Severe RLS solved for me

Posted by zombiewoof @zombiewoof, Feb 8 11:45am

The following is a true story without embellishment or exaggeration.

I’ve had RLS for 35 years now. It got worse over time and is very severe now at the age 69. It is the worst RLS symptoms my sleep doctor has seen being in the top 1% of severity from here experience.

In the years preceding finding my current sleep doctor I was getting three to four hours of sleep a night. I tried every RLS medication out there (with one exception explained below). Gabapetine and Requip were zero percent effective. OTC pain meds like aspirin, acetaminophen and ibuprofen did nothing. Tylenol PM and others like this wired my eyes open. High doses of magnesium also did nothing. I was tested for low iron. This was normal but I took iron supplements just the same. I then found a doctor who prescribed Pramipexole. I started out at .375 mg and got enough relief to sleep about six hours per night for four or five nights a week. What a relief to get some restful sleep after years of struggle and misery. I shelved my plans for moving to Oregon for doctor assisted suicide. Yes, it was honestly that bad for me.

Over the next years the Pramipexole worked well but I had to gradually increase the dosage as augmentation set in Eventually I was up to 1 mg/day (taking eight .125 mg tablets) but the effectiveness had decreased significantly. Taking even higher doses was having negative side effects with no RLS reduction benefits. At this point I was back to four hours of restless sleep per night. I stated augmenting the Pramipexole with several ounces of alcohol at around midnight to 1AM just so I could pass out and get some sleep. This continued on for about another year with varying effectiveness. The trajectory for this regime was bad, obviously not a good long term solution. Completely sleep deprived, drinking on a regular basis, legs thrashing when I laid down, pacing endlessly most of the night to get relief, only to fall into a fitful sleep at two, three or four o’clock in the morning, sometimes seeing the sun rise before collapsing into exhaustion. Emotionally I was a wreck, would break out crying in despair, no sex life or relationship with my wife. I started once again planning my move to Oregon for physician assisted suicide. I could no longer live like this.

Enter the solution for me. Miraculously I found a sleep doctor/specialist who dedicates her professional life to this affliction. During my initial visit she took an hour and a half listening to my RLS journey and asking probative questions. As noted above I had tried everything and I was at the end of my rope. Doing due diligence she ordered the normal tests, a sleep study (which was an abysmal failure since I didn’t sleep) and started me on the normal medication regimen (Requip, Pramepexole, Gabapentin, magnesium etc., etc..) all to verify that nothing worked. Finally, as the medications of last resort, she prescribed Neupro 2mg/24 hour patch, 5 mg methadone and 300 mg of Gabapentin daily. The patch stays on for 24 hours and the Methadone and Gabapentin are taken after dinner. After some trial and error the dosages were increased to 3mg patch, 10mg Methadone, 600 mg Gabapentin and daily magnesium citrate. The results were nothing short of miraculous. In my 35 years of having this horrible affliction I’ve never this much relief from RLS. Things are still not perfect I can finally lead a near normal life and get a decent nights sleep most nights. Thank god I found this doctor or I would not be here today.

Important things that are now part of my regimen and contribute to the effectiveness of the drug protocol.
1. I exercise on a daily basis. I lost 10% of my body weight through diet and exercise bringing my weight down into the normal range for my height and physical build. This helped.
2. I have dinner early and do not over eat. Not having a full stomach at bedtime makes a difference.
3. I take powdered fiber with lots of water at breakfast and dinner to control the constipation from the Methadone.

I hope this post and my contribution here can help someone else to get relief from this horrible affliction.

Interested in more discussions like this? Go to the Sleep Health Support Group.

After many years of RLS, the only medication that gives me
some relief is pramipexole 0.50 mg (prescription).

REPLY
@missjb

My story is no doubt a variation of the story of everyone suffering from really bad RLS. I identified with zombiewolf's joking/serious mention of traveling to Oregon (where assisted suicide is available) to combat RLS...

I was never suicidal, but one night, just before crawling into bed, the realization hit me that being dead would have been an improvement over the life I was living. That was a scary moment. I cried uncontrollably that night and almost nonstop all the next day. I was so sleep-deprived, miserable and broken. I had insomnia and was anxious about bedtime and had enormous difficulty falling asleep.

Then, I decided I had to find a way out of all the misery---which ultimately I did.

I had thought (for 13 years) that I had a weird muscular problem that strangely only occurred at night. I tried all sorts of non-prescription remedies, physical therapy, and the only thing semi-effective was a heavy duty massager, which I still continue to use (when symptoms strike---the massager is always next to my bed).

I had never considered RLS as causative because my symptoms felt like pain, instead of jerkiness--which is the common description one reads. I've since learned that RLS symptoms can vary quite a bit from person to person.

When I was finally diagnosed, it all made sense. My symptoms only occur when I'm asleep, or drowsy, or sleepy. They stop within a couple minutes, when I get up and walk.

Finding someone to treat me effectively took me another three years.

Fortunately, as soon as I was diagnosed I started to google and found Dr Early's webpage (he's at Johns Hopkins) and read about augmentation. So, when my primary doctor tried to prescribe a dopamine agonist, I refused and we settled on giving gabapentin a try. ...It didn't help, at all. Nor did taking iron supplements pills.

Long story short, pregabalin didn't help either. Nor did an IV iron infusion.

But, finally, buprenorphine has. I take it in the form of Suboxone. Like methadone, Suboxone is primarily used to treat addiction, but it has less side effects than methadone. And, Suboxone is less expensive than a prescription for buprenorphine alone (as my wise sleep neurologist, an expert in treating RLS knows).

(Like slkanowitz I also learned through this doctor which medications made RLS symptoms worse. You need someone well-versed in RLS treatment to have this kind of expert level information, which is critical).

Words can't describe what it means to have my life back. Miraculous comes to mind. I'm not cured. I still have episodes of symptoms, but they are less severe, less frequent, and now tolerable.

My advice to anyone with severe RLS is to first educate yourself about it. Standard treatment, for a long, long time, has been the dopamine agonist drugs which cause augmentation. Most doctors (like my primary) still believe this is appropriate to prescribe, although it is not.

The newest Guidelines for treatment of RLS are on the internet (authored by Winkleman--who practices in at Mass General in Boston-- and Berkowski--who treats via telemedicine in Michigan, Ohio and Florida). Reading these guidelines is a good place to start.

There is a Foundation for RLS and their website has bios of a number of RLS specialists, who serve on their board. My doctor is on the board and has been incredibly helpful, always understanding and supportive. Because RLS can be so awful, it's something that needs to be well-treated and because augmentation means symptoms get much worse, you don't want to be treated incorrectly. This is a situation where going to an expert--instead of settling for the most convenient physician---will pay off.

There is a company in California called Noctrix which has invented a device that is a pair of bands, worn on each leg just below the knee and delivers a "signal" that the brain (where RLS starts) interprets as leg movements--so that RLS symptoms are turned off before they start. This is a research backed therapy that the FDA has approved and my insurance will cover. Soon I will add this device as an additional treatment tool so my RLS will be as well-managed as possible. I mention this because it could be helpful to those who have augmented form of RSL and need all the help they can get. Google their website. It's a small start up company, headed by graduates of Stanford, Berkeley and Princeton (which impresses me). Right now, the device isn't available in every state, because they are still building a nation-wide support team. You have to ask if it is available where you live.

I hope anyone reading this posting, who suffers from RLS, can get effective treatment much sooner than I was able to. I hope your suffering will end soon.

Jump to this post

Thank you for this post. I learn something new every day. I have never used Suboxone but will discuss this with my sleep doctor at my next appointment. I’ve tried everything over the years to get this horrible affliction under control. Nuepro 3 mg/24 hr patch (generic name is Rotigitine) and 10 mg Methadone daily is the only thing allowing me to have some semblance of a normal life. So far no augmentation with Neupro after four years. I hate the side effects of methadone and hope Suboxone can be a substitute. Even with my current medications sleep is difficult. I resort to using Zolpidem 10 mg several times a week in order to get a good nights sleep. The problem with taking Zolpidem is my RLS needs to be under control first. A bad RLS attack coupled with 10 mg Zolpidem makes for some bizarre behavior as I pace around the house all night.

REPLY
@rjjb

After many years of RLS, the only medication that gives me
some relief is pramipexole 0.50 mg (prescription).

Jump to this post

Pramipexole work for years for me until the augmentation became so severe I had to take large doses while providing virtually no RLS relief. The side effect to the large dosages was some akin to a stiff muscle syndrome. I am glad it still works for you. I hope this continues without the augmentation I experienced.

REPLY
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