RLS Pot Pourri

[wbfann]

This is my first post. It is identical to one I wrote in Pharmaceuticals but it is relevant here. I wanted to repeat it in this section to garner as much information as possible.

Nearly two years ago I was totally incapacitated with daily, severe fatigue. I am currently on disability with my company as an airline pilot. I have not worked since April of 2003. I was finally diagnosed with Upper Airway Resistance Syndrome (UARS) in December 2003. Treatment with cpap and indicated surgeries gave some relief. During the past year while using cpap and submitting to surgery to open the upper airway, I ignored an increasingly problematic sensation in my right calf. The sensations were intermittent and mild initially but were rapidly becoming more frequent and severe. Ultimately it could no longer be denied (key word). I had been referred to this web site by sleepnet.com. After spending time reading this site, I realized in addition to UARS, I also had rls.

This was confirmed by my gp in October 2004. He prescribed .5 mg of klonopin. I did not like this med for several reasons. While I slept more soundly and had more energy, it gave me a mental/drug hangover affect. I also began to feel a psychological dependency towards this drug; as a recovered alcoholic for 28 years, I was paranoid about long term use. When I discontinued it's use, I experienced increased insomnia.

In December 2004 I had an appointment with a sleep physician that is a neurologist. She prescribed 300 mg of Neurontin at bedtime. This had a significant and positive impact on my ability to sleep and improved my fatigue levels overall. Specifically it diminished the rls sensation in my calf and improved the soundness of my sleep.

Unfortunately, I am still not experiencing 100% recuperative sleep. While I have been able to increase my levels of exertion mental and physical with the Neurontin, I am still limited by fatigue that is less severe. The residual rls sensations that I now experience in my right calf seem insufficient to preclude sleep onset or sleep maintenance. I have noticed that I continue to experience this lesser fatigue even in the complete absence of rls sensations in my right calf over periods of several weeks.

Is it possible that rls can continue to precipitate degraded sleep function in lieu of the absent rls sensations in my calf over protracted periods with the use of Neurontin? If yes, would a higher dosage of Neurontin rectify this?

During the current period of treatment with Neurontin, I have begun to realize that physical and emotional exhaustion can bring on the rls sensation in my calf . I assume this was happening before; I am just now making the connection . Additionally, prior to the onset of the fatigue, exercise enhanced the soundness of my sleep; now when I am fatigued and I exercise the soundness of sleep is diminished. Also, I have had since childhood a predisposition towards transient insomnia brought on by stress or excitement. It seems to me that this inclination towards transient insomnia worsened after the onset of the fatigue. Are any of the aforementioned variables related to or precipitated by rls? It is logical to me that they at a minimum complicate rls.

Prior to the onset of the severe fatigue, I had been running about 3 days a week with a clinical psychologist. Additionally, I completed psycho therapy last year with a different clinical psychologist for issues relating to childhood sexual abuse. Both psychologists indicate they do not think my fatigue and sleep issues are related to depression. However, I suffer reactive depression due to the interruption the fatigue has imposed on my quality of life. After reading postings on this web site, I do not need to go into detail about that.

I know this is a lot, but I would appreciate any insight or information as it relates to my experience.

[jrowley]

My first question is how long have you been taking the Neurontin (Gabapentin)? Because one of the side effects of this medication is drowiness.

What are the possible side effects of gabapentin?
If you experience any of the following serious side effects, stop taking gabapentin and seek medical attention or contact your doctor immediately:

an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).
Other, less serious side effects may be more likely to occur. Continue to take gabapentin and talk to your doctor if you experience

dizziness, poor coordination, or drowsiness;
blurred or double vision;
irregular back-and- forth movements of the eyes;
nausea and vomiting; or
tremor.

So I am wondering if maybe the combination of the drug and your problems with deppression are causing the still mild fatigue. As you know deppression alone can cause this so if you add the med which causes drowsiness then that may be why you still experience the fatigue.