Self help – DO TRY THESE AT HOME

• Exercise. Most patients find that mild to moderate physical activity tends to suppress symptoms. Stretching exercises just before bedtime are often helpful.

• Temperature. Very hot or, less commonly, very cold baths, or even alternating hot and cold baths can reduce symptoms.

• Caffeine, smoking, alcohol etc. Smoking and caffeine should be avoided completely. Alcohol may initially appear to reduce symptoms but this wears off and may be followed by a rebound worsening of symptoms. Most of the antidepressants and antihistamines (commonly found in allergy, cold and sinus preparations) seem to make things worse, as do drugs for nausea and sickness.

• Water intake. Increasing water intake to 2 litres per day is very helpful for some sufferers, despite the nuisance a full bladder can cause. In most people the bladder and kidneys readjust quickly to the increased water load.

• A low GI diet to reduce swings in blood sugar may be helpful for some.

DRUG TREATMENTS AND SIDE EFFECTS

As already mentioned, medical thinking is that there is a disturbance of a chemical in the brain called dopamine and treatment is based on the idea of correcting this imbalance. Drug treatment based on this approach can be very helpful for many RLS patients (at least initially) but there are many side effects of which you should be aware.

Dopaminergic agents

Combinations such as carbidopa/levodopa can be extremely effective in management of RLS. However recent evidence suggests that 65 -80% of patients will develop augmentation or rebound. Rebound is the tendency of symptoms to worsen at the end of the dosing period, so that they all come back during the late night or early morning. Augmentation is the tendency of symptoms to develop earlier in the day (eg morning or late afternoon instead of evening) and to be more severe than the symptoms that were present before treatment began. Put simply this means that you may get worse because of the drug treatment.

Dopamine agonists

Pergolide, although effective, can cause nausea, constipation and a drop in blood pressure. Again, 20% of patients taking this developed augmentation. Ropinirole (requip) has also been shown to be helpful for patients with RLS but side effects once more include augmentation and rebound. Other side effects reported are falling asleep while driving, hallucinations and inappropriate sexual or gambling urges.

Other drugs used

The opioids such as codeine can be helpful but may cause constipation, difficulty in passing water, sleepiness and inability to concentrate, particularly with prolonged use. The anticonvulsants such as carbamazine and gabapentin can cause nausea, sleepiness and dizziness.