RLS and Mental Health: Q&A with Dr. Brian Koo
Tuesday, April 14, 2026April 14, 2026 RLS and Mental Health: Q&A with Dr. Brian Koo Brian Koo, MD, is the director of the Yale Center for Restless Le...
April 14, 2026
RLS and Mental Health: Q&A with Dr. Brian Koo
Brian Koo, MD, is the director of the Yale Center for Restless Legs Syndrome, a certified RLS Quality Care Center, as well as the medical director of Sleep Laboratory at the Veterans Affairs Connecticut Healthcare System. In October 2025, Dr. Koo presented an RLS Foundation webinar, “Anxiety and Depression in Restless Legs Syndrome.” Following is a selection of his answers to questions asked by the attendees. Please note: The information presented in webinars is offered for informational purposes only and should not be considered a substitute for the advice of a healthcare provider.
Q. How can I tell if my bad mood is depression or just a bad mood?
Dr. Koo: It’s normal to occasionally experience a bad mood. People’s moods are generally the lowest in the morning, but a combination of waking up, moving around, socializing and doing work will increase their mood. However, if the feeling of low mood is pervasive, lasts more than at least two weeks and is affecting your ability to function at work, home or school, you should speak to your physician about signs of depression.
Q. Why do I experience a sense of doom and gloom when I’m woken up for a second time during the night with RLS?
Dr. Koo: There could be a number of possibilities. Nighttime is lonely – most people are asleep, so there’s a general sense of isolation when one is woken up. The anticipation of the next morning’s responsibilities, such as going to work or school, may contribute to the “doom” sensation. Some medications commonly used for RLS, such as methadone or buprenorphine, can cause a sense of doom, so be sure to consult with your physician.
Q. Are mood swings a common side effect for some of the medications that are commonly used for RLS?
Dr. Koo: Nearly any of the medications used commonly to treat RLS – gabapentinoids, dopamine agonists, opioids – can potentially cause depression as a side effect. It’s also important to consider that dopamine agonists can cause impulse control disorders – such as compulsive gambling, eating or shopping – that can impact someone’s mood.
Q. Can the use of buprenorphine or other low-dose opioids cause sleeplessness when used to manage RLS?
Dr. Koo: Nearly all medications can cause sleeplessness, but opioids may be more likely to do so. It is not uncommon to treat someone for augmentation with a low-dose opioid, which effectively manages the RLS symptoms but simultaneously causes sleeplessness. In that instance, I may try to treat the patient with a different opioid or add a hypnotic like zolpidem. It is also important to look for other triggers such as alcohol use, caffeine intake or comorbid conditions such as sleep apnea.
Q. Some days I get eight hours of sleep. Other days, only three or four. How does inconsistent sleep time affect someone’s mood?
Dr. Koo: Being well rested means having more reserve to do the activities that can increase your mood – socializing, hobbies, exercise, artistic endeavors, etc. Inconsistent sleep can make enjoying these activities much more difficult. If your RLS medication is not effectively managing your RLS and your provider has investigated potential triggers, comorbidities and optimal iron status, talk to your provider about adjusting the dose of the RLS medication or adding a hypnotic.
To view Dr. Koo’s webinar or other previously recorded webinars, log into your member portal at rls.org/login-member. Our expert-led monthly webinars are free to join live and offer critical information on topics relevant to the RLS community. Visit rls.org/attend-events to register.
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