I have been almost two weeks on time release morphine 30 mg, which I take about 7 PM, and it lasts 12 hours, to help me sleep. I tried 15 mg, which worked for about 6 nights, and then worked less and less until not working at all. (During the last three months, I got off 1 mg of pramipexole, and I think I am completely free of it now). My question: I am sleeping in three segments most nights, about 10:30 to 12:30, up for while with mild RLS, then 1-4:30 or so, up for a little while, then 5:30 to 7: 30 - times vary - but it is the three segment thing that is weird. I am tired during the day, and sometimes fight sleep while driving, while being VERY careful to not actually doze off. Has anyone else had this pattern on morphine? Is methadone better than morphine, and should I advocate for that? (my iron level is high, I take magnesium, I eat very low carb for two years now/permanently as a lifestyle, no drinking or other triggers). Thanks!
refractory RLS, taking morphine - Restless Legs Syn...
Methadone is the opioid preferred by most RLS experts. There are several reasons why they recommend it, when taken at the low doses (5 to 20 mg/day):
Much lower risk of addiction
Much less need to increase dosage (i.e., less buildup of tolerance). In one long term study with 76 RLS subjects, the median increase in dose over ten years was just 5 mg/day, with a maximum of 10 mg/day.
Fewer and milder side effects, especially much less dopey feeling.
All these are why it is often used in opioid addiction treatment. And for RLS sufferers, it has Ian additional benefit: it hits some novel receptors in the spinal column not touched by the morphine-derived opioids. This seems to confer additional relief from RLS symptoms.
I use it myself (10 mg) as part of my regimen, and have found it by far the best treatment.
Note: when you say "my iron level is high", what do you mean? Is that your ferritin level? For us, it needs to be at least 100, which is higher than what most doctors would consider adequate.
This is the closest to a gold standard article, authored by a number of RLS experts on the appropriate use of opioids in the treatment of RLS.
It covers a number of opioids, methadone among them.
If you’re in the UK you won’t get methadone prescribed - but maybe try extended release OxyContin- if you take twice a day it will even out the effects and ensure a steady supply of opioid without the ‘dip’.
I always wake at least once a night with mild RLS and I think most with severe RLS are the same.
You could add in the paracetamol as Madlegs advises.
Why can't we get in UK? I was going to ask my GP. I did wonder if only addiction specialist doctors here prescribe it but decided if it were for chronic pain or RLS then maybe a GP can.. Please God no, I recently tried methadone for a couple of days as an experiment (don't ask how) and it is fantastic for RLS and at a really low dose.
But a UK GP can prescribe for chronic severe pain I think? I just had a look at NICE blurb on it. My GP is pretty good (at off label) if we can put it down to me experiencing pain as the primary reasoning. I do experience (some) pain with my RLS too. He's especially prepared to consider when I've taken printed out evidence from US respected Specialists. I'll give jt a try. I'll be on opiates for RLS for rest of my life but the increase in tolerance on other opiates is a real problem for me. Meth doesnt haven't that problem and at considerably lower doses too. I'm one of the many who've tried everything else and opiates are only thing that works. I've heard about a med that helps prevent blood clotting, can't remember name of it, which looks promising for RLS too?
Wow, thanks for telling me. I appreciate knowing others have this experience. When I was on vacation, I slept much better than the last two nights I've been home. I have a fairly low stress job, so I thought I'd sleep as well at home. I am having trouble staying awake during the day yesterday and today when sleep is interrupted so much. I can increase the gabapentin from 300 to 600. I just hate to get on that pattern
I take 30 mg ms contin 3 times daily and .25 mg requip before bed and each time I wake up. I too sleep two hrs at a time . I find the requip causes me to need bathroom visits every two hrs as well. The methadone treatment I am interested in seems to be most recommended by the experts. Maybe lose the Morphine and requip altogether?