Restless Legs Syndrome
Lifestyle Considerations and Non-Pharmacological Treatments
Stimulant Avoidance. Certain chemicals (e.g., nicotine and caffeine) stimulate both the central and peripheral nervous system, and can affect the body long after being ingested. As a result, many experts recommend that patients with RLS eliminate nicotine and avoid excess caffeine consumption throughout the day (Pigeon 2009; Bayard 2008). There is some controversy, however, regarding nicotine: there is a case report of nicotine actually helping alleviate symptoms in a patient (Oksenberg 2009), and another case report of exacerbation of RLS symptoms following smoking cessation (Juergens 2008). However, the evidence for nicotine as treatment for RLS is otherwise undocumented. In addition, excessive caffeine intake and nicotine use can also contribute to insomnia, which may exacerbate already existing RLS and increase daytime drowsiness.
Exercise. Increased physical activity may be one way for RLS patients to reduce their symptoms. Risk factors for RLS can include a lack of regular physical activity (Phillips 2000), higher BMI, and obesity (Ohayon 2002). A randomized controlled trial found that aerobic exercise and lower-body resistance training 3 days per week significantly reduced symptoms of RLS (Aukerman 2006). Regular physical activity improved sleep patterns and reduced periodic limb movements (PLM), and thus may be a useful non-pharmacological treatment for PLM (Esteves 2009). However, it is important to not engage in physical activity shortly before going to bed, as this can exacerbate RLS symptoms (Ohayon 2002).
Massage and Acupuncture. Both massage and acupuncture may produce some benefit for people with RLS (Stanislao 2009; Rajaram 2005; Russel 2006). A comprehensive review found that more research is needed to determine the benefit of acupuncture in RLS, as only two studies were deemed suitable for inclusion in the analysis (Cui 2008). However, one study did find that combining dermal needle therapy with medications and massage was more effective than medications and massage alone (Zhou 2002). Similarly, massage of the affected regions of the leg may provide counter stimuli that can alleviate RLS symptoms (Gamaldo 2006). Other massage techniques (e.g., myofascial release, trigger point therapy, deep tissue massage), and enhanced external counter pulsation may also relieve RLS symptoms (Rajaram 2005; Russel 2006).