Is your circadian rhythm disorder definitely separate from your RLS/WED? You probably realize this, but WED/RLS (unless the symptoms are treated effectively) will push our bedtimes later and later. In un-augmented WED, the symptoms fade in the middle of the night, so that's when we go to sleep; the evil disease then adapts to this new schedule and starts up the symptoms later in the evening; and the cycle continues.
Plus WED/RLS is associated with insomnia, a hyperalterness that makes it difficult to sleep even when you're exhausted, this also tends to push our bedtimes later.
Blood iron work cannot reveal anything about levels of iron in the cerebrospinal fluid (and brain) - except, if ferritin (an iron storage protein) is low in the blood, that means iron stores are low somewhere in the body - probably the brain is iron is high in the blood. But if serum ferritin is high, there is no way to tell if it's high because you're not lacking iron anywhere, or because there is inflammation somewhere in your body, which raises the amount ferritin circulating in the blood. And perhpas there are other reasons. Low serum ferritin means you have a problem, high serum ferritin means you still don;t know anything more.
Gabapentin can have extreme effects on mood. You could try another medication of the same type - pregabalin/Lyrica - but very cautiously, to see if you don't get mood effects.
I doubt you can replace tramadol with gabapentin. Won't be effective enough, and anyway you should avoid gabapentin cuz of mood issues (could try Lyrica).
I'm unsure however, why I get severe rls 2 hours after taking my midnight dose of tramadol and THC
Either the tramadol is not enough, so your natural nighttime worsening overpowers the Tramadol, or the THC is causing the worsening. Or you're taking/doing something else?
should mention that now 4+ weeks into mirapex withdrawal I'm seeing a newer reduction in the severity of the rls.
I thought I had hit baseline , but I'm going to continue leaving even the smallest dose of mirapex out of my system for a bit longer .
I do aspire to try to taper and eliminate tramadol as well to get a further idea of where my rls is sans DA AND opiod
I plan on continuing clonazepam for a while
Before you try eliminating tramadol (I see you've started already_ oops) give your body time to adjust to the absence of DAs. It takes a lot longer for some of us than anyone had previously estimated (years). (Most people less tho.) Give yourself 3 months if you can. And don't be averse to resuming an opioid afterward, if you still need something. Hopefully you won't need it tho!
So I'll try to address the circadian rhythm disorder ...
I'm very glad you asked.
I'm actually full blown backwards with my sleep pattern at this very moment while trying to figure out my mirapex withdrawal/ tramadol situation
I have just left my wife and 2 small daughters tonight and moved myself into my parents basement to help facilitate this process
My disorder has hurt me physically, mentally and socially for years, but when it coincides with new medication regimes, I needed to isolate myself and eliminate certain variables .
I slept fine until age 15, where I developed a very profound delayed sleep phase circadian rhythm disorder (fancy way for saying I was a night owl )
I could basically do very little until after 12pm and sleep was rarely possible before 3am
My grades plummeted in school as I would constantly fall asleep in class
This is something that is somewhat common with 18 year old males but ...
This stayed with me until age 24, when this worsened and became a non-24 hour circadian rhythm disorder.
Something very common with blind people of any age (about half ) , but not with 24 year old sighted males.
I would have 4,5,6,7am bedtimes, to the point the only way to correct it was to go through chronotherapy (fancy way for saying I'd stay up 3 hours later/go to bed 3 hours later each day)
Once I was close to a normal sleep pattern, I'd slow down the "therapy"
I could never go backwards, only forward around the clock
Why I never grew out of this is unknown, but may have something to do with drug use (abuse) from ages 16-18 which, along with alcohol and daily cannabis, included perhaps 15 LSD experiences, perhaps 30 involving mushrooms, maybe 15 involving powder cocaine , and perhaps 10 that involved Crack at age 18 ( yes ... Crack cocaine)
And yes ... these had profound effects on my dopamine levels
I thought I overdosed at age 18 with Crack, but it was likely a combination of things that gave me a massive case of stress vertigo
This contributed to anxiety and avoidance tendencies when this snowballed into full blown chemical imbalance a month or two later )
I then ceased all hard drugs
This anxiety probably cant be fully attributed to drug use as I have pronounced family history of anxiety and mood disorders on my father's side.
Clonazepam was introduced and I was out of school for 4 months with home tutors )
I took clonazepam and a variety of antidepressants for years
I also drank very heavily and consumed cannabis daily.
I had sky high anxiety
Hard drugs ceased at 18, but alcohol continued until age 31 and marijuana until age 26 (at which point I really knew I had bad rls, which I was self medicating with marijuana to treat)
RLS began subtly at age 20 (I hope you're still followimg me lol)
I believe the circadian rhythm disorder came first .
Rls now (and has for years ) been the primary thing prevents me from keeping a regular sleep schedule.
I was also essentially a professional poker player until recently, but I would only play once my pattern was off, and not vice versa
With that said , I've quit that altogether now to eliminate that obvious variable (hey , I had to make money somehow)
I now believe I could retrain my sleep pattern and align with my children , but RLS prevents me from doing so
---- THC may in fact contribute to current worsening
I have considered this and have dialed back my overnight use considerably
---- if I'm going to get to 3 months without mirapex , I'm likely going to do it with kratom , or a bit of kratom in the morning to alleviate any withdrawal, and switch tramadol to codeine
I am simply not tolerating tramadol at the dose needed to stop rls
It 100% is the reason I suffer from drastic numbing of my midsection , and possibly the reason I have not digested food in 2 months (the other possible reasons are the mirapex withdrawal, or quite simply such little sleep. You'd think those would have sorted themselves out by now though , so I believe the tramadol is what wreaks havoc on my bowels )
This is now the primary reason I want off tramadol
My apologies for the long post