Restless Leg Syndrome: Triggers, Home Remedies and Treatment | Andy Berkowski, MD

[Laughter] [Music] hi thanks for joining us you're listening to the health essentials podcast brought to you by cleveland clinic my name is cassandra holloway and i'll be your host for this episode we're broadcasting virtually as we are practicing social distancing guidelines during the coronavirus pandemic we're joined virtually by sleep expert dr andy furkowski dr burkowski thanks for being here and welcome to the podcast thank you it's my pleasure so for someone who's never experienced restless leg syndrome before the disorder might kind of sound a little bit baffling or a little bit mysterious but for those who suffer from it they know all too well just how frustrating and intense it could be today we're discussing restless leg syndrome we'll talk a little bit about the physical sensations that go along with it the triggers some of the causes and we'll do our best to provide listeners with tips and advice for managing this condition and also when it might be time to see an expert before we dive into this full episode we just want to take one moment and remind listeners that this is for informational purposes only and is not intended to replace her own doctor's advice also this interview was pre-recorded and does not reflect any changes to covet 19 precautions that may have been made after the recording so dr burkowski i want to first start off by asking if you'll tell us a little bit about your practice at cleveland clinic and the types of patients you typically see so i'm a neurologist by training but i practice exclusively at the sleep disorders center at the neurological institute at the cleveland clinic and i see exclusively uh patients with sleep disorders and it's a fairly narrow field but very common in terms of the diagnoses and treatments that we administer and uh most patients in a sleep disorder center are going to be uh with obstructive sleep apnea and insomnia are going to be the two most common but i specialize in the previously mentioned restless leg syndrome so a significant portion of my patients perhaps maybe a quarter to a third have very severe uh symptoms of restless leg syndrome and that's my personal sort of sub sub specialty uh within sleep medicine so let's start off with the very basics then can you tell us what exactly is restless leg syndrome so yeah it can be a perplexing uh disorder if you haven't experienced it or you don't see patients with it but restless leg syndrome is exactly what the name describes is it's this unpleasant feeling in the legs it's really a restlessness of the legs that people experience and it's it's fundamentally an urge to move the legs and it's really not a leg disorder per se it really is is occurring in the brain in sort of the parts of the brain that actually feel the legs themselves and so it's a really a brain disorder neurological disorder but it typically affects people at night time and it's this unpleasant sensation where people have to move their legs and then sometimes it prevents them from falling asleep and in other people it can be quite distressful in situations where they can't move their legs to relieve those sensations so when you mention that these patients who have this condition feel restless and the need to move what exactly does that mean is there pain involved in that is there kind of itching or pulling kind of explain to me a little bit about more about the symptoms that people complain of from this disorder well a lot of times it's very hard to describe because it's it's it meets the criteria for a pain syndrome or a pain condition technically but it's not painful for the most for most people there are a certain uh variation of it where people do experience what they would describe as pain but they say it's just a uncomfortable undescribable sensation maybe bugs crawling on their legs or feeling like they want to explode from the inside but it's not really something that you can explain that patients have a easy time explaining to because it just doesn't have a corollary to anything so just the fact that you can't really explain what you're experiencing might be the fact that you have this condition does it happen exclusively only in the legs or can it happen in other parts of the body as well typically it it affects uh one leg or both legs but many times if the particularly if the condition gets worse or becomes very severe it can spread to other parts of the body into the torso and arms but primarily uh the areas of the brain and the pathways that are affected cover the areas that feel basically the legs and so it starts off in the legs it may spread to other parts of the body but classically it's it's in the legs but not exclusively so you mentioned that it typically happens at night i'm wondering if um you know obviously this is a sleep disorder but can it can it hit someone at any point of the day during like inactivity say at your desk when you're working and not really moving a lot or like when you're driving your car yes so the uh and we may talk about this later but there's a relationship to the body's biological clock and the body goes through these cycles throughout the day and it may correspond to iron levels in the brain and iron levels in the brain may fluctuate at night time which is why the symptoms start to come on at night time but they can occur throughout the day as well particularly during periods of rest or inactivity as you mentioned uh we're recording this during the pandemics and people aren't flying on planes anymore but uh air airlines are sort of like a torture chamber for people with restless leg syndrome to be on a confined tight space for two hours without moving your legs those situations typically uh bring on the symptoms so theaters movies uh flights long car rides where you're not driving these can be very uncomfortable so it's a combination of of inactivity and rest without movement of the legs particularly confinement of the legs but then also at night time when when people lie down to fall asleep at night combined with the fact that the symptoms are going to be naturally worse at night for most people on a regular uh sleep and wake cycle i'm curious how common is it like will most people experience it at some point or another during the duration of their life well probably not everyone but it's actually extremely common disorder it's a common disorder that most physicians don't know much about it and worldwide it may affect up to five to ten percent of the population depending on uh what epidemiology literature you look at but uh it tends to affect more of a northern and western european ancestry there are a lot of genetic factors involved but it does affect all all populations whether it's african middle eastern asian south asian but more so in the in the western and northern european uh ancestral lines but interestingly enough uh in addition to the five to ten percent worldwide up to 20 of women during pregnancy uh can experience restless leg syndrome so that's a significant number of people and and for most women who are pregnant once they deliver the the condition may resolve but that's a a lot of people who will have had symptoms of restless leg syndrome throughout their life is there a certain number of times a night or a week or a month for someone to experience this condition that kind of is a red flag that this might be the actual condition like what's the frequency estimate for experiencing this well it can vary there's a a big uh curve in terms of the symptom severity so there are people who can get it maybe like once a month there's some people who have it every night and it's it's really severe so there's a whole spectrum and some of the studies show that in this five to ten percent of the population that may have it maybe 50 have clinically significant symptoms meaning that you you may think if you are a patient you might bring it to the attention of a doctor whereas half it's just sort of a nuisance if you ask deeply about it which we do in the sleep clinic we take a lot of symptoms somebody might say oh well once a month i get this urge to move but it really doesn't bother me and and usually we can just ignore those cases so it depends on how severe it is to the the person who's experiencing the symptoms i think it's so interesting that you mentioned feeling this disorder it's often times like in an airplane like you said because i feel like you're already claustrophobic you're already confined you already want to be able to move but you can't and then for someone like me who i don't think i've ever experienced it before i think back to being on an airplane and i think maybe that was it you know maybe i have experienced it before maybe it's more common than i thought yeah it could be and and you can identify the people with restless legs because if they have it fairly severe you'll you'll go to some event and they'll be in the back kind of pacing and it's not because they don't enjoy the show or um they're they're getting tired of being on the plane it's it's because that's it it's getting kind of unbearable and and the relief which is fundamental to condition is it the sensation is relieved with movement so the movement sends some sort of feedback mechanism back to the brain to say let's shut off that sensation and that's why you'll see that the movement is also associated with the sensation in these situations so talk to me a little bit about like obviously this is a sleep disorder so you know sleep affects so many parts of our physical and mental health how does this disorder affect you know who you are if you're not getting enough sleep and kind of your performance during the day as well yeah so it it sort of is a a neurologic condition but it's fallen in the sleep disorders category for a couple of different reasons one is uh sleep medicine involves the body's biological clock and this is something that is affected like most things affected by the body's biological clock and the symptoms happen to occur at night so this can be what we call a dysomnia meaning it makes it difficult to fall asleep sometimes or it can interfere with sleep there are also associated limb movements which are not as clinically significant now that we've done more research on but there are these uh kind of kicking movements or where a person who's asleep their leg might pull away or a spouse or a bed partner might say they'll kick in their sleep and these occur every 20 to 40 seconds so people with restless leg syndrome often have these what are called periodic limb movements in sleep and so it's something that we can see on a sleep study not that we see restless leg syndrome which is based on just symptoms but we can actually see people with restless leg syndrome who have these limb movements and the lip movements not necessarily are shown to affect sleep quality at this point we we don't think that they should necessarily be treated but but that's why it falls into the domain of sleep because there's a nighttime component there's a disruption to sleep before you fall asleep or if you wake up uh during the night with symptoms and can't fall back to sleep because you're pacing the room or have to kick your legs constantly and then even when you're asleep you may be uh having these kicking movements that are occurring in your sleep and and but sleep is is really important so if the condition becomes worse uh it could actually prevent sleep quality it can it can cause a reduction in one's sleep and all of the bad effects that follow from that so it it's a problem in and of itself and it could be a problem secondarily to one's sleep as well do we know what causes restless leg syndrome i know you mentioned pregnancy um are there any other triggers that listeners should be aware of that you know the actual causes of this well restless leg syndrome is not fully understood it's mostly a problem that's occurring in the brain there are a couple different chemicals i guess you would call it that are implicated in the condition one of them the main one is iron and the element iron is deficient in the entire brain or in certain uh specific parts of the brain and that's been well studied at this point so people with restless leg syndrome actually have lower iron levels in their brain than people without restless leg syndrome even if their blood levels of iron like the iron you would get on a blood test looks the same their brain levels are lower and if you increase their iron levels their brain levels increase more slowly so it's this deficiency of iron there's also a chemical in the brain called dopamine and that is maybe better known because it's sort of the pleasure uh it's a neurotransmitter but it's a chemical in the brain that it reinforces pleasure so when you eat uh fructose or like a cupcake or something or with things like gambling or alcohol or or substances that reinforce pleasure dopamine is something that uh sends the signal uh from one brain cell to another but in restless leg syndrome uh the the shipping ports where the dopamine is received by one brain cell uh called the dopamine receptor they seem to be defective and so some of the medications that involve dopamine coincidentally were found to help with symptoms of restless legs and interestingly enough there's a deep relationship between iron and dopamine in the brain because dopamine is helped it's manufactured with the use of iron and it's transported with the use of iron inside of the brain so there are a lot of complex relationships between iron and dopamine but it's primarily a condition that's caused by low iron levels so a long-winded way of answering your question is that any condition that will lower someone's iron levels uh can cause worsening of restless legs or actually bring on the condition uh whether it's it's bleeding from some condition uh that causes blood loss or not getting enough iron in one's diet or different conditions that cause people to not be able to take in iron into their body when i mentioned pregnancy it's because of shifts of iron maybe the baby is stealing all of the iron uh from the mom and there's less of it for the brain that's the best theory we have on why it occurs during pregnancy due to the reduced iron levels to to just grow a human life so uh there are a lot of situations that can make this worse is there a genetic or like hereditary component of restless leg syndrome yes so i mentioned the kind of the northern and western european ancestry not to get deeply into genetics but there are certain gene variants that put people at greater risk of developing restless leg syndrome and again the most common ones are related to the function of iron uh in the brain and some of them even the function of iron and dopamine so it's not like you can inherit a gene you'll be guaranteed to get it but you're certainly at higher risk if you have some of these genes and some of them are available on these commercially administered tests that are on the market now so some people will come and say i've got this gene and and it makes sense that they have the gene one of the genes that put them at higher risk uh for restless like syndrome and it does tend to run in families because families share the same genetic risk factors uh but it's not uh a strongly inherited gene where you're guaranteed 50 50 to get it if your parent has it but it does tend to run in families at times and what about medications i know you kind of briefly touched on this are there any medications that might cause restless leg syndrome as a symptom of that medicine yes there a lot of the ways we deal with restless leg syndrome is making modifications to one's lifestyle but also looking at can it be triggered by other uh medications that uh people may be on and i call them kind of the the anti-drugs all the anti-drugs seem to make restless legs worse which are antidepressants uh antiometics which are medications you would take for nausea antipsychotic drugs that are used for some psychiatric conditions and anti-histamines so the over-the-counter drugs for sleep for example somebody with restless leg syndrome uh might take an over-the-counter sleep aid which is actually an antihistamine and instead of falling asleep the restless legs gets worse and it makes it harder to sleep so a lot of the the medications that are prescribed for other conditions can trigger restless legs they typically don't call cause really severe restless legs but that can be enough for somebody to say oh when i take this sleeping pill that i i got at the store this triggers my restless legs and that's that's a very common situation so we try to have uh avoidance of those triggers and then all the the natural vices whether it's nicotine alcohol uh or uh caffeine those can also be triggers of restless leg syndrome as well for each individual it's going to be a little bit different wow that's so interesting to think that you know an antihistamine or a sleep medicine could actually have the adverse effect and cause more restless leg syndrome you know symptoms i guess yes and uh some of the common ones uh tracidone is one that is a prescription drug that's it's really an antidepressant but it's most commonly used to help people sleep during the night and and that can be a trigger and uh one called quatiappine uh which is an antipsychotic that's is sometimes used for sleep these can also be mild triggers and then many many people are on antidepressants it's not that this isn't advice to go off your antidepressant but a little tweak here there uh with certain medications can make a difference with maybe annoying symptoms of this condition without getting into medications to actually treat the condition so speaking of depression or you know anxiety and then stress it's everyone's favorite topic right now you know obviously with the pandemic and just feeling uh just stressed throughout your life i'm curious if if maybe you only experience restless leg syndrome during times of stress or when you're going through something you know big life changes is it common to kind of have restless leg syndrome come and go throughout your life especially during periods of stress yes and it could be a bi-directional relationship because people with restless leg syndrome not everyone it's it's a very common condition but tend to be a little bit more prone to uh different levels of anxiety and but the anxiety is something it's a survival mechanism in the brain so when somebody becomes anxious it's it's historically in our evolution to like fight off a bear or run away from a bear or kill a bear to eat the bear so so it was kind of activating our fight-or-flight mechanisms our sympathetic nervous system and when that gets active our sensations may change as well so we may be more acutely aware of our surroundings including the sensations within our body and in conditions whether it's migraine headaches or or pain conditions restless leg syndrome will get worse particularly now in terms of times of stress and then you have indirect relationships where it's well if you're under a lot of stress you're not going to sleep well if you're not sleeping well you're going to be lying in bed for your legs to get more and more restless so a lot of these uh situations will feed on each other and and there's kind of an inner relationship between the stress and the restless legs and the restless legs can provide provoke anxiety and stress if if it's something that's very uncomfortable and preventing someone from falling asleep certainly it's all connected that's why we always say you know get get your stress under control it affects so much so many aspects of your life right yeah we're an integrated person there's not just the brain and the legs it's one you can't separate your brain your nerves from the rest of your body you're one whole person and it's operating together as one unit absolutely um okay so how does age play a factor in this does it typically affect one age group well that's a tricky question it restless like syndrome is more common as as one gets older so the in terms of the population of people as uh people age there's increased levels of restless leg syndrome among people it's not clear that it's it's due to aging itself but it could be due to the fact that more medical conditions are occurring uh that might provoke restless legs uh over time uh in women it's it's definitely uh something that may have two peaks one peak could be during uh when women have menstrual cycles and are losing a lot of blood and then it may get better uh after menopause yay menopause maybe one one benefit to it and then after menopause as women get older it might get worse because there are just more medical conditions involved but in general it is associated uh with aging uh but maybe not due directly to aging but maybe the the chances of having just more conditions more medications uh more disruption uh to different processes that are going on in the body but yes it does even happen in children and it can be very difficult to identify it's probably not identified well in children just because children just don't have the tools yet to describe it or it's kind of brushed off as something like being fidgety or or not sitting still when it's actually this maybe neurologic phenomenon going on but it's it's starting to be more recognized in children but it does occur and we think at all ages potentially so i want to get a little bit into treatment now and i want to start off with some home remedies or strategies for restless leg syndrome that listeners can try do you have any recommendations well yeah i mentioned some of the important things are limiting some of the things that we tell you to limit for other reasons whereas drunk don't do not drink caffeine excessively quit smoking or use of nicotine reducing the amount of alcohol that one drinks particularly close to bedtime because it does disrupt sleep quality uh but also it can also trigger restless leg syndrome a lot of habits that are just good healthy habits during the day are also helpful so activity tends to be helpful for restless legs however there's some bit of a u-shaped curve so basically there's a paradox whereas sometimes very very vigorous activity tends to make restless legs worse for a lot of people like so they may uh go for that nice bike ride and and they feel better at night on the days they've gone on the bike ride but if they they bike for like 50 miles their restless legs bothers them at night so we know inactivity is not good for symptoms of restless legs and sometimes vigorous vigorous activity uh high intensity activity may not be great but but definitely there's a sweet spot for some individuals with at least moderate activity whether it's in the moment uh a walk before or around bedtime but those are some habits that that can help and then stimulation to the legs themselves even though the problem is not primarily in the legs the stimulation to the legs somehow shuts off the loop of sensation sort of like scratching an itch so uh warm baths uh heat cold compresses there have been products on the market whether it's things that vibrate uh vibrating pads or pressure wrap devices that are available that can for some people pro provide some sort of stimulation uh to the feet or legs uh that will help shut off that sensation that they're experiencing so a lot of things uh can be done without even resorting to any type of doctor or medical treatment at that point and in in in speaking of in terms of home remedies like what are things that people can take over the counter well uh there's really not a lot of evidence for things to take other than one thing which i had mentioned before which is iron however i would not recommend uh that somebody with restless legs just blindly take iron because iron is a is a finicky uh substance even though it's over the counter you can't just take iron you know there's a quantity and amount that's appropriate based on the blood levels of iron because if you take too much iron it could actually be counterproductive and it can cause uh problems uh in in the bowels so if you were thinking that your symptoms are are bad enough that you would want to take iron you probably want to talk to your doctor about it and get your iron levels tested and based on those levels your doctor can recommend a particular amount of iron that would be helpful but iron will would be the most common over-the-counter remedy that has a lot of evidence behind it in terms of treatment use and that's really our first line treatment as physicians i want to go back a little bit to some of the products you have mentioned what about you hear so much about weighted blankets and if they're good for you would you recommend someone who's suffering from restless leg syndrome try a weighted blanket for their legs yes so so that one obviously or not obviously to my knowledge it hasn't been studied in any way for restless leg syndrome but in terms of what i tell patients is it it could be a double-edged sword because one the weighted blankets are going to prevent movement because you have something heavy on the legs so some people it may be unhelpful to them but for other people that maybe that pressure and the weight from the weighted blanket uh could uh provide some stimulation to the legs that might replace that need to move the legs to to relieve that restless sensation but i would leave that up to the individual the weighted blankets have many different effects uh whether it's physical or even uh psychological effects like emotional effects than just having it some say it's it's like being wrapped up like you're wrapped up in the womb when you were an infant kind of thing and so there are a lot of benefits to things like the weighted blanket but i would i would like to leave it up to the patient to decide on that we don't have evidence to say yay or nay to that as a home remedy for these symptoms sure sounds a little bit kind of like trial and error kind of what works for you what improves your symptoms at that point right and and that would go with with anything uh related to sleep and relate to rustle's legs because if the warm bath gets your legs too uh warm and and you feel like it's starting to get them moving you probably don't want to take a warm bath but for most people that tends to work but whatever works for the individual uh is what we want one to have because it's a very kind of a subjective condition where if the symptoms are relieved we're happy with that there's no way to quantitate the level of symptoms and so we can't say well you need this much of a bath i mean if the bath works take a bath if it doesn't work you shouldn't if you want to take a cold shower take a cold shower but but uh it really is going to depend on each individual people are so different in their responses to a lot of these uh habits or home techniques as to how to address their symptoms of restless legs so i feel like with restless leg syndrome you always hear about the iconic sleep with a bar of soap under your your sheet um is there any truth to that is it is it a wives tale or does that actually help improve your symptoms again that one might be more of um you know kind of a what we would call a placebo effect where the thought of having uh the bar of soap that's doing something may be uh evidence i i don't know of any evidence or any studies on the bars of soap uh sometimes restless leg syndrome gets confused with uh leg cramps that can occur at nighttime and that's more of a muscle situation that's not uh in the brain it's actually the muscles where cramps develop and so some of these home remedies that have occurred over years uh are are often to address leg cramps instead of restless legs syndrome but it's important to distinguish those two leg cramps are a little bit more difficult to identify and treat because it could be caused by many different things but those are going to be kind of a stiffening or a pulling of the muscle and i've heard the bar of soap for all of these conditions but again that's not based on evidence uh necessarily even i haven't had anybody have much success with that in terms of patients reporting this to me so obviously home remedies have their limits and they can only go so far so i'm wondering when should someone seek care for restless leg syndrome you know how long is too long to suffer from this yeah so restless leg syndrome is it's sometimes associated with different long-term conditions in terms of cardiovascular disease there's maybe an increased risk of cardiovascular disease for example but it's not necessarily a cause-and-effect relationship it's just what we call an association where some of these things kind of come together but there's really not great evidence to say that restless leg syndrome has to be treated so right now the the general consensus is that patients treat their symptoms based on how much the symptoms are bothering them and when i would say to go to the doctors if if um symptoms are starting to get worse they're starting to affect your ability to fall asleep if you're extremely discomfort uncomfortable or have a lot of discomfort with these activities we used to do like go to the theater or go onto a plane if it's causing a lot of distress in your life that's when you you would want to talk to your doctor if it and maybe anything just maybe check your iron levels to make sure your iron levels are not low but you don't necessarily have to feel the obligation to treat it it's it's not like another condition like high blood pressure or uh pre-diabetes where you have to make changes or there's going to be long-term side effects 30 years from now even if you don't have symptoms now so it's not something we do for preventative reasons and again i want to emphasize that these leg movements that occur while you're asleep if you have restless leg syndrome there is no good evidence to say that those should be treated either so if you happen to have a sleep study and the doctor says oh you had these periodic limb movements on your sleep study that doesn't mean you should run out and go get medications for restless legs syndrome uh so i want to caution people because that does happen a lot where something's identified and it's if you identify you got to treat it that's not this case just because you have it doesn't mean it needs to be treated and i would typically leave that up to the patient to decide on that of course if they're coming to see me then they already have symptoms enough that they're going to bring it up with me but if i happen to be screening for the condition and identify it among one of my sleep center patients i will tell them that hey if it gets worse we can re we can check your iron but otherwise don't worry about it sure so i'm curious then if if someone is really severe in this disorder and it's really affecting multiple areas of their life and i i understand you know not every you know symptom of this needs to be treated but if it does who should they start off with seeing like do they reach out to their primary care doctor do they see a neurologist right away kind of what's that first starting point yes so i would go uh if i if if i were recommending it to a patient i would go see their primary care doctor first the knowledge of restless leg syndrome is variable among primary care physicians because it's sort of a neurological or a sleep disorder but many primary care it's so common that many primary care doctors will at least know uh the initial aspects which is usually to check uh iron levels in the blood or or at least look at the hemoglobin which is the measure of one's blood count and if the hemoglobin is normal or low normal then you would move on to checking an iron level because the hemoglobin could still be normal but the iron levels might be a little bit low for restless legs syndrome so that's the first step and if the primary care doctor is uncomfortable typically they will send you to a uh sleep specialist and the sleep specialist tend to be the realm uh though though some neurologists do treat restless leg syndrome it's primarily fallen under the specialty of sleep medicine so that's where the primary care doctor will typically refer patients to a sleep center and and most sleep centers should should be good at uh managing this condition evaluating and treating it but i would start with the primary care doctor because if it's something as simple as uh somebody has anemia and they have a condition where they're losing blood just addressing that condition treating it uh and and getting the iron levels up might be all that they need so it could be another condition that the primary care doctor can identify that's triggering the restless leg syndrome if you do find yourself meeting with a sleep specialist because of this disorder is an overnight sleep study usually recommended is that kind of the typical course of treatment for how you go about diagnosing a more severe case well restless like there are no objective tests for restless leg syndrome even the exact there's nothing abnormal on an examination so unless you're trying to your doctor is trying to distinguish between another condition that they're not sure about uh they can probably do it by just how you describe the symptoms and those are some of the symptoms we discussed at the beginning but in in a sleep disorder center they would not necessarily order a sleep study now a sleep study may show these periodic limb movements uh maybe 70 80 percent of the time maybe up to 90 percent time if you had multiple uh sleep studies with restless leg syndrome but uh the the sleep study itself is meant to diagnose other sleep disorders particularly obstructive sleep apnea so if when the sleep center is screening a patient for restless leg syndrome if they happen to think that there might be another cause of sleep problems or a condition like obstructive sleep apnea uh which is a a problem in the throat where the throat is collapsing during the night which causes a snoring sound and and the brain to wake up frequently uh during the night that's something that they will order a sleep study for but it's not required for the diagnosis of restless legs syndrome so right now and we may touch on this uh later on but telemedicine is a great uh way of seeing your doctor during the pandemic because it doesn't require any examination or tests unless you of course need a blood test but just talking to a doctor they may be able to help identify this condition for you and and recommend some sort of treatment plan uh even without having to lay a finger on you yeah absolutely always a good point to mention virtual appointments and kind of just how accessible the pandemic has made seeing a healthcare provider so i know we talked a little bit about treatments we mentioned you know checking your iron and maybe using an iron supplement with the help of a doctor or health care provider we talked about some of the lifestyle changes and things that you could do are there any other treatments for this that a physician would recommend for a patient yes so if it gets to the point where uh iron levels uh have been tested and and they seem to be at goal uh as sometimes uh patients even with normal iron levels they can get what are called um iv iron infusions where iron is given directly into the bloodstream and the iron levels go up very high which is higher than they can be if you just uh take iron through your diet or or through supplementation uh so that's going to become a new treatment that one's not typically covered by insurance as as frequently because it's a relatively newer treatment but that's sometimes available at certain centers to get an iron infusion and that's based on a lot of clinical evidence so that would be one step you could take before you even consider medications uh but that one uh there's gonna be barriers for you as an individual to getting an iron infusion uh the the first line medications though if the doctor decides well this is the time to start medications are um they would fall into the class of nerve pain or seizure medications uh kind of drugs that have been repurposed that had been used for seizures or nerve pain and now are used for restless leg syndrome one that is fda approved uh is called gabapentin and a carbil uh there's also one called regular gabapentin and then one called pregabalin those are the three main medications and these are the the clinical consensus is that these are now the first line uh medications for restless leg syndrome and the majority of patients who have never been treated for restless leg syndrome uh if you have iron and then you have these seizure medications those are mostly as far as you would ever need to go to have your symptoms under control it's pretty rare to need any anything more but there are two other classes of drugs for restless leg syndrome one are actually opiate medications and or narcotics uh so medications like buprenorphine or methadone and these are classic what we call pain medications sometimes these are considered a second line or third line uh for restless leg syndrome but they're typically reserved for extremely severe cases of restless leg syndrome and most people would not need to ever resort to an opiate medication for restless legs but it is actually the oldest treatment medication treatment for restless legs that was it was first described in the 17th century uh for a noble woman in 17th century england when restless legs is thought to be first described in in the medical field and and they gave the patient the opium plant so that would be probably my second line as a physician and then what i would describe as third line but is actually very commonly used are medications called dopamine agonists and a couple of the ones that are fda approved the there are two pill forms that are fda approved which is uh ropinarol and pramipexole using the generic names and then a patch called rotigatine now these drugs were all fda approved for restless leg syndrome but now with 20 years of use it has been shown that they actually worsen the condition so i mentioned dopamine there's a problem with the dopamine shipping port inside of a brain of someone with restless leg syndrome but with the use of these medications it causes changes in the brain and we think there's an alteration in these shipping ports where the shipping ports start to close down and it causes this condition called augmentation which anybody with restless leg syndrome should know about is that if they've been on these drugs for maybe several months to many years the condition will gradually worsen and it's now thought that this is inevitable so if you're on the medication long enough or if you're taking a high enough dose of the medication the condition will gradually get worse with time so now the recommendations are not to use these medications which used to be first line are no longer considered first line and a lot of specialists in this area including myself this is not a consensus but i i will not start someone on a medication that will inevitably worsen the condition potentially because it could be a lifelong condition and you don't want to use a short-term treatment that's going to make things worse in the long run so philosophically i'm opposed to these medications even though they're fda approved but the the fda approval process doesn't last for 10 years it's a short term and now with 20 years of experience i would very very caution people to think twice before starting one of these medications because of that long-term risk absolutely not i just want to clarify for listeners so medications at this point especially provided from your healthcare provider are second or third line defenses to restless leg syndrome correct yes so the first thing is do you even need the medication and because all of the the three or four classes that i've described they all come with potential for a lot of side effects and you don't want to have any type of treatment where the the treatment side effects are worse than the condition themselves because again this is not high blood pressure where it's going to cause other things to get worse in 20 years or or in 10 years this is a condition that you're just treating symptoms of it doesn't need to be prevented necessarily so to take a lot of these medications uh like the nerve pain medications and the opiate medications and the dopamine medications you don't want to have long-term side effects from these drugs uh if your symptoms aren't really that bad if they are that bad that we have the drugs there i'm not saying not to take the drugs but again taking the medications i would say our third or fourth line uh compared to all of these different lifestyle modifications uh even uh things to improve uh levels of inflammation the body weight loss things that will generally make your body healthy tend to make restless leg syndrome improve as well improving diet increasing amount of iron in your diet those things should be the first approach we shouldn't drop necessarily jump to a medication just because the condition is there and then we can avoid some of the side effects of these medications absolutely so the last thing i want to ask you about today is just your general advice for why listeners should still seek care for restless leg syndrome even when we're going through a pandemic yes so again if these symptoms of restless leg syndrome are distressing or they're causing uh particularly sleep problems where you're lying down and you're not unable to sleep because you got to get up and move or you got to keep kicking your legs that's going to have a cascade of effects on your body because poor sleep quality sleep deprivation that can lead to all sorts of different problems throughout the entire body and uh even just the emotional uh stress of we have enough to deal with uh with the pandemic that we don't need to add emotional stress of having to just try to overcome this sensation that's really bothering you and preventing you from doing what you want to do or sit still for a period of time though these things can be addressed in a medical way again this is not going to require major surgery or or any type of hands-on intervention we have virtual health available many insurance companies are still providing it and we'll probably provide it forever at this point and so it's a good time to seek care it can be done in a safe fashion uh this is sort of my office that i see patients in more than 50 of the week and most of the patients with restless legs see me through this camera that you're watching me through now so uh it is something that there's no reason to delay care this this can be addressed um without having to be exposed to a hospital or clinic setting this can be addressed from your home and there are many providers out there whether it's primary care or or a sleep specialist that a person can see and get the treatment that they need and there may be other sleep conditions that often overlap that need to be addressed particularly insomnia and sleep apnea as i mentioned before which both worsen restless legs uh syndrome and those can be addressed uh separately at a sleep center as well yes that's wonderful advice to end on dr burkowski thank you so much for taking the time to speak with us and sharing your insight oh it was my pleasure to participate for the latest news about restless leg syndrome visit clevelandclinic.org sleep if you want to listen to more health essentials podcasts featuring experts at cleveland clinic like dr burkowski subscribe wherever you get your podcast from or visit clevelandclinic.org hepodcast also don't forget to follow us on facebook twitter and instagram at clevelandclinic all one word to stay up to date on the latest health news and information thanks again for listening

Channel: Cleveland Clinic

Views: 354,197

Keywords: cleveland clinic, video podcast, health essentials cleveland clinic, cleveland clinic video podcasts, restless leg syndrome symptoms, andy berkowski md, sleep expert andy berkowski, restless leg syndrome triggers, restless leg syndrome treatments, home remedies for restless leg syndrome, cassandra holloway, restless leg syndrome, restless legs syndrome, restless leg syndrome treatment, restless legs, rls treatment, rls symptoms, restless legs syndrome (rls), rls triggers

Id: tEtepQRWWXY

Length: 44min 17sec (2657 seconds)

Published: Fri Mar 12 2021