periodic leg movement

[DaveL]

PLM can be a sign of low electrolytes.  Magnesium being the one most people are deficient in.  Also could be low calcium, best one to use is calcium lactate.  Sodium is also a big one.  The bell curve for sodium shows it's more dangerous to have too little than too much.  It's worth it to try a supplement that incorporates all the electrolytes to see if that might be your issue.  I recommend Re-Lye by Redmonds.  They make Real Salt.

Thanks so much!
I have Restlss Leg Syndrome, first diagnosed about 30 years ago.

[kevrx]

I have found some relief for RLS with L-Tyrosine.  It is an amino acid that is a precursor to dopamine.  Dopamine agonists are used in the treatment of RLS.  I found 500 mg tablets at GNC.  I take it when I have symptoms and so far the RLS has calmed down after taking one.

[Shulamet]

Any progress on reducing PLM?
I have reviewed these posts and it seems complex.  PLM with RLS seems to be  considered neurological and may indicate PD. Some are treated with dopamine antagonists  ( has anyone benefitted from Sunosi?)

Mine is only PLM noted at 56 in a titration if it was accurate. PLM does not wake me up. I can sleep through the night ( AHI usually between 5 and 8) but I have severe Sleep inertia/ EDS/Idiopathic Hypersomnia ( "morning depression"....it makes common sense it could be related. But I can't find anything definitive. My iron and ferriten were fine, I take Calcium with Magnesium and Zinc.....i may try the  Re-lye by Redmonds ( how do you know if your electrolites are low?)

I was hoping to figure out what questions to ask  at new Pulmonologist  ( generally just prescribe Modafinil or Armodafil ) and Neurologist ( seem to prescribe  Sunosi or Wakii).  Psychiatrists  prescribe Antidepressants ( I have "resistance") and Adderall ( it helps but I have concerns reduced efficacy and other possible risk factors) 

Obviously no Doctors are treating Sleep issues as a whole spectrum just  through the lens of whatever specialty they have....I am seeking a  differential diagnosis  will be 4th and 5th  doctors( Some  new studies at Emory look promising). Past Doctors kept ordering titrations on my APAP. and "arbitrarily setting single pressures.... they did not review the past data or they would see avrability.
Please advise if this is hijacking a post and if I should start a new thread. I err on reading through everything first to see if  questions has been asked and answered  and to learn from others.

[sheepless]

Shulamet, it's fine to post here, especially plm related stuff.

all I can say is that in my experience docs don't seem to want to address rls/plm. maybe because little is known about the problem and treatment, finding relief seems to be a matter of trial and error. (as seems to be the case with much of the practice of medicine.)

my iron, magnesium etc levels are normal. I've tried gabapentin and for the last year or so ropinirole. judging by my flow rate in oscar, ropinirole has reduced my plm by a noticeable amount, maybe 80%, to guess at a number. I do think my waking rls has gotten worse but I have no idea if that's 'augmentation' caused by ropinirole, simply further degradation of the condition or something else entirely.

I quit taking 60+mg adderall/day to give pap a decent chance of improving my sleep. it was initially prescribed for ADD but became crucial to compensating for severe sleep deprivation before pap therapy. I'm still taking some modafinil but would probably be fine without it now that I've reduced my plm to a noticeable degree.

plm may not be waking you up but being physically jerked around half the night is exhausting nonetheless. I suspect it may be at least part of the reason for your ongoing fatigue and might well explain the morning depression, sleep inertia & hypersomia.

[DaveL]

sheepless wonderful post.

I've never had a sleep doc address restless leg syndrome.

I was diagnosed 35? years ago when I was diagnosed with OSA.

I'll do a search for ropinirole to learn some more.

I wonder if there are some holistic remedies that will help?

[sheepless]

Dave, if you find something that works for you, especially of a wholistic nature, please let us know. afaik, the closest to the latter would be supplements if your iron, magnesium, etc. are low. the rest of the home-brew remedies like diet and exercise strike me as well intentioned but not very effective. the kind of answer we give instead of 'who knows?'. I'd probably think differently if these kinds of things to worked for me.

from Merckmanuals website (picked at random among many similar website descriptions of rls/plm):

Risk factors include the following: A sedentary lifestyle, Smoking, Obesity

Periodic limb movement disorder commonly occurs in people with narcolepsy or rapid eye movement (REM) sleep behavior disorder.

Both restless legs syndrome and periodic limb movement disorder are more likely in people who have or do the following:

Stop taking certain drugs (including benzodiazepines such as diazepam)
Take stimulants (such as caffeine or stimulant drugs) or certain antidepressants
Have iron deficiency
Have anemia
Are pregnant
Have a severe chronic kidney or liver disorder
Have diabetes
Have a neurologic disorder, such as multiple sclerosis or Parkinson disease

Treatment
Changes in the diet
Drugs used to treat Parkinson disease and other drugs
Avoiding caffeine, which can make symptoms worse, is recommended. If people are deficient in iron, the primary treatment is iron supplements.

The same drugs are used to treat periodic limb movement disorder and restless legs syndrome. These drugs include

Drugs typically used to treat Parkinson disease: Pramipexole, ropinirole, or rotigotine (used as a patch) may help. These drugs imitate the actions of dopamine—a chemical that transmits messages from nerve cells to other cells (neurotransmitter). They increase nerve impulses to muscles. Sometimes these drugs cause symptoms to worsen. They can also cause nausea, an excessive decrease in blood pressure when a person stands (orthostatic hypotension), compulsive behaviors, and insomnia.
Antiseizure drugs: An antiseizure drug that is also used to treat pain is effective in some people. These drugs include gabapentin or pregabalin.
Opioids: An opioid such as oxycodone may be used. However, doctors use them cautiously because they can have serious side effects, including the possibility of addiction.
Gabapentin enacarbil is the main treatment for people with periodic limb movement disorder or restless leg syndrome. This drug relieves symptoms of restless legs syndrome and does not cause symptoms to worsen.

[sheepless]

a couple things that resonated with me from another site:

rls/plm may be associated with ADHD, stimulant use, spinal cord injury, diabetes (among many other things)

melatonin may help some people

[Shulamet]

 Sleepless........"so ropinirole. judging by my flow rate in oscar, ropinirole has reduced my plm by a noticeable amount, maybe 80%, to guess at a number. I do think my waking rls has gotten worse but I have no idea if that's 'augmentation' caused by ropinirole, simply further degradation of the condition or something else entirely."

So I need to try to upload my data  again to Oscar to get a "base line" to track my "flow rate".... Is flow rate the same as Apneas? I read the WIKI but I am still not knoweldgable about the Oscar Data info.


I quit taking 60+mg adderall/day to give pap a decent chance of improving my sleep. it was initially prescribed for ADD but became crucial to compensating for severe sleep deprivation before pap therapy. I'm still taking some modafinil but would probably be fine without it now that I've reduced my plm to a noticeable degree.

I went off Adderall for  the March 2020 Titration and then  for 3 weeks before the December 2020 PSG home study. I was comatose....
My AHI did not change when I was off it. 
I set the alarm an hour early to take the Adderall, go back to sleep and try to get out of bed an hour later...fumble around to drink coffee. I try not to take an additional dose, no caffeine after noon I often have to nap around 4pm but not long  so I can go to sleep by 11.
If I went off the Adderall and explained my symptoms of Sleep Inertia  without naming it, they would think I had dementia....Oscar data and respritory stuff are still out of my grasp...but I suspect it could help better identify the sleep disorders.... I want to try the resmed Airsense 10 algorythym to improve my AHI but then wonder if I actually need a BiPap or AVS.....I have spendt three years getting no evaluation or ideas so thanks this  gives me hope.Can a Neurologist do other tests for PLM? Will he roll his eyes when I ask about Ropinirole without having RLS?

[Shulamet]

DaveL how do you like the Resmed Auto sense for Her? Did it reduce your AHI? Do you feel more refreshed upon waking?
 I have the Phillips Dream Station and want to switch but not sure if I need a BiPap... no one is looking at my study and advising...its all cookie cutter.

[DaveL]

@Shulamet---I really like it.The ResMed AutoSense for Her.

I feel better! I'm more refreshed. AHI is about the same. A comment == I've been chasing to reduce numbers for a long time. I've done this for about 35 years. I became my own advocate when I came here. I had the sleep-doc-from-h... for about 15 years.

I started feeling refreshed just after I finally listened and bought the ResMed A.S.F.Her.

Please consider asking for help here. OSCAR is amazing. I don't have the skill that others do here. I want to! I have "some learnin' to do"

Can we move our talk? Do you have a post where you discuss your OSCAR results? If you don't please start one....Glad to talk there.