Tips for Coping with Opiate Withdrawal Induced Restless Legs Syndrome

Restless legs syndrome (RLS): hard to describe - but you know it if you get it.

Some people describe insomnia-provoking RLS as the most unbearable of the opiate withdrawal symptoms. Your legs will calm naturally as your dopamine system recovers with abstinence, but in the meantime, here are a few ideas for minimizing the discomfort of this miserable symptom.

Read on to learn more about:

• Basic RLS facts
• Medication options for opiate withdrawal induced RLS
• Coping Techniques that can reduce your symptoms
• Avoiding other environmental triggers which can worsen your symptoms

What Is RLS?

RLS is a neurological condition that causes overwhelming urges to move the legs. It is a serious cause of chronic insomnia and it affects more than 7 million Americans – and it’s also frequently a symptom of opiate withdrawal.

Symptoms and Features of RLS include:

• Irresistible urges to move the legs. Legs feel creepy-crawly.
• Symptoms typically get worse as you lay at rest and worsen as your rest deepens and lengthens.
• Symptoms go away when you move your legs – but only for so long as you continue to move.
• Symptoms cause significant sleep disruption and affect energy levels and mood. ¹

There are two kinds of RLS:

1. Idiopathic – primary condition without a known cause.
2. Secondary – caused by another medication or condition (such as when caused by opiate discontinuation)²

Medication Options for Opiate Withdrawal RLS

Because opiate withdrawal RLS tends to dissipate within a period of days or weeks, your doctor may be reluctant to prescribe the serious medications typically recommended for RLS, such as dopamine agonist Parkinson’s medications.

However, some medications that are commonly prescribed to treat other opiate withdrawal symptoms can also help to reduce the severity of RLS.

Ask your doctor about:

• Clonidine: Some people find that clonidine reduces RLS severity.³ Clonidine is a hypertension medication that’s very commonly prescribed to reduce the anxiety, agitation, muscle aches, sweating, runny nose, and cramping of opiate withdrawal.⁴
• Benzodiazepines: Benzos like clonazepam or valium can help you fall and stay asleep and are a recommended (though not first-line) treatment for RLS. These medications can also reduce the anxiety and agitation of opiate withdrawal. Because of the high dependence risk, it’s not advisable to take benzodiazepines for more than 5 days or so when treating opiate withdrawal.
• Baclofen: This drug is sometimes recommended as a temporary treatment for opiate withdrawal induced RLS. It may relieve the severity, though not the frequency of symptoms. (Note - the RLS foundation does not recommend baclofen due to insufficient evidence of efficacy and due to concerns over side effects.)⁵
• Marijuana: There is anecdotal evidence (internet forum reports) that marijuana may help to reduce RLS symptoms. Apparently, only very small doses are needed for good results. ⁶

Coping Strategies and Home-Remedies

Sometimes a little relief is as close at hand as a pair of tight socks or a long hot bath.

Try any or all of the following:

• Try a temperature treatment – Soak in a hot bath or alternatively, try a cold shower. Use hot pads or ice packs on your legs - experiment to see what helps.
• Massage – Get a leg massage just before bedtime. (Some people find this beneficial, though others find it worsens symptoms.) You might also want to try a handheld massager or leg massager machine that you can use on yourself in the middle of the night.
• Get regular moderate exercise – Moderate exercise during the day decreases restlessness at night, but avoid vigorous exercise within a couple of hours of sleep, since this can exacerbate sleep problems. Ideally, choose exercises that engage the leg muscles.⁷
  
• Wrapping – Try a tension bandage wrapped around the legs (be careful not to wrap so tight as to impair circulation.)
• Pantyhose or compression stockings – Some people prefer compression stockings by day and pantyhose or long socks for a more comfortable night’s sleep.
• Creams and lotions – such as Icy-Hot, Tiger-Balm, etc.
• Stretch or do yoga – Stretching may help alleviate symptoms temporarily, but some people find that deep stretches provide hours of symptoms relief.
• Weight – try weighting down the blankets over your legs to ‘smother’ them.
• Mindfulness
• Sex to orgasm – Most people need the release of orgasm to get symptoms relief.
• Lying on your stomach on the floor for half an hour⁸
• Soap under the blankets – this is an odd remedy but many people swear by it – place a bar of regular soap under your blankets by your feet – (not dove or dial brands, for some reason.)⁹
  
• Choose chairs that allow movement – if restless legs bother you while you relax in the evening, such as while watching television, try sitting in chairs that allow for natural movement, such as a rocking chair or on a yoga ball.¹⁰
  

Avoiding Common RLS Triggers

Although clearly your opiate withdrawal is causing the problem, to play it safe, you may also want to avoid these other common RLS triggers:

• Caffeine
• Alcohol
• Nicotine
• Vigorous exercise (though moderate exercises is beneficial)
• Excessive stress
• Excessive refined sugar intake
• Antihistamines, such as Actifed, Sudafed and Benadryl. Though these first generation antihistamines are commonly recommended as OTC sleep aids, they can worsen RLS symptoms.¹¹

Sleep Habits

You probably don’t need to worry about your sleep habits if experiencing RLS during the acute phase of a cold-turkey withdrawal – but if you get regular or even occasional RLS during a prorogued opiate taper, then you may want to pay more attention to good sleep hygiene.

For the best odds of a restful night’s sleep:

• Keep your bedroom cool and dark. Take special care to limit screen glow.
• Limit outside noise.
• Make your bed an inviting place with clean sheets and blankets.
• Keep an even sleep schedule. Go to sleep and get up at a similar time each day.
• Try to give yourself enough sleeping time to get fully rested.
• Get enough daily exercise (but don’t exercise too close to bedtime.)¹²