Question About Apnea and RLS

[MandoJohnny]

Sorry for the length of this, but I know having the details helps people be able to give advice. I have read some of the previous posts on this subject, but I haven't found a specific answer to these questions:

Background: As a result of sleep study, I was diagnosed with moderate to severe apnea. I am on CPAP with a pressure of 11. I am 100% compliant after 5 months and it seems to be helping a lot. My leak and AHI stats are consistently good.

My doc also said the study showed moderate RLS that was not improved during the CPAP titration part of the study, although he considered me "borderline" for RLS, because I don't have hardly any of the waking symptoms of RLS. He wanted me to try RLS meds, but he left it up to me whether or not to continue on them. I first tired Requip. I did progressively increasing doses over two weeks and continued at the top 2.0 dosage for two more weeks. I didn't feel it improved my sleep, but it did leave me drowsy druing the day, even after 8 hours of sound sleep, so I stopped it and contacted my doc. Then we tried Nuerontin. At 100 mg it did not seem to do anything at all, one way or another, after 2 weeks. At 200mg, I slept like a log, but I felt like I was in a fog during the day. I was not drowsy, but more like "fuzzy." This was again even after plenty of sound sleep with good CPAP stats. I cut back to 100mg and the fuzziness got better, but still did not go away.

I am going to cut out the Nuerontin now and see how that goes, but I know that when I talk to my doc, he will still suggest I should be on meds for RLS. I am going to do what I think is best for me, but I want to get more facts.

I am skeptical that I have significant chronic RLS. When I did my sleep study, I had just flown into town early that evening, sitting in a cramped airline seat and I was over-tired. Those are just recipies for temporary RLS, in my experience. Also, the doc gave me Ambien to make sure I slept, because I did not sleep well during an earlier sleep study. The one time in my life previously where I took a sleep med, it was something that began with a "T," but I don't remember the name, I had to stop using it because it actually caused me to have RLS symptoms. So I suspect the RLS on my sleep study was due to other factors than chronic RLS.

Also, I have used a pretty high-quality, low light camera, pointed at my legs, to videotape my first 3 hours of sleep (the length of the tape) on two different nights. My legs appeared to be as still as logs both times.

Here are my specific questions: If RLS is actually disturbing my sleep cycle, what should I be experiencing? Would it show up in my AHI stats? Would I necessarily be visibly kicking? Would I be actually be waking up? What I can't tell is whether my daytime drowsiness is due to RLS or due to the RLS meds. It's kind of a "dammed if you do and dammed if you don't" situation. Any thoughts would be a great help.

[Vader]

I too was diagnosed with RSL during my sleep study.
I was never aware of it. My wife tells me that I don't move at all in my sleep since using CPAP. I would never have known that I have it ( if I really do). I don't take any meds for it.
I'm sorry that this doesn't really answer your question, but I would really like to know if there are well documented studies showing a link between OSA and RSL.
MY sister has RSL, and she has it very bad. She's on all kinds of meds for it , but gets very little relief. Her Doctor has suggested maybe she should do a sleep study, but she has none of the classic symptoms of OSA.
So I also wish I knew more FACTS on this, myself .

[AlexLaw]

Hi,
What is RLS? Thanks.
Alex

[Missy]

RLS is restless legs syndrome.

[ailsaek]

I was diagnosed with mild to moderate RLS during my sleep study (which also found I had severe sleep apnea). I was also diagnosed with severe anemia soon after, however, so my doctor put me on high dosages of iron. Now I have iron and a CPAP and no more RLS (can't comment on the anemia as I haven't had bloodwork done since starting the iron).

Just a personal anecdote to the effect that if one does have both, they can be from radically different causes.

[kteague]

MandoJohnny,
If you have copies of your sleep study during titration, see how many arousals were caused by limb movements. RLS does not require medication unless it is disrupting one's sleep. (Sleep can be disrupted without you becoming awake enough to be aware.) Cpap may be helping you sleep sound enough to sleep thru any mild movements, some of which can be so negligible as barely more than a twitch. If, without meds, you feel rested and not sleepy during the daytime, they are not hurting you. If your wife says you're not moving, any RLS movements you might have are infrequent and/or very small. As with anything "borderline" you could fluctuate from one side of the fence to the other, and it sounds like you're on the right track to not pursue treatment at this time. Besides, it's unusual to not have trouble in the evenings then have trouble overnight. If you start being symptomatic regularly in the evenings and sleepy during the day, medication may be in order. I'm not a medical professional, just a veteran in movement disorders.
Kathy

[lferrel]

My sleep study showed that I was having RLS but it was not causing sleep arousals. Thus, I do not worry about it. Since it is not disturbing my sleep, I would not want medication because of the carry over sedating effects the next day.

[MandoJohnny]

Thanks everyone. Last night was my first night without the RLS meds since I started them. I did not sleep as well as usual, but I think there may have been some unrelated causes for that. Also, I imagine I might have some withdrawal effect for a few days. But I really did feel a lot more clear-headed today, even though I didn't get a full night's sleep. The "fuzziness" was gone. So I'm staying off 'em.