New Guidelines Bring a Better Way to Treat Restless Legs Syndrome

What the latest research means for people living with RLS and why it matters

If you live with Restless Legs Syndrome (RLS), you know how frustrating it can be. The urge to move your legs, the uncomfortable sensations, and the way symptoms seem to worsen just as you’re trying to relax or fall asleep can make nights exhausting and days even harder.

RLS affects an estimated 5–10% of adults worldwide, and for many people, it’s a long-term condition that requires ongoing management.¹ For years, treatment options focused mostly on medications that affect dopamine in the brain. While those treatments often helped at first, clinical researchers discovered that these medications actually made RLS worse over time.

The new treatment guidelines released in 2025 by the American Academy of Sleep Medicine (AASM) are an important step forward in the treatment of RLS.² These updated recommendations reflect years of new research and offer safer, more sustainable options, especially for people who have struggled with medications in the past.

Why Were the Guidelines Updated?

Previous guidance was last updated in 2012, so the new Restless Legs Syndrome guidelines reflect many of the scientific and treatment advancements of the last decade. One notable update is the reversal of the use of certain class of medication.

In the past, doctors commonly prescribed medications called dopamine agonists—such as pramipexole or ropinirole—to treat RLS. These drugs were once considered the go-to option and are still FDA-approved today.³

However, research over the last decade has shown a serious downside: many people taking these medications long term experience a condition called augmentation.²

What Is Augmentation?

It might be augmentation if your symptoms:

Start earlier in the day
Become more intense
Spread to other parts of the body
Appear more quickly when you’re resting

In other words, the very medication meant to help can slowly make RLS worse. This can be incredibly discouraging, especially because increasing the dose, a common response, often speeds up the problem.²

Because RLS is usually lifelong, the new guidelines place a strong emphasis on treatments that work over time, not just in the short term.

A Big Shift: Moving Away From Dopamine Medications

One of the most important changes in the 2025 guidelines is a move away from routine, long-term use of dopamine medications for RLS.²

While these medications may still be used in very specific situations, such as short-term relief during travel, they are no longer recommended as standard, ongoing treatment for most people.

This change doesn’t mean past care was wrong. It means researchers now understand RLS better and want to prevent people from experiencing years of worsening symptoms caused by treatment itself.

So, What Is Recommended Now?

The updated guidelines highlight treatments that are less likely to cause worsening symptoms and are better suited for long-term use.

Medications That Calm Nerve Signals

Several medications that work on nerve signaling, not dopamine, are strongly recommended:

Gabapentin
Gabapentin enacarbil
Pregabalin

These medications have been shown to:

Reduce RLS symptoms
Improve sleep quality
Support daily functioning

While side effects like dizziness or sleepiness can occur, they are generally manageable and less likely to cause long-term problems compared to dopamine-based treatments.²

Iron: A Key Piece of the Puzzle

One of the most important discoveries in recent years is the role iron levels in the brain play in RLS. Even people who are not anemic can have low iron where it matters most.⁴

Because of this, the guidelines now recommend that everyone with significant RLS symptoms have their iron levels checked, including:

Ferritin
Transferrin saturation

These simple blood tests can help determine whether iron treatment might reduce symptoms.²

Iron Treatment Options

Depending on results, treatment may include:

Oral iron supplements
Intravenous (IV) iron infusions

IV iron, in particular, has shown meaningful improvements for many people with RLS, especially when oral supplements aren’t enough.⁵

A Non-Drug Option Is Gaining Recognition

For people who want to avoid medications or who haven’t found relief from them, the guidelines also recognize the first effective non-drug treatment.

High-frequency Nerve Stimulation Therapy

One option now supported by research is high-frequency peroneal nerve stimulation (like the Nidra device from Noctrix Health), a wearable therapy used when RLS symptoms are present.^2,6

This approach:

Stimulates nerves below the knee
Helps reduce RLS sensations while resting
Does not involve medication or chemicals
Avoids the risk of augmentation

For many people, this type of therapy is an alternative to more medication.

Other Recommended Options

There is also clinical evidence for two other treatments:

Low-dose opioids can be very effective. Due to risks, opioids are often reserved for severe or treatment-resistant cases, alongside careful monitoring.²
There is one study suggesting benefits from dipyridamole, a medication that modulates brain signaling related to adenosine. This is not widely adopted in clinical practice.

What This Means for People Living With RLS

The updated guidelines point to a more thoughtful, personalized approach to care. Key takeaways include:

Iron testing matters—even if you’ve never been told you’re iron deficient
Long-term dopamine use carries real risks
Newer treatments focus on sustainability
There is now a research-backed non-drug option
Treatment plans should be tailored to you, your symptoms, and your lifestyle

If you’ve struggled with worsening symptoms, side effects, or limited relief, these updates may open the door to new conversations and new options.

A More Hopeful Path Forward

For many years, people with RLS were told that worsening symptoms were just part of the condition. The latest research tells a different story: in many cases, treatment choices play a major role.

The 2025 AASM guidelines represent progress toward safer, longer-lasting relief. By focusing on iron management, reducing reliance on dopamine medications, and expanding non-drug therapies, these recommendations offer renewed hope for better sleep and better days ahead.

If you’re living with RLS, consider discussing these updates with your healthcare provider. Understanding your options is an important step toward regaining control.