Ask:
REstless Leg Syndrome
Hi Dr Joshua,
Thank you in advance for any insight you can offer with my questions and for taking the time to respond.
I have Restless Legs when I get into bed and it seems to have kicked up full speed when I began taking generic Remeron a few months ago to HELP me sleep. The RLS started off mild, but now I'm being tormented by it nightly for hours on end. Most nights now the restless leg is just in my left leg which happens to be the side of my head where all my troubles came from in the past.
On top of the generic Remeron, which I'm having to increase every week or two, I take generic Restoril 30 mgs and have taken this for more than 10 years. The problem is, I'm only getting 5 or 6 hours of poor quality sleep from these meds.
Is is possible I have built up a tolerance for the Restoril? I'd love to be drug free but can't imagine how that could happen.
Is it better for a Neurologist to manage this (I am looking for a new local doc as my current neuro is 4 hours away) or my PCP?
~Thanks again and Happy 4th~
Answer:
REstless Leg Syndrome
What dose is the Remeron? Usually Remeron is used in small dosage such as 7.5 mg for sleeping problems. Higher doses are used in the treatment of depression. If you are taking a higher dose (and not suffering from depression), talk to your doctor about trying a smaller dose and see if the restless legs get any better. It may be a side effect of Remeron, but not necessarily. Restoril 30 mg every night for 10 years is an undesirable situation, but I understand how difficult sleeping problems can be. If you stop Remeron and the restless legs improve significantly, then it maybe worth giving up Remeron and finding some other drug. However, in my opinion Remeron and other antidepressants are much better for chronic use that benzodiazepines such as Restoril.
Sometimes (rarely), restless legs can be a symptom of some underlying cause such as electrolyte imbalance, kidney dysfunction, etc, so it's a good idea to talk to your primary care physician about this and see if he/she sees fit to order any lab tests.
Make sure you drink enough liquids and not go to bed dehydrated, get exercise during the day, try some footbaths, massage, and make sure you get all the necessary vitamins and minerals in your diet. It may be worth trying a magnesium supplement to see if that helps any - but talk to your physician before you start any supplement.
In difficult cases of restless legs, Parkinson's disease medication is sometimes used. Levodopa and dopamine agonists may provide relief in difficult cases but these are a last resort and should be discussed with a neurologist. If all else fails, in the extreme cases, intrathecal (administered into the cerebrospinal fluid via a spinal catheter) drug pumps have been used with success.
In a recent publication in the Journal of the American Medical Association, cognitive behavioral therapy was found more effective than sleeping pills in the treatment of insomnia in older adults. Check out the related .
Talk to your PCP, discuss the possibility of consulting a neurologist, and see if you can find a psychiatrist or a neurologist who specialises in the treatment of sleep disorders. Good luck!