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Dear Dr. Roach: I am an active senior and have started to feel symptoms of restless legs syndrome (RLS). I'm wondering how and why this started. In the evenings, I use an athletic foam roller, drink water, and take magnesium supplements. I'd like to hear how to remedy this so that I can get some much-needed sleep. -- J.L.
Answer: We don't understand exactly why people get RLS. One common finding is low iron stores, so you should have this tested by your regular doctor. If your iron is low, it should be supplemented, but your doctor should also find out the cause of why it's low. Sometimes iron supplementation is all that is necessary.
Before considering specific medicines for RLS, your doctor should consider any other medicines that you're taking, a few of which can trigger RLS. Moderate exercise and avoiding alcohol are wise. Magnesium doesn't have strong evidence that it helps, but it's pretty safe.
In some ways, RLS resembles neurological diseases like Parkinson's, which is why the anti-Parkinson's drug combination carbidopa-levodopa is often used, especially in people with occasional flares. In people with symptoms that occur for two or more days per week, most experts try a drug like gabapentin. Other dopamine drugs like pramipexole can be considered.
Sometimes poor sleep itself can trigger RLS, so considering other types of sleep disturbances (especially sleep apnea) should be considered. Behavioral techniques to help sleep can also be tried.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.