Restless Legs Syndrome (RLS) Discussion Board

I am trying Tramadol (after failing at methadone, Belbuca, Oxycontin), despite Dr. Buchfuhrer's and others commenting that PLMD (my chief complaint) can often not be helped by Tramadol.

Regardless, my first night now and at 2am I am guessing from my being wide awake that 100 mg of Tramadol caused alerting. 50mg didn't seem to effect me so I took 2 pills and did sleep 3 hours and now I am up with this familiar wide-awakedness. I am going off on a two week trip tomorrow and all I have is Tramadol so I have to somehow deal with this.

I am guessing how early I need to adjust is individual, just like everything else about how we respond. Any thoughts or suggestions about this predicament are much appreciated.

Many thanks in advance. Wantok

Tramadol can be one of the most stimulating / alerting properties because it also has additional serotonergic effects. Tramadol is not a classic, pure opioid and it is chemically related to a very stimulating antidepressant (Venlafaxine). In fact there are even people who get addicted to Tramadol because of those stimulating properties and need Tramadol to do any kind of work.

For me Tramadol and Oxycodone we very stimulating for me. Overall it seems to be a side effect that can disappear but for me it took over 3 years!

I would recommend Morphine or Hydromorphone. Morphine had some classic hypnotic properties. Unfortunately they disappeared after a few months but at least it was not stimulating. Hydromorphone was my first alternative for Oxycodone and it was way less stimulating, maybe even neutral.

When Tramadol is causing alertness: you have to take additional hypnotics like Clonazepam (which would cause many complicated problems in many case) or you are forced to switch medication.

Alertness is a common opioid side effect and it seems to affect RLS patients way more common than regular people. It is one of the most complicated side effect to treat in RLS patients when RLS patients have opioid alternes but are also forced to take opioids since there are no other solutions to treat the physical symptoms anymore.

a) Yes, you can prescribe hypnotics like Clonazepam or Z-Drugs long term for RLS patients. But this often causes many problems like physical addiction, depression and an overall worsening of sleep unless the drugs are stopped after a nasty withdraw. There seem to be some exceptions for some people but for most people who go down this route it doesn't well.

b) You can't use all the classic sleeping aids like low-potent antipsychotics or some antidepressants who make you sleepy since it will only make the RLS worse up to a point where even opioids don't help anymore.

b) The only two escape solutions that kinda work are Cannabis / THC products and some antiepileptics. For example additional Carbamazepine helped me sleep for 4 years. So far this have been the best years with my disorder and since it stopped working, I can't do much. Cannabis helps ... but it also doesn't help enough to make the difference that would ben necessary.

I would continue trying different opioids until you find one that works for you.

Thanks for the input and encouragement. I've just started Tramadol and I am hoping I can take it early enough in the day to wear off so that it will help my symptoms and I can sleep too. We will see. I did sleep in two chunks last night on 100mg (3 + 4) which is not that terrible.

I take 50 mg. Tramadol at 5pm and another 50 around 10pm along with .25mg ropinirole and 150 mg. Lyrica. I can't say for sure that Tramadol causes any alerting issues with me tho. Not nearly as much as Norco anyway...which i also take on occasion.

I have had issues with sleep ever since i can remember. Lyrica helps with the sleep issues but I hate taking it.

Patiently waiting till Jan 1st when THC becomes legal for recreational use here in Illinois.

Took the Tramadol ER 100mg at 5pm yesterday and all was much better (I had been taking IR and I am so blessed I have a doctor that is so responsive and helpful). Wore off a bit too early but very relieved this might work.

wantok wrote:Took the Tramadol ER 100mg at 5pm yesterday and all was much better (I had been taking IR and I am so blessed I have a doctor that is so responsive and helpful). Wore off a bit too early but very relieved this might work.

:thumbup:

QyX wrote:For example additional Carbamazepine helped me sleep for 4 years. So far this have been the best years with my disorder and since it stopped working, I can't do much.

Time to try it again? or is it too soon?

wantok wrote:Took the Tramadol ER 100mg at 5pm yesterday and all was much better (I had been taking IR and I am so blessed I have a doctor that is so responsive and helpful). Wore off a bit too early but very relieved this might work.

Wonderful, hope it stays that way! Is it helping with the PLMD? (What is does IR stand for?)

Ah! I had been wondering about the difference in my sleep quality since starting on Tramadol. Definitely not sleeping as well since I started it! I am still on 100 mg Lyrica, weaning down to 50 mg tonight and am on 50 mg Tramadol. I need to stop Lyrica because it has caused profound depression that began at 300 mg/day and is better, but still present at 100 mg. I will probably have to go up to 100 mg Tramadol/night. Medical marijuana with a 4:1 ratio of CBD:THC in a vape pen has also become part of my nightly regimen, and even middle of the night.
QyX, you mentioned some antiepileptics can help with sleep. I know Gabapentin is one that works for many people (not me) but would that include topiramate (Topamax)? I take it for migraine prevention and had been weaning down, but maybe I should keep my dose higher if it would help.

I am just starting on the Tramadol and the 2nd night the Tramadol caused anxiety/alerting (?) and disturbed all sleep last night, so I am taking it at 3pm today to see if that helps. Don't know if it is helping with PLMD which drives me nuts (since I wonder if all of this pill-caused illness is worth something). My PLMD waxes and wanes. And I am not always sure what awakens me during the night although sometimes I know it is the PLMD. Crazy making. It is just too soon to really know anything and so I have to grin and bear it for a while here and see if my body will adjust at all. Read somewhere that Dr. Buchfuhrer doesn't think Tramadol helps PLMD, nor do some other sufferers here, and that can cause day time sleepiness which I am having big time with the Tramadol so far. (IR, I think, stands for "immediate release".)

All I know is that I put off trying anything because nothing really helped the PLMS. For over 30 years (since a toddler), I had broken and crappy sleep. Then I started losing jobs (was self-employed), staying in bed up to 16 hours and still exhausted. I couldn't catch up anymore. I finally tried things. It made it worse (augmentation), which we solved, and now I have some sort of life. Much better than when I couldn't function, but not great.

I do know that I have very few movements with methadone - my husband reports them as he wakes much before I do. And, they easily wake him if they are annoying. I have none with pramipexole. But, it is evil in its own way.

For me, I LOVED tramadol - it was the only thing I have ever tried that made me feel "normal" again. Cannot remember if it was alerting, but think so. I didn't care at the time - I felt like a human being again.

No answers.

I took Tramadol for quite some time and it did help with RLS symptoms. However, I eventually started to have uncontrollable random jerks. My legs, shoulder or arm would suddenly jerk. I weaned myself off it and the jerks have more or less gone just the very occasional one, maybe two in a day.

I'm told this can be an interaction with an antidepressant and I do take a minimal dose of Citalopram. I was also told that it can be a sign that the Tramadol dosage is getting a bit too high.

badnights wrote:

QyX wrote:For example additional Carbamazepine helped me sleep for 4 years. So far this have been the best years with my disorder and since it stopped working, I can't do much.

Time to try it again? or is it too soon?

I tried. It is not really helpful anymore. The Oxcarbamazepin I take as a replacement is similar in the way it works. So I am just too used to the overall effects of this drugs.