How can I effectively manage a patient with restless legs syndrome who is experiencing significant daytime impairment?

Effective management of a patient with restless legs syndrome (RLS) experiencing significant daytime impairment should begin with a thorough assessment to confirm diagnosis and identify any contributing factors such as iron deficiency or medication effects ¹. Addressing reversible causes, particularly correcting iron deficiency with oral iron supplementation if ferritin levels are low, is a key initial step ¹. Non-pharmacological strategies including good sleep hygiene, moderate exercise, and avoidance of caffeine and alcohol can provide symptomatic relief and improve daytime function ¹.

For patients with moderate to severe symptoms causing daytime impairment, pharmacological treatment is indicated. First-line pharmacotherapy typically involves dopamine agonists such as pramipexole or ropinirole, which have demonstrated efficacy in reducing RLS symptoms and improving quality of life ¹. Gabapentin enacarbil or pregabalin may be considered especially if pain or sensory symptoms predominate or if there is comorbid insomnia ¹.

Recent literature emphasizes the importance of individualized treatment plans and highlights that in some cases, augmentation (worsening of symptoms due to dopaminergic treatment) can occur, necessitating careful monitoring and possible medication adjustment (Benbir Senel and DelRosso, 2025). Additionally, emerging evidence suggests that addressing sleep fragmentation and associated restless sleep disorder features can further improve daytime impairment (Benbir Senel and DelRosso, 2025).

In summary, effective management integrates correction of underlying causes, lifestyle modifications, and tailored pharmacotherapy with dopamine agonists or alpha-2-delta ligands, alongside vigilant follow-up to monitor efficacy and side effects ¹; (Benbir Senel and DelRosso, 2025).