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OSA Sorted then CAs Sorted but left with restless legs/PLMD
#1
OSA Sorted then CAs Sorted but left with restless legs/PLMD
To cut a long story short:
@ After years of gradually-worsening daytime sleepiness (I'm a man in my late 50s), a home sleep study showed that I had OSA, so I was started on CPAP.
@ The CPAP worked on the OSA (typically contributing 1 to 2 on the AHI score) and I felt better with it. I still suffered from excessive daytime sleepiness and CAs pushed my AHIs to typically 15-25. I changed to an auto CPAP that effectively removed the CA recordings, taking my AHI to typically well below 1.
@ I still suffered from daytime sleepiness and feeling cr@p from fighting it, so I did a full sleep study.  I fell asleep OK in the study but then woke in the middle of the night and couldn't get back to sleep.
@ In the 2-month wait before a consultation on the sleep study, my occasional depression got worse and I eventually sought help, being prescribed Sertraline (Zoloft).
@ My sleep study showed large numbers of PLMD leg movements (over 30/hr), which fitted in with what my wife says and the restless legs that I've had for a few years in the evenings.  The consultant prescribed Gabapentin 600mg.
@ The Gabapentin has made no difference to how I feel.  I still have excessive daytime sleepiness, I feel cr@p and I find doing anything other than vegetate to be a struggle.
@ Over the last few weeks my restless legs has got far worse and I was taking over 30 minutes of uncomfortable legs and twitching before i could get to sleep.  I read that Sertraline/Zoloft often makes it far worse, so I decided that I'd rather struggle with depression than restless legs so discontinued it a week ago.  I can get to sleep immediately now. However, after getting better over a few days, my restless legs came back with a vengeance last night.
@ I saw a neurologist 2 days ago and he had nothing constructive to add.  He told me to go back to the sleep centre over my restless legs.
@ I exercise and eat well. Blood tests show some less-than-optimal results (cholesterol, some vitamins, thyroid) but nothing significant.  My ferritin levels are OK.

i still have one option left, that of going to my sleep centre and asking for a prescription for Dopamine agonists.  That may be a long wait for an appointment and I'm a little dubious that they didn't point out that Sertraline could contribute to restless legs/PLMD.

I've spent countless hours searching the internet for help, only finding generalized information that doesn't seem to fit my case.  I've drawn a blank on finding directly-useful support forums.

I feel that I'm running out of possible explanations and likely to submerge into depression and misery. I feel this is a long shot, but does anyone have any experience or knowledge to help (other than the general encouragement that I know people here give)?
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#2
RE: OSA Sorted then CAs Sorted but left with restless legs/PLMD
I deal with restless leg or restless body with point pressure. I either put something hard and small under my ribs or i put my leg between metal parts of my bed. Also something small and vibrating helps too, like a pocket vibrator, no joke.

Also if you noticed you had a peaceful period after discontinuing Sertraline, I'd go on and off it. Take for a day or two and then stop and again. To minimize restless period when taking it and maximizing the good period after you discontinue.

I myself started with a trycyclic Opipramol, and just from taking it for 3 days I could no longer fall asleep, for over a year. I cured myself with Sertraline. I read somewhere falling asleep have to do with the Sigma receptor, and Opipramol is a Sigma agonist and Sertraline a Sigma antagonist.

I would beat the sh*t out of my ex-doc for prescribing me that crap.
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#3
RE: OSA Sorted then CAs Sorted but left with restless legs/PLMD
I got Gabbapenten from my doctor to deal with restless legs.
It was down to nerve pain triggering leg movement.
Even when I was sleeping this was going on, the pills sorted it out.
I don't know what they are called in the USA.
I am NOT a doctor.  I try to help, but do not take what I say as medical advice.


Every journey, however large or small starts with the first step.

Sleep-well
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#4
RE: OSA Sorted then CAs Sorted but left with restless legs/PLMD
There are several meds, For PLMD I'm on lyrica
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#5
RLS/PMLS
Hi ,
so is my case....after 1.5 years I have worked out serious flow limitation, after going through CPAP, Autoset, and, finally BPAP!
Now, my strugle is put PLMS under control, which have become clearer after working out the respiratory issues. PLMS wakes me up some 3 to 5 times/hour. Doctor has put me on Pregabalin, threshold 50 mg; after 21 days I realized it works, indeed. However, side effects are significant, yet not totally unbereable. 
These days I have gone back to Clonazepan 0.25 mg, today is going to be 0.5 (maximum I will go through). Next plans are: (1) Within one week I am going to stop clonazepan, and go to (2) L-Tyrosine 500mg. Pending on outcomes I am going (3) Cannabidiol, and pending on outcomes, I would go back do Pregabalin, which, again, indeed work.

good luck
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#6
RE: OSA Sorted then CAs Sorted but left with restless legs/PLMD
Talk to your doctor/s and get a Rx for "Ropinirole" (Brand "Requip"). It is typically used for Parkinsen's but has an alternate benefit for RLS patients. It works very well but do not take more of a dose than necessary, as it sometimes has a side effect of Augmentation (daytime restlessness). I take 1MG plus 600MG Gabapentin and it does the trick. 600 Gabapentin alone did little to nothing for my RLS. This should solve your issue hopefully.
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