rls and going to sleep

[Caperry]

taking 3mg neupro patch and 900 mg gabapentin have had rls for 20 years Mirapex controlled it forever at .25mg or less now having trouble falling asleep been on patch for 3-4 months any suggestions? rls got a bit worse on Mirapex that was reason for changing meds doctor did not think it was augmentation

[involuntarydancer]

Is the trouble falling asleep because if rls symptoms breaking through or because you are simply not as sleepy or for some other reason?

When I came off mirapexin after augmentation my then sleep consultant put me on rotigotine (neupro) patches. They were never as effective as the mirapexin. They just don’t cover my symptoms as well. I have since read a number of accounts of people who find that neupro is not as effective as the other dopamine agonists.

[Caperry in reply to involuntarydancer]

I am sleepy, usually no restless leg problems, just cant go to sleep! Yes the Mirapex did seem to work better until the last 3-5 months that I was on it and I was having more rls problems than now. not sure what else to do, some nights I sleep 8 hours then others 3-4 and I do everything the same each night then every now and then im up most of the night

I am noticing a rash where I use the patch

[Hidden in reply to Caperry]

It's not east to say exactly what's going on here. Howver here are some ideas you might consider.

1) If the pramipexole (mirapex) wasn't working as well towards the end of the time you were taking it, then it was, at least, beginning to fail. This a known complication, ("loss of efficacy"), of the dopamine agonists, (DAs). This is what pramipexole is.

Since you have switched to the neupro patch i.e. rotigotine this is another DA and it could be the loss of efficacy is still a problem.

2) The higher the dose of a DA you take, then the greater the risk of loss of efficacy and subsequently augmentation. It may have been best if when you switched from pramipexole to rotigotine that you switched to an equivalent dose of rotigotine before increasing the dose, if necessary.

An equivalent dose to 0.25mg of pramipexole is 1 mg of rotigotine. By switching to 3mg, you have trebled the dose and increased the risk of augmentation.

3) I recognise that you seem to be experiencing more insomnia yet appear to have no increase in RLS symptoms.

One possible explanation in this case may be that it's the increased amount of DA you're taking that's causing this. This is a side effect of the DAs, they can cause worsening insomnia, although this is usually early waking rather than preventing sleep.

This is just a thought.

4) Increasing the gabapentin ( or switching to pregabalin) may help. They do promote sleep. You coudl try reducing the rotigotine at the same time.

I've never used the patch myself, but I've read quite a lot of people in this community saying it causes a rash and it seems one way of dealing with this is to put the patch in a different place every time, but many have to stop using it.

[Sshifflett2]

Mirapex makes it worse read up on it..

[Caperry in reply to Sshifflett2]

I’m not on mirapex I’m on patch