1

Substances to Avoid

• Alcohol - Consumption can trigger or worsen RLS symptoms and disrupt sleep quality 1
• Caffeine - Found in coffee, tea, chocolate, and some medications; can exacerbate RLS symptoms 1
• Nicotine - Should be avoided, especially close to bedtime 1
• Heavy meals - Avoid eating heavy meals within 3 hours of bedtime 1

Medications to Avoid or Use with Caution

• Antihistamines - Including over-the-counter sleep aids and allergy medications 1
• Serotonergic medications - Such as certain antidepressants 1
• Antidopaminergic medications - Including many antipsychotics and anti-nausea drugs 1
• Dopamine agonists for long-term use - While sometimes prescribed for RLS, these medications (including ropinirole, pramipexole, and rotigotine) should be used cautiously due to risk of augmentation - a paradoxical worsening of symptoms with long-term use 2, 3
• Levodopa - The American Academy of Sleep Medicine suggests against standard use due to high risk of augmentation 1

Sleep Habits to Avoid

• Irregular sleep schedule - Maintain consistent sleep and wake times 1
• Bright light exposure at night - Avoid screens and bright lights before bedtime 1
• Looking at the clock - Can increase anxiety and worsen sleep quality 1
• Poor sleep environment - Avoid environments that are not dark, quiet, and comfortable 1

Medical Conditions to Address

• Iron deficiency - Low iron levels can worsen RLS; supplementation is recommended if ferritin ≤75 ng/mL or transferrin saturation <20% 1
• Untreated obstructive sleep apnea - Should be addressed as it can exacerbate RLS symptoms 1

Medication Side Effects to Monitor

• Augmentation - A paradoxical worsening of symptoms that occurs with long-term dopaminergic medication use, characterized by earlier symptom onset during the day, increased symptom intensity, and spread of symptoms to other body parts 2, 3
• Impulse control disorders - Patients taking dopamine agonists should be monitored for development of compulsive behaviors including gambling, hypersexuality, compulsive shopping, and binge eating 3
• Withdrawal symptoms - Abrupt discontinuation of RLS medications, particularly dopamine agonists, can cause insomnia, anxiety, depression, fatigue, sweating, and pain 3

Practical Tips

• Avoid sedentary activities for long periods, especially in the evening 1
• Avoid looking at the clock when experiencing symptoms at night, as this can increase anxiety 1
• Avoid high-intensity exercise close to bedtime, though moderate exercise earlier in the day may be beneficial 2

Following these recommendations can help minimize RLS symptom triggers and improve overall management of the condition. Remember that addressing exacerbating factors should be the first step in RLS management before initiating pharmacological treatment 1.