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Requip and Sleep Quality

Posted: Fri Mar 16, 2018 2:12 pm
by Oozz
I’ve been taking .25mg of requip for about two weeks. Although it is effective in terms of reducing my WED symptoms and allowing me to sleep 6-8hrs; howev XX wake up feeling groggy and my sleep is definitively not as restorative as it is naturally.

I’m wondering if anyone else experiences this? If so, Is this a temporary side-effect of the drug that will diminish once my body gets used to it?

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 3:36 pm
by stjohnh
Oozz, what you are describing is "normal" for everyone with moderate-to-severe RLS. RLS has two distinct problems when it is past the mild phase. The first is the jumping of the legs. Requip helps control this. The second is severe sleep disturbance. For people with mild RLS these seem to be related, however they are actually distinctly separate problems. RLS is thought to be caused by abnormal transport of iron into the brain, reducing brain iron levels, and causing changes in the adenosine, dopamine, and glutamatergic neuro transmitting systems. The dopamine system is the one primarily related to the jumping legs symptoms, or urge to move. The glutamatergic system abnormality is the one that causes abnormal sleep. The sleeping disturbance of RLS is different than nearly any other type of insomnia, and marked by poor responses to all regular sleeping medicines. The only medicine classes that seem to help with some consistency noted on these boards are gabapentin (and its relatives Lyrica and Horizant) and medical marijuana.

Some of your symptoms may be related to side effects of the Requip, and reducing the dose of Requip as low as possible may help a little bit, however, improvement in your feeling refreshed is more likely to require addition of gabapentin or medical marijuana, or both. Unfortunately, the likelihood that you will get back to completely normal, refreshing sleep is low.

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 3:41 pm
by Oozz
St John, you have been an incredible resource and I’m sure myself and many others appreciate the effort you have put in.

Just to clarify - are you saying that the MMJ/GABA/Horizant as a stand-alone prescription prevents the poor sleep quality? Or, in addition to other meds allows you to get more restorative sleep?

I have yet to take MMJ while I’m requip, so I’m not sure what the effect would be.

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 3:52 pm
by stjohnh
Oozz wrote:St John, you have been an incredible resource and I’m sure myself and many others appreciate the effort you have put in.


Thanks :D

Unfortunately using Gabapentin or medical marijuana doesn't completely reverse the abnormal sleep problems of people with RLS, however it does seem to partially improve the unrefreshing sleep problem. The gabapentin and/or medical marijuana are used usually in addition to Requip or other medications.

I take 15 mg of THC as a portion of an edible brownie at 7:30 in the evening along with 100 mg of gabapentin. I take an additional 5 mg of THC and 50 mg of gabapentin at approximately midnight. These don't help my jumping legs at all, however they do make my sleep more refreshing.

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 4:04 pm
by Oozz
Will start this tonight, thanks.

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 4:11 pm
by Rustsmith
Oozz, I will add my two cents to Holland's reply to your question. I use a slightly different combination of medications. I augmented on dopamine agonists, so I use 5 mg methadone mid-day to control the leg jumping side of RLS. I have to take it mid-day to avoid the alerting side effects of opioids, which would prevent me from falling asleep at night.

I still use 0.25mg of pramipexole at bedtime, but it is used to control my severe PLMS, which the methadone doesn't help. Also at bedtime I take 900mg of gabapentin and 5mg of an edible THC candy (no CBD). The gabapentin helps me fall asleep somewhat normally and the edible THC helps me stay asleep several hours later when the gabapentin starts to wear off. I cannot always use the THC (partly because I travel a far amount) and when I don't, I find that I don't sleep as soundly during the early morning hours when my sleep is normally the deepest. I tried larger amounts of THC, but still felt a bit stoned when I got up in the morning.

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 4:27 pm
by stjohnh
Oozz, you might notice that Steve takes much more Gabapentin than I do, this points out one of the peculiar traits of Gabapentin, it is variably absorbed and the necessary dose for different people can be quite different.

Re: Requip and Sleep Quality

Posted: Fri Mar 16, 2018 4:45 pm
by Rustsmith
I should add that gabapentin serves a dual purpose for me. I also take it to prevent my migraine headaches. My doctors tried a number of other medications that helped reduce them in number, but did not really prevent my headaches. Gabapentin has been great in that regard, i.e. no more headaches. At one time I was up to 1200mg, but it was having side effects with sex. So, I cut back and the side effects disappeared and it worked the same. I also had a doctor who insisted that I try Horizant (he ran a Horizant clinical trial). I couldn't tell any difference in the two medications even though Horizant is supposed to be more completely adsorbed.

Re: Requip and Sleep Quality

Posted: Tue Apr 10, 2018 4:45 pm
by Stainless
If you can get by on such a low dose of Requip,maybe you should try just Gabapentin and maybe avoid DA problems.

Re: Requip and Sleep Quality

Posted: Tue Apr 17, 2018 4:33 pm
by Oozz
I'm very much convinced that, although DA's allow you to sleep, the quality of the sleep is severely lacking. I've been sleeping for 6-8 hours consistently for the past 14 weeks on Mirapex; however, I feel only slightly more refreshed.

Re: Requip and Sleep Quality

Posted: Tue Apr 17, 2018 6:54 pm
by stjohnh
Oozz, Lots of folks on opioids notice the same problem. It is theorized that the urge to move symptom is mainly mediated via the dopaminergic system (which is treated by the DA), but the sleep problems are mediated by the glutaminergic system, which is not addressed by the DA. I take gabapentin, THC (edible marijuana), and kratom, all to improve sleep duration and quality. I believe, but don't know, that the sleep quality problem that we have is a separate problem than either the urge to move problem or the sleep duration problem. What has helped me the most to feel better during the day is the addition of dipyridamole to my other meds.

Re: Requip and Sleep Quality

Posted: Tue Apr 17, 2018 7:31 pm
by Rustsmith
I agree with Holland and will add my recent experience to his comments.

I have been in the process of changing my PCP during the last six weeks. The change was necessary because I finally found one locally who is willing to write scripts for opioids. The only condition is that he wants monthly urine tests to verify that I am not drinking alcohol or using illicit drugs. I forgot to ask during my first visit whether they test for marijuana since it is legal where I live, so is only illicit in the eyes of the feds. So, I went without using my edible marijuana (THC) for six weeks while still taking the rest of my RLS meds, which include methadone, gabapentin and a low dose DA for PLMS. What I found from this is that I need the THC to achieve the deep, restorative sleep during the early morning hours. With the THC, I only need eight hours of sleep to feel rested. As an example, last night I slept for 10 hrs and still needed to take a nap mid morning to keep from falling asleep at my computer.

The good news is that I saw my new PCP this morning to pick up my new methadone script. I asked whether THC would be a problem. He said that since it is legal in Colorado he doesn't look. So, now I get to go back to sleeping better than I have been.