Most restless legs advice online reflects guidance that has since been revised. If you or someone you know is being treated for it, this is worth knowing.
The change
For years, dopamine agonists — pramipexole, ropinirole, levodopa — were first-line treatment.
In its 2025 clinical practice guideline, the American Academy of Sleep Medicine conditionally recommends against their routine use.
That's a substantial reversal, and it is not because the drugs don't work. They do, at first.
The reason: augmentation
Augmentation is the phenomenon where the drug that was treating restless legs begins to make it worse over months to years. It typically looks like:
- symptoms starting earlier in the day than they used to
- symptoms spreading — to the arms, or the trunk
- symptoms becoming more intense overall
- shorter relief from each dose, prompting a higher dose, which accelerates the whole thing
The cruel logic is that augmentation looks exactly like the disease getting worse. So the instinct — and historically the response — was to increase the dose, which makes it progress faster.
What moved up instead
Iron. The guideline's strong recommendation is for intravenous ferric carboxymaltose where the iron thresholds are met, and iron assessment is now front and centre rather than an afterthought.
Other medication classes carry conditional recommendations. Which is appropriate for a given person is a clinical decision.
If you're currently taking a dopamine agonist
Do not stop it on your own. Stopping abruptly has its own problems, and these drugs need managed withdrawal.
Do book a review, particularly if any of the augmentation signs above sound familiar. The guideline still allows short-term use in specific circumstances with monitoring — so this is a conversation about whether your situation is one of them, not an automatic switch.
What to bring: when you started, the dose and whether it has increased, what time of day symptoms now start compared with when you began, and whether they've spread beyond the legs.
If you have not been diagnosed with anything
Restless legs is one of several sleep disorders that get mistaken for ordinary poor sleep, and the distinctions matter because the treatments are completely different. Obstructive sleep apnea is the most common and the most commonly missed. Sleepwalking, night terrors and acting out dreams are a separate family again. And narcolepsy takes an average of nearly a decade to diagnose, largely because the symptoms get attributed to something else first.
If what you actually have is not enough time in bed, that is worth establishing before anything else.
Why we're writing about a prescription drug
Because Proco's sleep content reaches people who think they have insomnia, and a meaningful share of them have restless legs. Some of those are already being treated, on guidance that has since changed. Saying nothing because there's no product involved would be the wrong call.
And to be explicit about where we sit: no supplement treats restless legs, melatonin included. Iron status is a blood test and a clinical decision, not a shelf purchase.
Based on the 2025 AASM clinical practice guideline. This article is not medical advice. Do not stop prescribed medication without speaking to your doctor.