Psychopharmacological Management of Restless Legs Syndrome and Periodic Limb Movements in Sleep

Psychological (e.g., stress), physiological (e.g., pregnancy), pharmacological (e.g., caffeine and SSRIs) and pathological (e.g., renal failure and Parkinson’s disease) factors all play a role in RLS and PLMD. Sleep specialists debate whether continuous long-term treatment for an undulating (but at times very disruptive condition) is merited. In “quiet” times, there may be the unnecessary ingestion of regularly prescribed medication. However, the disruption of sleep is unpredictable for most patients and an overall improvement of symptoms and quality of life may be achieved with continuous treatment. We generally favor the latter approach but have observed (especially with patients on Seligiline) that there may be several months of symptom free respite after inadvertently stopping the medication. This implies that some patients may be well on published regimens.