Nidra TOMAC device

Hi linn4549, Nidra is a TOMAC device--tonic motor activation. It works with high frequency, while a TENS unit works with low frequency (for those familiar with TENS). It feels like a weird "buzzing."My husband, sleeping beside me, has no idea if it's turned on or not.

Before it was made available by the Noctrix Company, Nidra was FDA approved, a step necessary for insurance coverage. Nidra is a prescription-only device.

Noctrix developed the Nidra and then, made it available on a state-by-state basis. There is an in-person "activation" session necessary and it took a while to hire and train personal to do the activations in different locations, across the country. My state wasn't included early on, so (after I waited over a year) I was allowed to have my Nidra shipped to a friend in another state and have my activation session there.

Then noctrix provided someone who emailed weekly (during the first couple of months), making sure I had no questions. This person can still be contacted by me, anytime, if new questions arise.

My Nidra was prescribed by my expert RLS doctor, J Andrew Berkowski, MD. I had already been through a number of unsuccessful RLS treatments and my RLS was severe. I'm sure he documented all this clearly. From the time he wrote the prescription to my receiving the device was about 3 weeks. My guess is that insurance probably requires other, cheaper, treatments be tried first (and fail) before the Nidra is approved--and I met that criteria.

I have Medicare. Someone in our forum posted a while ago about her Medicare Advantage Plan refusing to approve the Nidra for her because it is "experimental." (Untrue! FDA approval means it isn't experimental.)

Medicare doesn't "buy" the device outright--it rents the Nidra for 13 months and then, after that, the patient owns it. I got mine in April 2025, a little over 13 months ago.

Commercial insurance and Medicare Advantage Plans buy the Nidra--they don't rent it, initially, like Medicare does.

I asked a lady in the Noctrix billing dept, out of curiosity, if there was ever successful billing to a Medicare Advantage Plan and she said there was.

My RLS doctor indicated some frustration with insurance denials for some of his other patients, although we didn't go into whether it was certain kinds of insurance or all insurances--or what symptoms the denied patients had.

The cost, (if insurance denies) is about $6,000 for the bands, plus a month's supply of "sticky pads" (technically: "charge dispersing interfaces") is $75. The sticky pads are supposed to changed weekly. (That adds up to $900 per year)

Does it work? It did for me, beyond my wildest dreams. But, my doctor told me it hasn't worked for all of his (RLS) patients. There is no guarantee that it will work for everybody.

The Nidra are two bands, worn below the knee on both legs. There is a button you press to turn them on, when RLS symptoms start. They run for 30 minutes and I have had no problem going back to sleep while they are running. Nidra helps me go back to sleep. It makes the RLS stop.

It took time to adjust. It wasn't instantly "oh, this feels good." It was a matter of using it, over and over. Since I had episodes almost every night, there were many opportunities to use it. Settling in took 3 to 4 weeks for me.

"Neuromodulation" (thank you, Dr Aggarwal, for sharing this term), was something I never expected. Months into using the Nidra, I also started to experience fewer and less severe episodes. I had been told this could happen, but frankly I didn't believe it, so when I start to notice an overall change in my RLS I was very surprised and, obviously, delighted.

It is comfortable to wear? Not as comfortable as "nothing" but it was well designed and not uncomfortable. Although I have had two long spells (one a month long and another about 8-9 weeks long) with NO night-time RLS symptoms, at all, I still wear the bands religiously, every night.

Like you, linn4549, initially, I thought about ultimately reducing, or stopping, medication by using the Nidra. For me, this did not work. I still need medication.

Also, when my RLS symptoms were particularly bad (after I overstretched and overexercised) the Nidra could not combat those episodes (I just had to live through them).

So, my initial hopes were not realized, but instead the "neuromodulation" effect (reprograming my brain through use of the Nidra) has been a pretty fabulous outcome. Night after night--sleeping without any RLS at all!

The Noctrix company has been very supportive. Look on YouTube for their presentations about Nidra.

I have the sense that insurance can be an issue. Make sure your need is well documented (by your doctor). An expert RLS doctor may have more success doing this. Noctrix wanted "patient history"at the same time my prescription was submitted. You can always call Noctrix and ask them questions about submitting a prescription.

My story was that I had tried gabapentin, IV iron and pregabalin--three medications that can treat RLS successfully, but did not work for me, at all. I had been to 2 sleep psychologists without improvement. I had developed insomnia and anxiety about sleeping--and the insomnia/anxiety went on for years. I refused to take a dopamine agonist drug and my doctor refused to prescribe one because of augmentation. (Lucky me!) The medication I was on (buprenorphine) since 10/2025 gave substantial improvement--but was still not entirely effective. I still had RLS episodes almost nightly. Before my Nidra, the longest run of episode-free nights I ever had (since 2010) was 3 nights in a row. Nidra has now given me about "personal best" of 59 symptomless nights in a row--before that there was a 28 days symptomless run, a couple months ago.

It may be that insurance won't be impressed with wanting to get off a dopamine agonist drug--which has been controlling RLS symptoms successfully--as the only reason to approve a Nidra. For years, dopamine agonist drugs were the mainstay of RLS treatment.

I have no idea if the Nidra is--or could be--effective treating someone with RLS augmentation. My only experience with augmentation is reading about it and wanting to avoid it, by never taking a dopamine agonist drug.

While I recommend Nidra to all of you, insurance approval is a practical consideration. Can anyone else share experience with insurance paying (or not paying) for Nidra? I think that information would be helpful to our forum.

@missjb Thank you so much for your very informative response. I really appreciate you taking the time to share both your experience and your knowledge about the Nidra TOMAC device.

From what you've described, it sounds like your RLS symptoms are considerably more severe than mine, which makes me wonder whether I would even qualify for insurance coverage. I'm also somewhat skeptical about whether the device would allow me to come off my Pramipexole completely, which is one of the things I'd hope for if I went through the whole process.

At this point, I'm honestly questioning whether it's worth the time and effort required to pursue approval, especially if there's no guarantee that insurance will cover it or that it would significantly reduce my need for medication. Still, hearing a real-world perspective from someone who has experience with it is extremely helpful.

Thank you again for sharing your story and answering my questions. You've given me a lot to think about.