PLMD and pain

[papdad]

Was diagnosed with moderate OSA and severe PLMD. Doctor did not initially mention or medicate PLMD -- after I read the sleep studies I called Dr. back -- prescribed Miraplex 0.5 MG at bedtime. Don't know if this is helping the PLMD movements or not but it definitely not helping the pain. Did a search on this forum and did not find anything mentioned that would really help the pain. Can anyone help. Will it get better.
--- sleep study showed 50.6 PLM's/Hr.

[kteague]

Your doctor may have to gradually increase your dose until you get some relief. You will want to maintain ongoing contact with your doctor if you don't feel better within a week or so after each change.

Treating both OSA and PLMD can be a bit of a balancing act. Once the limb movements are effectively treated, it sometimes happens that the OSA manifests itself more, so you'll want to be sure the pressure prescribed remains therapeutic. Also, getting the OSA in line can allow more limb movements to manifest. Both of these sleep disorders cause arousals, so treating one gives the other more opportunity to express itself uninterrupted by the other.

Has your doc done a Ferritin Level on you? For some there is a correlation between low Ferritin and limb movement issues. Most of what I've read says that those with such problems should maintain a Ferritin of 50 to 60, but some docs want it even higher. Worth considering. As far as the pain, if it's from the PLMD, which mine has been, the more controlled the movements, the less pain I have. It might be helpful if there's someone who can observe you sleeping and see how the limb movements are doing.

[papdad]

My Primary Care Physician did a complete blood work up some three weeks ago and everything checked OK with the exception of high colesterol. Will check back with them to see if they checked Ferritin level or not. Just had a visit with my cardiologist last Thursday. Cardiologist chanced my blood pressure medications taking me off of a calcium channel blocker and putting me back on a beta blocker and HCTZ (water pill) due to leg swelling. Go back next Thursday to check pressure inside heart, which could indicate a blockage that might contribute to the leg swelling. Have since read that calcium channel blockers can make PLMD worse.
papdad

[birdshell]

In your initial posting, you did not specify where your pain occurs. I wasn't sure...Is it in your legs? The upper thigh (quadriceps), lower shin, calf, hamstring, gluteus maximus (butt muscles, more or less)? If your pain is from muscle cramping, then there are stretching exercises that may help a bit.

I was diagnosed with moderately severe PLMD. I had not noticed it, but it was there! Thankfully, my PSG at one year showed this; only a sleep tech or two on this forum suggesting that we need to have a follow-up study at 1 year made me go for another.

The leg movements were not painful to me. (I also suspect that they are partially caused by some of my other meds, as I tend to have a lot of leg bouncing and other movement during the day.) I have had no pain with my PLMD, unless it is from the movement during the day causing sore muscles. For that, I try to be sure to do achilles tendon/hamstring stretches.

My doctor started me on 0.05 mg of Mirapex, and after the initial time increased it to 0.25 mg. Are you certain that your dosage IS 0.5 mg and not 0.05 mg?

From the Mirapex site for health professionals:

"MIRAPEX quickly (2-3 weeks) titrates to an effective dose and offers a flexible dosing schedule"

So, if you have been on the current dose for a few weeks, it may be time for your doctor to increase your dosage. I had to request an increase from my doctor, which I did after finding that the standard dosage is usually 0.25 mg.

Kteague--Kathy is the expert on this problem, as she has been there and done that (plus made the t-shirt?) when it comes to leg movements. I know that she found that there was a rebound effect of sorts from taking too much Mirapex. In addition, Mirapex was not the most effective of medications for her. There are other drugs for RLS, so maybe those would be appropriate? The two terms (PLMD and RLS) seem to be interchangeable for many purposes.

Note, please, that I am not in any way a medical professional; I am merely making suggestions based on what I have experienced.

Best of treatment to you, and please keep us posted on your progress.

Karen,
Who wishes PLMD equaled exercise

[papdad]

The hurting is in both of my legs primarily in the lower calves. It bothers me every day, all day. When I get up in the morning I feel as though I walked in a marathon the day before. Am doing a little assuming here in thinking that is is caused by the PLMD as no one has actually told me that. I checked my Mirapex script bottle again and it does say 0.5 MG.

Noem

[papdad]

Following taken from the Mirapex site for health professionals referenced above.

" Patients have reported falling asleep without perceived warning signs during activities of daily living, including operation of a motor vehicle, which sometimes resulted in accidents. Hallucinations and postural (orthostatic) hypotension may occur. "

Sounds rather like sleep apnea doesn't it.

[Julie]

Your problem may be one called claudication and there is a surgical procedure sometimes done to relieve it. One thing I'll say is that if you are a smoker, that's likely the chief cause of it, and continuing to smoke makes it worse. I'm not trying to lecture you, just inform you of a well known answer. You might want to ask your MD about it.

[papdad]

Am not currently a smoker since I was diagnosed with COPD some two years ago and put on supplemental oxygen.
Will do some research into claudication.
Thanks for the comment,
Norm

[papdad]

Nope -- don't have that. Just read about claudication on the Mayo Clinic web site. They were talking about, that if it got bad enough, could require taking off the legs. Nope -- no way I got that.

[kteague]

Norm, the more you read about it the more possible side effects you'll find. Seems it's with higher doses there is a greater liklihood of some of the side effects. I had relatively little trouble except for feeling like road kill until I was up to 3mg. For a few years it was fairly effective at 1.5mg, but as its effectiveness waned and my dose was increased, so did my side effects of compulsive/addictive behaviors and wild flailing of limbs, even when not asleep. It is the nature of these meds to at some point cause more trouble than it fixes, and then it's time to try another med. Before Mirapex I was on Sinemet for a few years. Recently using Requip and already up to 3mg without full effectiveness. The only way I know to describe these meds is "a necessary evil" for who experience the full wrath of this disorder.

P.S. Word to the wise - never go off these meds abruptly. Wean off slowly or you may really regret it - I did.

Just read your prior post about claudication and its possible result of amputation. I had earlier wondered out loud to my daughter if a person had no legs, would they no longer have PLMD and thus be able to sleep normally. Aww, they'd probably get phantom PLMD.

[papdad]

That would be kinda like -- we wouldn't have any crime if we make everything legal. And the phantom pain thing is real -- Got my right hand intertwined in a table saw some seven years ago and, long story short, had to have one of the fingers, that they had reattached, removed. If I don't look at my hand I can still move that finger and some nights it is quite painful.
Have been doing some reading concerning various medications used for PLMD and the fact that they loose their efficitiveness over time. To remedy this, one must do as you are doing and switch among the drugs.
Hhmmmm -- Would phantom PLMD still shake the bed.
Norm

[kteague]

Norm - LOL!

[taberge]

There is a difference between two disorders and they are so similar I think many confuse them.
RLS Restless Leg Syndrome - Most people are aware of this condition because of the pain/irritating feeling felt in the calves.
PLMD - Most people are unaware of their disorder because it only happens during sleep.
secondary PLMD - same as PLMD but has an underlying cause to which treated usually alleviates the condition.

http://www.ninds.nih.gov
http://www.talkaboutsleep.com
http://www.emedicinehealth.com

These three sites have articles that can explain the difference.

It seems you may have RLS and you need to be checked for any of the conditions that can cause this disorder. Treating the underlying cause will give you better relief if an underlying condition is found.

My doctor tried to put me on Requip (the alternative to Mirapex) after misreading my PSG. Please make yourself aware of all the possible side effects of theses medications. These two meds affect people in many different ways. Normally they are safe. But, they can, depending on the person, actually make the condition worse.