What substances, such as alcohol and smoking, should be avoided in restless leg syndrome?

Substances to Avoid with Restless Legs Syndrome

If you have restless legs syndrome, you should avoid alcohol, caffeine, and nicotine, particularly close to bedtime, as these substances can worsen your symptoms and disrupt sleep quality. 1

Primary Substances to Eliminate or Reduce

Alcohol, Caffeine, and Nicotine

• The National Comprehensive Cancer Network explicitly recommends avoiding alcohol, caffeine, and nicotine too close to bedtime as part of general sleep hygiene measures for RLS patients. 1
• The American Academy of Sleep Medicine recommends addressing these potential exacerbating factors as a foundational step in RLS management, before or alongside pharmacological treatment. 2, 3
• These substances can worsen the uncomfortable sensations and urge to move that characterize RLS, particularly during evening hours when symptoms are typically most severe. 4

Timing Considerations

• Avoid heavy meals or drinking within 3 hours of bedtime, as this can exacerbate nighttime RLS symptoms. 1
• Since RLS symptoms are more pronounced in the evening or night, the timing of substance exposure becomes particularly critical during these hours. 1

Medications That Worsen RLS

Antidepressants and Psychiatric Medications

• The American Academy of Sleep Medicine recommends addressing serotonergic medications (SSRIs and other antidepressants) as potential RLS exacerbators. 2
• Antipsychotics that block dopamine receptors can trigger or significantly worsen RLS symptoms due to dopamine antagonism. 5
• Bupropion is specifically recommended against for treating RLS and may worsen symptoms. 2

Antihistamines

• The American Academy of Sleep Medicine identifies antihistaminergic medications as potential RLS exacerbators that should be avoided or substituted when possible. 2, 3
• This includes both prescription and over-the-counter antihistamines commonly used for allergies or sleep aids. 2

Other Medications to Avoid

• Antidopaminergic medications can worsen RLS symptoms through their mechanism of blocking dopamine receptors. 2
• Lithium has been reported to exacerbate RLS symptoms in some patients. 2

Additional Lifestyle Factors

Sleep Environment Optimization

• Enhance your sleep environment by ensuring it is dark, quiet, and at a comfortable temperature. 1
• Increase exposure to bright light during the day while avoiding bright light exposure during the night. 1

Physical Activity Timing

• Regular exercise in the morning and/or afternoon is recommended, but avoid vigorous exercise close to bedtime as this may worsen symptoms. 1

Critical Pitfalls to Avoid

Do not assume that "normal" consumption of caffeine or alcohol is acceptable—even moderate amounts, especially in the evening, can significantly worsen RLS symptoms and should be eliminated as a first-line intervention. 1, 4

• Many patients fail to recognize that over-the-counter sleep aids containing antihistamines (like diphenhydramine) can paradoxically worsen RLS, creating a vicious cycle of poor sleep. 2
• Smoking is particularly problematic as it can alter the metabolism of RLS medications (increasing clearance by approximately 30-38%), potentially reducing their effectiveness. 6

When to Seek Medical Evaluation

If avoiding these substances does not adequately control your symptoms, the American Academy of Sleep Medicine recommends checking iron studies (ferritin and transferrin saturation) and considering pharmacological treatment with alpha-2-delta ligands like gabapentin or pregabalin as first-line therapy. 2, 3