If you have ever suffered from an irresistible urge to move your legs when, say, relaxing in front of the TV at night—or, even worse, when you’re in bed trying to sleep—you know that restless legs syndrome (RLS) can drive you batty.

The condition, which affects up to 10% of people in the US, is so frustrating that some sufferers pace the floor, toss and turn in bed or even consider suicide, according to research recently published in Sleep Medicine

To get relief, many people who would prefer to forgo pharmaceuticals think they have no choice but to turn to drugs that are commonly prescribed for RLS, including medications for seizures or so-called dopamine-agonist drugs mainly used to treat Parkinson’s disease. But these drugs can lead to side effects such as nausea and dizziness…and sometimes cause RLS symptoms to worsen (see Step #6).

Good news: You may not have to take medication to relieve RLS. There are lesser-known strategies that can restore your precious sleep…and your sanity. Eight of the most effective steps… 

Step #1: Ask to have your ferritin level tested. If it’s low or even borderline (still within normal, but on the low end), iron supplements could be all you need to reduce RLS symptoms. Though this has been known for some time among RLS specialists, many primary care physicians aren’t aware of it. Note: Checking ferritin, a protein that stores iron in your body’s cells, is not the same as checking your iron level. An iron blood test can still come back normal even after ferritin stores have started to decline. 

Some people with an iron deficiency respond best to an iron infusion (through an IV) every few months or even two or three times over a few weeks. Note: RLS may accompany end-stage kidney disease and peripheral neuropathy, too. Your physician should also check to see if either condition is contributing to your RLS. 

Step #2: Get a “medication checkup.” A number of medications can make RLS worse. These range from over-the-counter (OTC) antihistamines and sleep aids, such as melatonin, to prescription antidepressants, anti­psychotics and antinausea drugs. If you take one of these, you may sleep better without it, but consult your doctor before stopping a medication. If the drug was prescribed by a psychiatrist, he/she should confer with your RLS doctor to look for alternatives.

Step #3: Review your sleep quality and quantity. You know that getting a good night’s sleep can improve RLS, and you may already be practicing good sleep hygiene by keeping your bedroom cool and turning off all electronic gadgets at least an hour before bedtime. Just be sure to get enough sleep—seven to eight hours nightly. 

Important: If you snore (ask your bed partner if you aren’t sure or set your smartphone to record yourself while sleeping), talk to your doctor about scheduling a sleep study to check for sleep apnea. Correcting apnea often improves RLS symptoms.

Step #4: Exercise the right way. Physical activity can help if it’s performed during the day or early evening at the latest. Vigorous exercise, such as running many miles at any time of day, may worsen RLS symptoms. If that’s true for you, opt for walking, slower and less intense jogging, slow cycling and/or swimming. Research has also found yoga to be a good option for RLS.

Step #5: Reduce stress. If, like many people with RLS, stress worsens your symptoms, try relaxation techniques, such as a warm bath…massage…acupressure or acupuncture…and/or meditation. These therapies may calm down the brain arousal systems that appear to be overactive in RLS.

Step #6: Get help for augmentation. The same drugs that can help RLS at first, such as the dopamine-agonist medications mentioned earlier, can worsen symptoms over time. The initial dose may become less effective, and RLS symptoms can grow more intense. Called augmentation, this medication-related phenomenon usually happens after six months. When the drug is discontinued, symptoms typically improve. However, you’ll need to work with your doctor to identify augmentation and then treat it, often with a gradual switchover to a different drug, such as gabapentin (Neurontin).

Step #7: Ask your doctor about RLS devices.Two devices that require a doctor’s prescription can be used whenever you’re lying down. Both were relatively recently cleared by the FDA and are eligible for FSA/HSA reimbursement.Restiffic is a vibrating foot wrap that exerts gentle pressure on strategic muscles in the foot. The device costs $199 online at Restiffic.com. Relaxis is a vibrating pad that you place beneath your legs for better sleep. It costs about $600 online at MyRelaxis.com.

Step #8: Go to an RLS center. As frustrated as you might feel, RLS is very treatable. If you suffer from this condition on most nights or your symptoms have worsened after using an RLS drug, contact one of the nine Quality Care Centers in the US that are certified by the Restless Legs Syndrome Foundation.*

At these centers, specialists take a comprehensive look at your sensory, motor, psychological and sleep symptoms…do a detailed analysis of factors that could be affecting your symptoms (including sleep, diet and medication)…and then personalize treatment to your unique situation. Also helpful: Consider joining the Restless Legs Syndrome Foundation to share ideas with other patients in its forums and be in the loop on new developments.

*To find a center, go to RLS.org and click on “treatment.”