Anyone with "Hyperalertness" at night

[TiredinCharleston]

I have 12 yr history of RLS. Just weaned off Requip 1 mo ago due to augmentation. Started Lyrica (150mg) and Oxycodone (2 tabs/night of 5mg/325mg). The RLS has been gradually improving but am having wakefulness in middle of night for 1-4 hr without the RLS! I had this problem before while on Requip, but the episodes were shorter. I have called it "hyperalertness" for lack of a better term. I don't know if it is related to the RLS, or if it is because I am anxious about the RLS returning or maybe caused by primary insomnia.
Anyone else out there with this or know what causes it? Seems like I read somewhere that RLS brains make too much of the the "alertness" neurotransmitter, Glutamate??

[Polar Bear]

I am very aware of what you refer to as 'hyper alertness' as it visits me every night and has done for more years than I can remember.
Glutamate has been discussed as a contributor. It has also been considered that it might be a part of RLS/WED.
For myself, I don't know what causes it.
The regular pattern for me would have been to have had snatches of sleep perhaps 1.5 or 2 hours at a time and could be awake for 2 or 3 hours at a time.
It improved gradually over this last month to only one awakening of an hour or so, (occasionally 2). I have no idea why the change, the only difference is that I've added Vit B complex supplement to aid with my fibromyalgia.

We all suffer so differently with RLS/WED, the same .. only different.

[Rustsmith]

If you search this board for the term "hyperalertness", you will find lots of hits.

Like Polar Bear, I have experienced this for many years. It is currently limiting me to no more than 4 hrs of sleep each night. Although I have learned to cope with the situation (and have become quite productive in the hours before 6AM), my doctor and I both realize that this is not a good situation in the long run. Unfortunately, we have not yet found anything to help with it. I have taken just about every form of sleeping pill that there is on the market. Some work for a while and then my body finds a way to overcome them. The old benzo drugs effect me sort of like the old joke about giving coffee to a drunk, you end up with a wide awake drunk. For me on benzos, I end up walking around bouncing off walls because I cannot walk a straight line. I was given a double dose of one of the newer drugs, Sonata, during an in-lab sleep test. It didn't even make me yawn.

The only thing that improved the situation just a bit was that my doctor put me on a fairly heavy dose of gabapentin. It is still not proven, but the concept is that it somehow modifies the glutamate problem that Polar Bear mentioned. Johns Hopkins has been studying glutamate issues in RLS/WED and hopefully will be publishing something about it pretty soon. Hopefully the address approaches that might help treat what appears to be the other half of RLS/WED.

[ViewsAskew]

As the two before me said, it's more like who doesn't have hyperaltertness!

Some of us have managed solutions to is, others of us not so much. I'd agree with Steve that a higher dose of pregalalin or using gabapentin might help.

One thing that helps me - taking the opioids earlier in the day. We all tend to think that since our symptoms are worst at bedtime, taking the opioids close to bedtime is best. But, I find that the opioids contribute to the hyperalertness and that I need about 3-4 hours to "get over" it and become sleepy.

Because of tolerance that I didn't figure out and address early enough, I've taken about 25 mg of methadone for about 5 or 6 years now (started at 10 and increased by 5 mg every 10 months or so until I figured out how to prevent it - have been stable since). I take 5 mg about 4 hours after I get up. Another 5 mg about 6 hours after, 5-10 mg about 9-10 hours after, then the last 5 mg about 13-14 hours after. I don't need that much that early, but if I take what I need to be able to sleep, I both cannot get to sleep and it's not enough medication. I can't figure out why - you'd think it would, but it's not. If I take it within 2-3 hours before sleep, I can guarantee you I will not sleep.

I have no idea if that would work for anyone else or what your doctor would say. Another thing that has helped me is to just move my bedtime later. No matter how hard I try, I cannot sleep regularly on a normal schedule. I know a lot of people couldn't do what I do, though. I generally go to sleep around 2:30 to 4 AM. That seems to help, too.

Gabapentin helps me a lot, but it makes me groggy the next day. I only need about 100 mg to make me sleepy, thankfully - I must absorb it quite well! Because it makes be so groggy - and I don't seem to get "used" to it, I only use it if I have no where to be and I've forgotten my schedule and have taken my meds close to bed time.

Do poke around a bit - you'll likely find tens if not hundreds of similar posts - you might glean some other insights from them.

[TiredinCharleston]

Thanks to you all for posting replies to my dilemma of hyperalertness. Sorry you have it but good to know I am not alone. I will check others' posts.