Restless Legs Syndrome

In January 2025, the guidelines reversed. Most patients have not been told.

For twenty years, the first drug offered for restless legs syndrome was a dopamine agonist. In 2025 the American Academy of Sleep Medicine issued a clinical practice guideline that recommends against using them as standard first-line treatment — and recommends, instead, the alpha-2-delta ligands and intravenous iron.

Millions of people are still taking the older drugs. Many of them are getting worse and have been told it is their condition progressing. Often it is not. It is augmentation: the medication itself driving the symptoms earlier into the day, into the arms, into the hours when they used to be free.

This book is a neurologist's explanation of what changed, why it changed, and what to do about it — written for the person living with it, not for the clinic.

Inside:

• The five criteria that make the diagnosis, and the conditions that get mistaken for it
• What augmentation looks like from the inside, and the questions that distinguish it from ordinary worsening
• Why a ferritin result marked normal by the laboratory can still be too low for restless legs — and why the thresholds moved again in 2026
• What the 2025 guideline actually recommends, and what it recommends against
• The medications, supplements, and over-the-counter sleep aids that quietly make it worse
• Peroneal nerve stimulation, compression, exercise, and the folklore — sorted by evidence, with the manufacturer-funding caveats stated plainly
• Surgery, pregnancy, dialysis, long flights: the situations nobody prepares you for
• For the partner who has not slept properly in years
• Printable forms, a glossary, an index, and a page of questions to take to your appointment

This book contains no doses and no tapering schedules. That is deliberate. Those decisions depend on your examination, your blood results, and everything else you take. What this book gives you is the ability to walk into an appointment knowing what to ask.

Tae Ho Guak, MD is a neurologist with twenty-five years in practice and a member of the American Academy of Sleep Medicine.

Educational only. Not medical advice. Do not stop a dopamine agonist abruptly.