Restless legs syndrome used to feel simple. If the legs were jumping, we reached for a dopamine agonist, the safer alternative to older meds. Over time, we learned that the very medication calming symptoms could make the condition worse. But just as guidelines changed in favor of gabapentin and related medications, new research raised concerns about the medications link to cognitive decline and dementia. So where does that leave patients? In this episode, we will:

• Define restless legs syndrome and review why dopamine agonists became the standard treatment in the first place
• Explain augmentation and rebound in plain language, and why it led to guideline reconsideration
• Walk through the AASM’s updated recommendations and why gabapentinoids are now considered first-line therapy
• Examine the recent study linking gabapentin exposure to increased dementia and mild cognitive impairment risk
• Discuss what observational research can and cannot tell us about causation
• Compare the real-world risks of dopamine agonists versus the emerging safety signals around gabapentin
• Explore how these recommendations may be interpreted differently by sleep specialists versus primary care providers
• Highlight the “rock and hard place” many patients feel caught in when every option carries caveats
• Review practical strategies: iron optimization, careful dosing, monitoring for augmentation, and individualized care
• Offer a balanced framework for making thoughtful, evidence-based decisions without panic or oversimplification

Produced by: Maeve Winter

Music by: Dr. Abhinav Singh (@sleep_vigilante), all rights reserved

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Thanks for listening and sleep well!