About 6 to 10 percent of the U.S. adult population is affected by restless legs syndrome and it is more common in women. RLS is defined by four essential criteria needed for clinical diagnosis which are established by the International Restless Legs Syndrome Study Group.

These signs and symptoms are:
1. The urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. While symptoms can vary from person to person, they are generally described as an urge to move the legs accompanied by burning, creeping, crawling, aching, tingling, or tugging sensations in the legs.
2. Symptoms are worse during rest or inactivity
3. Symptoms are partially or totally relieved by movement such as walking or stretching.
4. Symptoms are worse at night with periodic limb movements.

As a direct result patients may experience daytime tiredness, mood disturbance, and inability to perform daily activities, which can have a substantial negative impact on quality of life. The dopamine neurotransmitter system appears to be mostly involved with this condition. Restless legs syndrome is mostly thought of as a condition that affects adults, but it is also fairly common in children and teenagers. Older men who suffer from RLS at night are almost twice as likely to have erectile dysfunction as those without the condition. The mechanisms underlying the association between RLS and erectile dysfunction could be caused by hypofunctioning of the brain chemical dopamine in the central nervous system, which is associated with both conditions.

Symptoms are frequent or severe enough to require medical treatment by approximately 3% of the population. The symptoms of RLS can be managed effectively by treatment.

Natural treatment of restless legs syndrome
Reduce or eliminate coffee including decaf, tea, cola beverages including Diet or regular Coke or Pepsi, cocoa from all sources including chocolate. Even small amounts of caffeine or other stimulants found in sodas or teas can cause sleep disturbances. Even though green tea has health benefits, its use can lead to insomnia and RLS. Stop all herbal teas except perhaps hops tea which has sedating effects.
Stop or reduce smoking and drinking alcohol.
Reduce or eliminate any type of stimulant, including herbal teas, dietary supplements -- especially those of a stimulating nature such as tyrosine, SAM-e, phenylalanine, St. John's wort, most of the sexually stimulating herbs -- and over the counter cold or decongestant medicines, including antihistamines. Sometimes even multivitamins and herbal supplements that one may not be suspecting can cause sleep disturbances. If you are not sure, stop all of them for a while.
Exercise and movement help a lot. Take long, daily walks for at least an hour, especially in the morning. The more tired your body becomes, the better you will sleep and the less likely your legs will move in bed. If you can, walk several hours a day or as much as your body can tolerate. Your muscles and nervous system will be much less likely to trouble you at night if they have been thoroughly exhausted during the day by various activities.
Perhaps massage, warm or cold baths, and acupuncture could benefit.
Weight loss could help.
Follow the suggestions on how to sleep deeper.

Some herbal remedies and supplements that could be tried although I still think that prolonged daily physical activity is the best option:
An herb to try is valerian root although some people have mentioned that it did not help at all or made their symptoms worse.
Perhaps small doses of 5-HTP or theanine could be of benefit.
We have also received emails that small amounts of mucuna pruriens taken in the morning may be helpful.
Magnesium mineral may be of some benefit to some individuals.
A case study of two individuals showed D Ribose supplement to be of benefit.
I am not sure if kava is helpful but it is worth a try.
Iron pills may be a treatment for RLS in some people.

Supplements that may not work
Some people claim treatment with vitamin B may reduce the frequency, intensity, and duration of nocturnal leg cramps but more research is needed to determine whether B vitamins, such as B6. really work or make it worst in some people. B vitamin supplements are best taken in the early part of the day in a low dose. I suspect high doses of B vitamins could cause insomnia. If you have been taking B vitamins or multivitamins and you still have symptoms, stop them all for a while to see if your symptoms improve.

Testimonial
Everywhere I look for advice on restless leg syndrome, I see recommendations for taking vitamin B6. I find this strange because I find a dramatic increase in my restless leg sensations when I use B6.

Emails
I am very sensitive to any caffeine. I get restless leg syndrome from any caffeine -- even in regular tea, cocoa, chocolate, regular cola, regular coffee, etc.
   Yes, some people are very sensitive to caffeine and have sleep disruption from even small amounts.

My husband and I both have some problems with RLS, but his is worse than mine. We have found that a calcium / magnesium supplement (300 mg calcium and 200 mg magnesium) a day plus an extra 200mg of magnesium at dinner controls the RLS for us, in addition to trying to eat more dark green leafy vegetables. Thanks for your website, it is very helpful.
   If anyone else has benefited from a combination of calcium and magnesium, do let me know.

Exercise and physical activity
Dr. Marco Tulio de Mello and colleagues at Federal University of Sao Paulo-UNIFESP evaluated the effects of acute intensive exercise on sleep patterns in 22 volunteers with periodic leg movements, which are often associated with restless legs syndrome. Eleven subjects continued with 72 physical training sessions for roughly the next 6 months. Reductions in periodic leg movements were observed after both intensive and regular physical exercise. Intensive exercise increased sleep efficiency (actual time asleep) and rapid eye movement (REM) sleep, and reduced wake time after sleep onset. Chronic physical exercise increased sleep efficiency and REM sleep and reduced sleep latency (time to takes to fall asleep). The release of beta-endorphins, opioid compounds that provide a feeling of well-being, after acute intensive exercise are associated with reduced periodic leg movements levels. Med Sci Sports Exercise 2009.

D-ribose benefits restless legs syndrome
We report on two affected male individuals, a father and son, ages 71 and 47, from a family in which three generations with RLS. To evaluate any potential benefit of D-ribose in this condition, each individual orally consumed 5-g doses of D-ribose daily at different trial stages. Each stage lasted 3 weeks with a 2-week washout period between stages. The initial stage involved a single 5 gm dose of D-ribose consumed at breakfast. Throughout the second stage, D-ribose was taken at breakfast and lunch. In the third stage, D-ribose was taken at all meals, breakfast, lunch, and dinner. Diaries by the subjects pertaining to their documentation and severity of restless legs syndrome symptoms was compiled. During the initial stage both men reported a general feeling of more energy and less fatigue, most notably after exercise, without any significant changes in their symptoms. With the increase in the daily dose of D-ribose, in the second stage, their leg twitching and the feeling to move during the day was reduced for 1 subject, and rarely present in the other. Both still experienced the unpleasant sensations during the night. However, during the final stage, a further increase in the daily dose of D-ribose eliminated their daily symptoms and the symptoms at night were of a lesser degree and had a later occurrence. Both men reported that D-ribose did not totally eliminate their discomfort, but the severity and onset of symptoms affecting their quality of life was substantially improved with D-ribose without any adverse reactions. J Alternative Complementary Medicine 2008.

Iron supplements
The purpose of this study was to determine if symptomatic RLS patients with low-normal serum ferritin levels benefit from oral iron replacement. This was a randomized, placebo-controlled, double-blinded study. Eligible patients were randomized to oral iron therapy vs. appearance-matched placebo and followed over a 12 week period. After 12 weeks, IRLS scores decreased more in the treatment arm  than in the placebo arm. Ferritin levels increased more in the treatment arm than in the placebo arm. We observed a nonsignificant trend toward improved quality of life in the treated patients. This is the first double-blinded, placebo-controlled study to demonstrate statistically significant improvement in RLS symptoms using oral iron therapy in patients with low-normal ferritin. The findings from this study suggest that additional larger randomized placebo-controlled trials of iron as treatment for patients with low-normal ferritin are warranted. Efficacy of oral iron in patients with restless legs syndrome and a low-normal ferritin: A randomized, double-blind, placebo-controlled study. Sleep Med. 2009 Febrary. Wang J, O'Reilly B, Venkataraman R, Mysliwiec V, Mysliwiec A. Department of Medicine, Madigan Army Medical Center, 9040A Fitzsimmons Avenue, Tacoma, WA, United States.

Iron (ferrous sulfate) 325 mg in patients with serum ferritin levels <50 µg per dL. Ideal means of administration has not been established. Oral treatment may take several months to be effective and may be poorly tolerated.

Magnesium mineral supplement use
Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study.
Periodic limb movements during sleep (PLMS), with or without symptoms of a restless legs syndrome (RLS), may cause sleep disturbances. Anecdotal observations have shown that oral magnesium therapy may ameliorate symptoms in patients with moderate RLS. We report on an open clinical and polysomnographic study in 10 patients suffering from insomnia related to PLMS or mild-to-moderate RLS. Magnesium was administered orally at a dose of 12 mmol in the evening over a period of 4-6 weeks. Following magnesium treatment, PLMS associated with arousals (PLMS-A) decreased significantly. Sleep efficiency improved. Our study indicates that magnesium treatment may be a useful alternative therapy in patients with mild or moderate RLS-or PLMS-related insomnia. Sleep. 1998. Department of Psychiatry and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany.

Valerian root herb
A prospective, triple-blinded, randomized, placebo-controlled, parallel design was used to compare the efficacy of valerian with placebo on sleep quality and symptom severity in patients with RLS. Thirty-seven participants were randomly assigned to receive 800 mg of valerian or placebo for 8 weeks. The primary outcome of sleep was sleep quality with secondary outcomes including sleepiness and RLS symptom severity. The results of this study suggest that the use of 800 mg of valerian for 8 weeks improves symptoms of RLS and decreases daytime sleepiness in patients that report an Epworth Sleepiness Scale (ESS) score of 10 or greater. Valerian may be an alternative treatment for the symptom management of RLS with positive health outcomes and improved quality of life. Altern Ther Health Med. 2009. Does valerian improve sleepiness and symptom severity in people with restless legs syndrome? University of Pennsylvania School of Nursing, Philadelphia, PA, USA.

Email - This is not a study on valerian, just me and 2 other people that have RLS. I have been troubled with it for 15 years. When I sit down to relax is when it becomes a problem. Valerian is the only natural thing I have found that works. I take no other medications. I thought this might be of some interest to you. In talking with the few people that use valerian as I do for restless legs syndrome I found we were using it the same way. If the problem started we could take 2 to 3 capsules, 150 mgs each and the problem would go away in about 30 to 45 minutes. If I felt the problem before bedtime I would take 2 to 3 capsules 45 minutes to 1 hour before bed. valerian is not used as a daily thing, only if the restless legs syndrome was problematic. When at work and I was sitting it would cause problems also. I did the same, 2 to 3 capsules and it went away in about 30 to 45 minutes. I would try other things to make it go away also so I didn’t have the use the valerian, getting up and walking it off worked but was not useful if you were trying to go to sleep, but at work it was ok. Then if the RLS returned I would use the valerian. I would take hot shower and take the Valerian if it woke me up from sleep. I am a light sleeper so it was easy for the symptoms from restless legs syndrome to wake me.

Obesity and weight loss
People who are obese have an increased risk of developing RLS. In a study of more than 88,000 U.S. adults, Dr. Xiang Gao at Harvard Medical School discovered that obese men and women were more percent more likely to have RLS than normal-weight study participants. Abdominal obesity, in particular, was strongly linked to RLS risk. Dr. Xiang Gao thinks there are multiple mechanisms through which excess weight contributes to the neurological disorder. Neurology, 2009.

Causes
RLS is an intolerable internal feeling of itching or creeping sensations in the legs that forces the affected person to move his or her legs to get relief. It usually occurs at the end of the day in bed or when seated. Primary restless leg syndrome probably has some genetic basis. Secondary causes include iron deficiency, neurologic lesions, pregnancy (folate deficiency or high level of estrogen?) diabetes, and uremia. Other possible causes include fibromyalgia, thyroid disease, B12 deficiency, and varicose veins. Symptoms may be induced or exacerbated by medications such as antidepressants, lithium, and dopamine antagonists (neuroliptics, metoclopramide), and H2 blockers. Caffeine has been implicated in the worsening of symptoms.
   People who suffer from this condition often have debilitating psychiatric disorders, including depression and anxiety, which may cause the restless legs syndrome or be a result of the lack of sleep. Other risk factors are heavy smoking, unemployment status, hypertension, gastroesophageal reflux disease (gerd), arthritis, and diabetes. Sleep apnea and insomnia appear to be other risk factors, along with difficulty falling asleep (taking more than 30 minutes), driving while drowsy and excessive daytime fatigue. Subjects with self-reported restless leg syndrome also have a higher incidence of being late for work, missing work, making errors at work and missing social events because of fatigue more often than those without it.

Over-the-counter allergy medications, such as antihistamines Benadryl, may worsen symptoms of restless legs syndrome.

Runs in families
Dr. Guy Rouleau of the University of Montreal Hospital Research Center and his colleagues found sons and daughters of people with the bothersome syndrome were at nearly double the risk of having it themselves, while the risk for brothers and sisters of restless legs syndrome patients was nearly four-fold greater. Dr. Guy Rouleau published his research in Archives of Neurology, May 2010.

Evaluation of the patient
The physical examination is usually normal and is performed to identify secondary causes and to rule out other disorders. A neurologic examination with emphasis on spinal cord and peripheral nerve function. A vascular examination to rule out vascular disorders. Do SMA, CBC, ferritin, and TSH. Patients with newly diagnosed restless legs syndrome or recent exacerbation of symptoms should have serum ferritin levels measured.

Intensive care unit patients in a hospital are especially vulnerable to have unmasking or exacerbation of restless legs syndrome because of sleep deprivation, circadian rhythm disturbance, immobilization, lack of movement or physical activity, iron deficiency, and use of multiple medications that can antagonize dopamine or cause stimulation.

Pregnancy
Approximately one-fourth of pregnant women experience RLS, with more intense symptoms experienced during the third trimester, and resolution of symptoms typically occurring within a few months after delivery.

Predisposing factors of restless legs syndrome in pregnancy.
Mov Disord. 2007; Department of Neurology, Ankara Research and Training Hospital, Ministry of Health, Ankara, Turkey.
The occurrence of restless legs syndrome in pregnancy is well known. However, the mechanism of this association is unclear. In this study, we aimed to identify the factors that predispose women to have restless legs syndrome during pregnancy. In this study, lower hemoglobin levels and supplementation deficits of iron and vitamins were found be the risk factors for restless legs syndrome in pregnancy.

Medication for Restless Legs Syndrome
Pharmacologic treatment includes dopaminergic agents, opioids, benzodiazepines and anticonvulsants. FDA approved the dopamine agonist ropinirole (Requip) as first-line therapy. The following medications are considered to be of benefit: levodopa, ropinirole, pramipexole, cabergoline, pergolide, and gabapentin.

Those with RLS may have some issues with the dopamine system, perhaps some genetic causes, or alteration in neurotransmitters such as hypocretins, endorphins levels and immune dysfunction and inflammatory mechanisms. Dopamine agonists such as rotigotine transdermal patch, pramipexole, ropinirole, gabapentin enacarbil, pregabalin and gabapentin are sometimes effective in the short-term treatment of RLS.  Agonists such as pergolide 0.05 mg, bromocriptine 1.25 mg, pramipexole 0.125 mg, ropinirole 0.25 mg can be tried for moderate to severe restless legs syndrome if natural methods have not shown improvement. Use of the dopamine agonists pergolide and cabergoline is associated with an increased risk of cardiac valve regurgitation.      

2011 -- The FDA has approved a new drug, Horizant Extended Release Tablets, as a once-daily treatment for moderate-to-severe restless legs syndrome. Horizant's active ingredient is gabapentin enacarbil, which becomes gabapentin in the body.

Opioids such as codeine, hydrocodone, oxycodone 5 mg, propoxyphene 65 mg, tramadol 50 mg can be used on an intermittent basis to help the discomfort of restless legs syndrome. However, they can cause constipation, urinary retention, sleepiness or cognitive changes. Tolerance and dependence possible with higher doses of stronger agents. Only use opioids in severe cases.

Benzodiazepines such as clonazepam 0.25 mg, temazepam 15 mg, are helpful in some patients when other medications are not tolerated and may help improve sleep. Can cause daytime sleepiness and cognitive impairment, particularly in the elderly.

I am am a Chiropractic physician specializing in integrative pain management and, of course, run across RLS in the course of many a patient history. Unfortunately, I have been a sufferer my self for 15 years. I am 46 now. I found, as many have, accidentally that Mu agonists (opioids) were very effective. However, I tried many alternatives not wanting to go the opioid route. I tried everything from natural substances to dopamine agonists. The best so far has been Tramadol (SSRI / SNRI to M metabolite Mu agonist) at 50 mg dinner time. I titrated down from 100 to 50 mg. I plan to try something else as I do not want to stay on Tramadol. J. Adam Wagner, D.C.

Q. I love the website. I currently take half a 0.25 mg tablet of Pramipexole each evening for Restless Legs and it is reasonably but not entirely successful. A naturopath has suggested that GABA supplementation may help. Are the 2 OK to take together?
   A. I have not tried this combination before with patients, but if you were to try them together, it is a good idea to initially begin with low doses of GABA. Let us know how it works for you.

Emails
At 43 years old, I am a long-term sufferer of restless legs syndrome, which is worsening with age. I am getting to the point where I am ready to take prescription medication for it. Before I do, however, I am trying to explore all other avenues. I tried taking a combination of vitamins (the B's, Vit. C, folic acid) , including tyrosine, prescribed by a naturopath...to no avail. I am a partial vegetarian. I eat no red meat (I eat fowl and fish/seafood). I have one cup of coffee in the morning. I drink minimal alcohol. I have a healthy lifestyle..am a serious cyclist but lack of sleep prevents me from training to my full potential. My routine blood tests shows my iron level as normal.
   As I have more information on this condition, I will post it.

I found a quote on the muira puama page, "Indigenous peoples use muira puama for the therapy of ...neuromuscular problems..." Is it worth trying this herb for restless legs? I have not restless legs but leg jerking that prevents all sleep unless I take pharmaceuticals. Currently I'm on gabapentin which does work and seems harmless, but I'm always looking for other options. My leg jerking, BTW, is definitely a "brain thing" and not a leg muscle thing. Tiring the leg muscles has zero effect.
   Muira puama may cause insomnia in high doses, I don't think it would be helpful.

My husband started having symptoms with restless legs syndrome RLS in his early 20's. After a surgery he had on his elbow he realized that the Hydrocodone helped tremendously with the restless legs syndrome symptoms and found ways to get his hands on more of them (Opiates) for a couple years before I realized that he had a problem. After I realized what was going on I was shocked!! This was not the man I married ( a drug addict). He had a sleep study done and the restless legs syndrome was then confirmed, but the medicines they tried him on still didn't help get rid of the restless legs syndrome. So, he went back to the hydrocodone. Someone mentioned to him about a Methadone clinic. They told him it would help him come off the pain meds. HUGE MISTAKE!!! Little did we know what a huge mistake we had just made!! Not long after that he inrolled himself in a rehab center, but within 3 months after discharge he started back on the pain meds. because of the restless legs syndrome. Now, don't get me wrong he does have a family hx of addictions. His uncle and his grandfather were both alcoholics. So, this is not all to blame on the restless legs syndrome, but he says it has a lot to do with it. It has been approx. 3-4 years since the rehab and needless to say one thing has led to another and he has now tried hard drugs. He says he hates this and he wants help. He says he wants to go to rehad and end this, but he's affraid of the restless legs syndrome coming back. He says "you have no idea what it's like". I can't tell if this is more of a drug abuse thing or underlying restless legs syndrome thing.

I am 38 and have suffered with Restless Legs Syndrome for many years. I wanted to let your readers know that I have found that taking coral calcium before going to bed helps my legs to relax and I sleep great. Also, mangosteen seems to have helped keep the twitches and creepy crawly sensations to a minimum.
   Thanks for letting us know. We will wait to see if others give us feedback with similar benefits in regards to coral calcium or mangosteen.

I had suffered with restless leg syndrome for many years, not knowing it had a name, or that other people experienced this very uncomfortable disorder. I have been able to track episodes directly to the eating of high sugar foods in the afternoon, or later in the day/evening. Elimination of the sweets has helped.

Could 5-HTP or the amino acid tryptophan help with RLS?
   I am not sure, I have not tested these nutrients for this condition.

I am a very active 72 year old woman who has had restless legs since I was in my early 40's. I have tried about everything and have been to a number of different doctors. One doctor put me on Valium and that has been a wonderful thing for me. I am also on Mirapex and Neurontin for the same restless legs syndrome problem. I only take a half of a 5mg Valium table every night. Without it, I do not know what I would do. I have a severe case, and I hate to increase the Valium, but I have so many nights where I end up sleeping on the floor, because I have to move so much. I am considering increasing the Valium to at least a whole 5mg tab at night. I know Valium is addictive, but to prove to myself that I could go off of it, I did it completely without any effects in less than 3 months. Of course, I am back
on it. I loved your web site on restless legs syndrome and will subscribe to your newsletter. Thank you for your interest in a very severe health problem.
   Hopefully someday we can find a natural cure for restless legs syndrome.

When ever I sit down to rest, one or the other lower leg, starts to twitch every 45 seconds or so. My Doctor without doing any testing said I have restless leg syndrome and Rx Requip to supposedly replace the dopamine levels that he believes I am deficient in. The Requip usually, but not always, stops the twitching within an hours or so and then I can sleep. My question; have there been any studies to show that taking tyrosine boosts your bodies ability to produce dopamine, thereby eliminating the deficiency and potentially the twitch?
   We have not seen such studies. The use of tyrosine is likely to increase alertness and interfere with proper sleep.

SAM-e
I was reading other questions in your column that had to do with SAM-e acting similarly to Wellbutrin. I can't take Wellbutrin because of it works on the dopamine neurotransmitters. Is there a likelihood that SAM-e will exacerbate restless legs syndrome?
   Wellbutrin focuses on the dopamine system and SAM-e influences many types of neurotransmitters. I have not prescribed SAM-e to patients with restless legs syndrome, however I prefer not to use medicines or supplements that have a stimulatory effect and causes insomnia to patients with RLS. SAM-e, even at 100 mg, may, in some people, cause insomnia.

I have been suffering with Restless Legs Syndrome for 10 years. Most recently I have had horrific insomnia and depression and anxiety. Have taken sertaline (Zoloft) only 25mg most recently 12.5mg and it has worked wonders but as augmentation resulted from 7 years of using Sinamet and Clonazepam I've been through the gambit on various RLS Rx's without much success. Anyhow, sertaline exacerbates RLS now. So, recently referred to a Psychiatrist who was very good and recognized my extreme sensitivity to most all Rx's. He started me on 100 mg (split pill) of SAM-e with plans of dialing up to 400mg of SAM-e within a month. First 2 days of 100mg I had an extreme anxiety within 2.5 hours of taking 100 mg. I was overwhelmed, shaky, crying and slight panic attack. Took .25 clonazepam and calmed down within 45 minutes. Then INSOMNIA, but good kind just wired not restless and RLS breakthrough insomnia. So next day took 50mg and had 2 great days no crying almost no depression. But by day 4 evening, started getting depressed again and started crying. And by 5th day, very depressed and uncontrollable crying. Next day (6th day) took even less, appx 30 mg of SAM-e and been doing that last 3 days. Sweating less at night too, as well sleeping better. I may try to increase back up to 50mg as my psychiatrist wants me on a higher dose and I do think depression could still improve if I don't have the anxiety and restlessness. Do you have any information on SAM-e for treatment of RLS? Does it hit dopamine is an issue for RLS.
   At this time I have seen no studies with SAM-e in regards to RLS natural treatment.

I recently read on your website that you avoid giving your patients with restless legs syndrome any type of supplement that is a stimulant in nature. You suggested not using Sam-e since that is a type of stimulant. I was wondering what you feel about NADH and since that is used to combat fatigue, if that is considered a stimulant.
   The effects of low dose NADH, such as 2.5 mg, when used in the morning, should not interfere with sleep. Perhaps higher dosages such as 10 mg may interfere with sleep. We don't have any first hand experience with NADH regarding the treatment of restless leg syndrome. Please let us know how it works for you.

I am trying to find out if L-tryptophan helps with stages 3 and 4 sleep. Also wondering if it is safe to take along with Wellbutrin XL. I know it's risky with the SSRI's. I had a sleep study done which confirmed a previous study's results -- restless leg syndrome, periodic leg movement disorder, positive EMG activity during REM sleep, and almost no stage 3/4 sleep. The sleep neurologist had nothing to offer except Mirapex, which I do not wish to take (Am on Clonazepam for the RLS, Gabapentin helps as well...). In retrospect, I have had PLMD since at least high school! I had taken L-tryptophan in the 80's before I went to medical school, and remember it helping something, but cannot remember what. I have read a fair amount of anecdotal things about valerian, but would like to give the tryptophan another shot. I need good, restorative sleep!
   I am not exactly sure which stages of sleep tryptophan helps, but many people who take a tryptophan supplement do notice deeper sleep. It is difficult to predict the interaction of tryptophan with Wellbutrin, Clonazepam and gabapentin, much depends on the dosages used and the timing of the drugs and the supplement. You could try tryptophan several hours before or one or two hours before bed on en empty stomach to see which works better. Let us know if any natural supplement works for your restless legs syndrome condition.

Q. Just ran across your website yesterday and am very impressed with it! For one year my husband has been taking SAM-e for his restless leg syndrome, plus Vitamins B6, B12, and Folic Acid (to manage the homocysteine level). All this was not prescribed by any doctor (we live in a rural area and do not have access to a doctor knowledgeable in restless leg syndrome or insomnia). My husband has had the restless leg syndrome for 40 years and of course has tried everything for it. We are happy to report the SAM-e is actually working! However, his insomnia, which he has had for the same length of time and which we attributed to the restless leg syndrome, has not lessened. The way I ran across your website was while looking for side effects of SAM-e. To my amazement, you listed insomnia (if taking too large a dose of SAM-e) as a probable side effect. The reason I was amazed is I had asked both a pharmacist and a M.D. if such a thing were possible and they both assured me it was not. My common sense told me an antidepressant could likely have this effect; but when both a pharmacist and a M.D. assured me it was not, I didn't listen to my common sense. Then I ran across your website! My husband has been taking 400 mg SAM-e a day for over a year! We are going to gradually adjust his SAM-e downward and see how that works.
   A. Do keep us updated.
        Q. My husband has had severe RLS and severe insomnia for over 41 years. He has tried everything. The only thing that helped his RLS was SAM-e, which we have learned is a substance that is contained naturally in the body and has many , many purposes, one of which is the production of neurotransmitters; and that with age the amount of SAM-e declines in the body. Although the SAM-e made my husband's RLS better, it made his insomnia worse. So he quit taking it. Later, we learned from reading your wonderful article that SAM-e can build up in a person's system and if too much is taken, can actually cause insomnia. Since my husband quit the SAM-e, his RLS has worsened considerably. He has been taking Temazapam, a sleep medication, which seems to be the only one that works for him but only for a couple of days. Then he has to take a holiday from it before taking it again. He would like to go back on the SAM-e for his RLS, only taking it just in the morning before breakfast, along with the necessary B6, sublingual B12, and Folic Acid. He wants to continue Temazapam while taking the supplement, and wants to know if there is any contraindication in doing that. We have not been able to find any info on this and wondered if you have any info you can give us. We understand you cannot give us specific advice on health matters but just need to know. We cannot ask any doctor as they do not seem to believe in supplements. A long time ago one did prescribe Mirapes but it did not help and was very difficult for my husband to withdraw from.
           A. I have not seen such studies regarding the combination. It is best to use low dosages of the supplement to avoid insomnia.

Great website I suffer from time to time with RLS so does my wife. I think that the RLS symptoms are aggravated by some mild depression and lack of sleep due to stress. I have found as a CMT that I am able to completely turn off the RLS with some simple pressure with a T-bar in the lower thoracic upper lumbar area. Even some simple rubbing with a finger tip can have the same effect.

I am 57 and have mild restless leg syndrome symptoms. My father had that. After reading about Passion Rx that it may increase dopamine levels, are you saying that this is the product I should be talking to increase my dopamine level and reduce the symptoms of RLS. I have been taking melatonine 3 mg a day and it does not seem to do anything. I am at a loss. It seems by reading your description that when you increase dopamine serotonine level diminues. Should I take a dopamine test first and is Passion Rx the product you are suggesting for RLS?
   Passion Rx may cause shallow sleep and is not recommended for RLS.

Mucuna Pruriens herb is helping my restless leg syndrome.

I am 48 years old and have had RLS since I was a teenager and it has been getting worse with age. I took Neurontin for about 6 months which helped at first, then switched to Requip and have had to increase the dosage over a few years. I was about to ask the doctor to increase the dosage again (currently 1mg) when I discovered "Chiropractors Blend: Muscle Ezze." This is the regular blend (not the PM blend). It has magnesium, calcium and valerian along with some other herbs. I have been taking it for a few weeks and have slept better then I have in years. I had tried a natural remedy called "Amazing Restless Leg Remedy" which had melatonin in it which seemed to make my RLS worse. I take 3 of the "Muscle Ezze" at bedtime on an empty stomach and sleep most of the night. It does not work as well if not taken on an empty stomach. I am still taking the Requip but have gotten a prescription for a lower dose so that I can get off of it to see if the Muscle Ezze will work alone without the Requip. Do you know of any long term side effects from taking this?
    Magnesium, calcium are safe minerals to take. The long term use of valerian has not been well-studied, nor has the long term use of other herbs.

I have written you before about my experiences with RLS. I also have PLMD, REM sleep disorder, and no Stage 3/4 sleep. I have had the RLS and PLMD since at least high school, but it never had a 'name', and it was not bothersome. As I have grown older, the intensity of both have increased, often being somewhat painful. I would like to share some personal experiences, as well as some things I have come across in searching for more natural treatments. I saw some of the first articles that put a name to the problems I had had growing up around 1993. I was so excited that "it" had a name...RLS can involve the legs, just the foot, or other parts of the body. I remember a documentary on TV which profiled people who had it so badly they had to put padded rails on their beds, and spouses could no longer sleep with them. I believe that the protocols for RLS start with the Parkinson's medications, old and new. Lyrica and Gabapentin are tried next. Next in line are actually the opiates, then the benzodiazepines. None of the drugs are without uncomfortable side effects. We tried the then current Parkinson's meds which I was not able to tolerate. I was put on Klonopin. It helped! But with the discomfort and intensity increasing with age, the dose was slowly increased. And Vicodin was added. I found that Flexeril helped, though the sleep neurologist I am seeing says it makes it worse. I have also tried Requip (Insomnia developed) and Mirapex. I have also tried Lyrica and am now on low dose Gabapentin.I am working closely with a sleep neurologist now. I have been on the Klonopin for about 17 years. If I knew then what I know now about Klonopin, I would never have started it. It causes depression, tolerance (requiring increased doses), physicians are uncomfortable with it, etc. And it is hell getting off of it. I tried once several years and the withdrawal was horrible. I begged to be back on it. I now am on both Klonopin and Hydrocodone. I am once again trying to taper off the Klonopin. It may take over a year. Then I wish to taper off the Hydrocodone, hoping to try the Parkinson's meds. again. I want my life back. I have noted some things:
1. Yes, iron supplementation is useful. It is involved with dopamine in the brain, I think. A "normal" iron level is not a useful indicator of stored iron. Ferritin levels are important. It needs to ideally be above 50. If not, OTC iron is useful, though it can cause nausea and cramping. It should also be taken under a physician's guidance as one can develop hemochromatosis.
2. Diet can affect RLS. (Of note, RLS and Irritable Bowel Syndrome (IBS) have been associated with each other). In looking back at my own medical history, I have had both IBS and RLS since childhood. I did not know my symptoms were abnormal. Sugar consumption makes the RLS worse (?Link to IBS, ?increased yeast in gut, ?decreased 'good bacteria'). Probiotics might help if this connection is there. Sugar is likely a culprit in exacerbating RLS due to its excitatory properties. Caffeine can make it worse. Caffeine issue--most people do not connect chocolate with this! I personally think a diet free of processed foods, artificial sweeteners, preservatives, dyes, additives (MSG, soy oil), etc. also makes a huge difference in the severity of symptoms of RLS.
3. Any kind of injury (Old or new) or inflammation makes it worse. Even a skin problem can exacerbate it.
4. Stress makes it worse.
5. Exercise (Not just before bedtime) helps.
6. Antidepressants (Except perhaps Wellbutrin) and phenothiazines (Antipsychotics, anti-emesis medications such as Phenergan) can cause agonizing cramping. I even carry a note with me stating that those medications are contraindicated for me.
7. I have found that fairly high doses of Magnesium help for me. I take 600mg in the morning (Not at the same time as the morning dose of Gabapentin). I take it at dinner time. And I take it just before bedtime. Usually 400 to 600mg. I take what my body seems to tolerate (No diarrhea, etc.). Last year I came across a wonderful product, Magnesium Oil. Incredible! I put it on my arms, legs, and feet in the evening. It's somewhat sticky, so I shower after it. The manufacturer recommends waiting for at least one hour before showering to allow maximum absorption. Topical absorption is usually more effective. There are less expensive versions than the one I take. I do not know how well they work. It does not stop the RLS. I don't quite know how to describe it, but it is relaxing. I think it makes the RLS less bothersome. I am thinking about using it more often, hoping it might be more helpful and enable me to get off the medications. I do think magnesium is helpful, but one must be careful. I can hear Dr. Sahelian saying I take a lot of magnesium. And I do. But it helps. I also know it is a calcium channel blocker, causing vasodilatation. And therein lie issues for those who try it. Headaches, interference with blood pressure medications can occur. Gabapentin is also a vasodilator, warranting care when taking magnesium. The two must be spaced apart, as well. Lastly, warm magnesium salt baths, especially with a calming essential oil such as lavender, are often helpful.
8. Calcium makes it worse for me if I take it at night. It is thought to be excitatory.
9. I think having diabetes can make RLS worse. Especially if blood glucose not under fair control. But I have to wonder if RLS and diabetic peripheral neuropathy are confused by some clinicians. However, it makes sense that RLS might be a form of peripheral neuropathy due to abnormalities of dopamine concentrations in the pertinent part of the brain.
I would urge anyone who has RLS not to get on the Klonopin merry-go-round (My sleep neurologist states it does not treat RLS, it just suppresses it and also ruins other stages of sleep). With tolerance and depression as issues, along with needing to increase the dosage with time, it is awful. I feel it may have robbed me of part of my life, just as Stevie Nicks says (See link below). The benzodiazepines can affect mood, concentration, ability to focus, and memory problems. I have experienced these problems as have others. Trying to get off Klonopin is horrible, can take a very long time, and can require hospitalization. Tapering should always be under the care of a physician, preferably an addiction specialist. Seizures are a possible risk. And the withdrawal symptoms can last well over a year for some. Some withdrawal symptoms may never disappear. Much depends on how long one has been on Klonopin. Stevie Nicks described her experience with Klonopin: benzo dot org.uk/nicks.htm): When asked "I've heard detox from pills is the toughest. How was it for you?", she responded, "I felt like somebody opened up a door and pushed me into hell." It is a fantastic site for anyone whose physician suggests benzodiazepines for RLS (Or anything else) and those on any benzodiazepine. I continue to search the web for other more natural products. I have been on benzodiazepines for many years. I have paid a price. I dearly wish to be off all the medications, using OTC products that, hopefully, have fewer side effects. I hope this helps. If it helps just one person, I am happy. I hate to see others go down the same path I have been on.

About 11 years ago I started having RLS at 47. I ran six marathons since then and take a number of supplements for athletic needs, prevention of metabolic syndrome, and 6 grams Arginine which normalized my high blood pressure over three months. I take a multimineral with calcium and magnesium in a 2:1 ratio. I've looked all around for solutions to my increasing night time RLS for years. I can calm my RLS at night temporarily by pacing about for ten minutes; my reliable solution on waking is: take 100 mg magnesium oxide and 1000 mg GABA, then walk for a few minutes and go back to bed. Taking this prior to bed doesn't work as the effect seems to wear off after an hour or two, about the time the RLS would arrive. I was stunned about three months ago when I started taking Vitamin K2 for my cardiac health. I take the NSI Ultra Vitamin K with Advanced K2 Complex. This has 1000 mcg Vitamin K, 100 mcg Vitamin K2, MK-7 fraction, and 1300 mcg VitaminK2, MK-4 fraction. I've had a major reduction in my RLS symptoms after three days! My mental clarity and energy have increased. My five mile runs come up 5% to 10% faster after two months and I recover faster. It appears from reading at the Weston Price organization web site that scientific research suggests Vitamin K2 is functional in nerve cell energy production in the mitochondria and is also helpful in producing the nerve myelination substrate needed to help nerves function. I hope this proves a promising entry to your web site.

I think I developed this condition from taking Cymbalta.

I was recently diagnosed with celiac sprue at age 53 and upon modifying my diet my RLS went away.

After 30-plus years of struggling with RLS at night, I have finally found a solution that has worked for me! I sought the help of a local chiropractor and nutrition counselor (because I was not going to take prescription medication to simply mask the symptoms, not try to find the cause and eliminate it). He put me on mega doses of calcium, magnesium, potassium, vitamin E, and within ONE DAY my symptoms were GONE! This may not work for everyone, but I have been so blessed with total freedom from restless legs at night that I wanted to pass this on for your readers on your blog.

I read with great interest your page on RLS and would like to contribute a couple things I've learned treating my daughter's relatively severe RLS:
Benedryl will always trigger it. Zyrtec does not seem to trigger it.-- Daily iron supplement in the morning fully resolves it within two weeks. If she skips several days the RLS returns-- On occasion I have chipped off a small piece of propranolol and that works well after about 45 minutes-- DXM, Advil, Tylenol have no effect.

I have Restless Legs Syndrome and Polycythemia Vera. My doctor in Thailand is treating RLS with Sifrol tabs, but this medication is not working. I tried to take mucuna as a supplement since I really believe in natural care. My first try with Mucuna was a disaster because I started with an high dose 700 mg, and I had tachycardia, vomiting and weakness. Can you suggest me if I have to interrupt Sifrol medicine using mucuna herb?
   A. I am not familiar with Sifrol medication and not able to provide specific personal suggestions.

Good Night Rx is a formula that helps with sleep but is not in stock at this time.