oxycodone-induced insomnia

[halperinchen]

Has anyone experienced oxycodone-induced insomnia and anxiety. I have been taking oxycodone 5 mg since 2016 with no side effects but right now 5 years later, I all of sudden developed terrible insomnia with only 3 to 4 hours sleep and daytime anxiety. I have been taking pregabalin 300 mg very night to get some sleep for the past 2 weeks, but unfortunately, I develop tolerance to it so pregabalin 300 mg no longer relieve my insomnia, now I am sleepless every night and unable to nap during the day either, life has been hell for me and I don't know to live on like this without sleep every day. My Kaiser doctor is unable to help my situation. So if anyone can Kindly help me with this. Thanks.

[joepublic]

I am getting the insomnia but not anxiety.

[Jumpey]

Hi, so sorry you are suffering. I have never taken oxycodone but have taken other opioids.I used to take codeine and did so very successfully for a number of years.Then suddenly it caused severe insomnia. So I went onto Tramadol which again worked for a number of years. Recently I tried codeine again and it didn't cause insomnia. I'm saying this because you could try another opioid such as Tramadol.And after a long break you may be able to return to oxycodone. Good luck.

X

[halperinchen in reply to Jumpey]

Your suggestion is very helpful and gives me some hope to solve this issue. Since my RLS categorizes as refractory the only med is opioid, and all opioid would cause insomnia because it alters brain chemicals for the rapid eye movement essential for deep sleep to occur to happen. For you case, swiching to another opioid for a while would solve the insomnia side effects when you return to the original drug. I would bring up to Dr B for next appointment. Thanks a lot. Greatly appreciated for all of you.

[Steg12]

HiI have been on Oxy for over 15 years on 160 mg per day but now they have decided

To cut down my allowance because of all the trouble in USA but they have not given me any thought . Dropped me to 40mg it was the worst thing I ever felt I was leaping about shaking sweating burning up I had to take some oxynorm just to calm down . I am lucky if I get 4 hours sleep every night my pains are coming back my life is hell and do the doctors care no you cannot even get to see a doctor. They put you on the drug and just keep giving you more. And what can you do.? Nothing. I’m not sure if it’s the pregrablin that makes worse.?

[halperinchen in reply to Steg12]

Thanks for the reply, I actually try skipping oxycodone one night, and the next day, I have no anxiety attack at all therefore I attribute it to the oxycodone and not pregabalin.

[Elffindoe]

Sorry to hear of your problem. I'm afraid I have no experience of taking opioids for RLS. However, I have some thoughts about your situation which you may find helpful.

Perhaps you could clarify a few things.

The first is that you've been taking pregabalin for 2 week, so presumably you mean you've ONLY been taking it for two weeks. Is that correct?

If so it is unlikely that you would develop tolerance in such a short time. In fact, it usually takes pregabalin a few weeks to start working fully.

Secondly, perhaps you could clarify what your insomnia experience actually is as there are different forms of insomnia

Insomnia can take the form of diffuculty getting to sleep, difficulty maintaining sleep or both together.

Thirdly, how are your RLS symptom? Were they under control when taking just oxycodone, i.e. when you started experiencing insomnia or was it your symptoms causing your insomnia?

Something you might consider is that it isn't only people with RLS, or only people taking opioids that suffer insomnia. Insomnia is very common and happens for all sorts of reasons.

It's possible that your insomnia may not be due to oxycodone, why would it happen suddenly?

I have heard that opiolds can cause insomnia, but not that they cause anxiety.

It's just a suggestion then, but your insomnia may be due to your anxiety, just that!

What your anxiety might be due to is a different issue.

[halperinchen in reply to Elffindoe]

Thanks greatly to Elffindoe's reply with gratitude. To clarify the tree points you brought up, I'd like to elaborate it a little. 1. I have actually been taking pregabalin 300 mg once a week to catch up with a week-long lack of sleep since the beginning of 2021 I found out I am suffering with insomnia. As the lack of sleep gettin worse, I start taking 300 mg or every night along with oxycodone 5 mg in the past two weeks and these two nights the pregabalin lose the effectiveness. 2. I have both difficulty initiating sleep no matter how lack of sleep and tired I am, and wake up at 3 to 4 am wide awake unable to fall back to sleep despite of only 3 hours of less. 3. My RLS has been well under controlled by 5 mg oxycodone, the insomnia occurs despite the peaceful legs.My questions for you is if it is possible the accumulation of oxycodone in my system after 5 years of taking it can cause the insomnia and anxiety?

[Elffindoe in reply to halperinchen]

Hi and thanks for the clarification.

Firstly, pregabalin isn't the sort of medication you can take off and like say a painkiller!

In addition, it's not safe to start taking 300mg of it.

The starting dose is 75mg. It can then be titrated upwards in steps of 75mg until it works. Then KEEP taking it.

If you do decide to stop it you must reduce the dose slowly!

It is effective for RLS but it usually takes 3 weeks to start fully working. It's action is to boost the amount of a neurotransmitter called GABA and reduce the amount of another one called glutamate.

RLS is partly caused by an excess of glutamate which can also cause sleep problems.

However it is NOT a sleeping aid, nor an anxiety medicine, although it can help with those. It's main use is for nerve pain or epilepsy.

It is unlikely to build up tolerance in a short space of time.

As I said I've no experience of taking opioids long term. However I do know that it doesn't "accumulate". From what I've read from others, if oxycodone causes sleep problems it happens quite early, not after five years.

Since without knowing anything about you, your circumstances or other health conditions, the most likely cause I can think of for your insomnia is anxiety circumstances.

It's just a possibility to consider.

Otherwise it may be helpful to consult a sleep specialist.

[halperinchen in reply to Elffindoe]

Thanks greatly for your knowledgeable reply which I benefit a great deal. It was my ignorance about the pregabalin and took 300 mg in the very beginning to get one-night good sleep per week, then continue to take every night until no longer relieve my insomnia so that I thought I have built up tolerance. I will start taking 75 mg of it and titrated upwards gradually to relieve my anxiety. Concerning the insomnia case, I agree with you that it does't make sense to all of a sudden experience insomnia after 5 years of use. I will go to see Dr Bucfuhrer for this issue, since he is a sleep specialist.Again, thanks for your knowledge and compassion with gratefulness. Especially when someone is desperate and in the dark, your help means so much.

[Elffindoe in reply to halperinchen]

I'm so glad ( and envious) that you can see Dr Buchfuhrer. You're very lucky, I'm sure he'll help you.

[halperinchen in reply to Elffindoe]

Thanks to Elffindoe's reply. You hit the nails on the head to have a right diagnosis on my insomnia issue. I went to see Dr Buccfuhrer yesterday, he indicated that I am suffering from anxiety and the insomnia is caused by anxiety. He prescribed Xanax 0.25 mg for me to take 5 days a week. I will try it tonight too see how it works, thanks for your reply.

[Elffindoe in reply to halperinchen]

I'm pleased you seem to have a solution for your insomnia.

I hope you sleep well tonight.

Best wishes

[wantokporo]

For me, oxycodone causes what I cause alertness; my mind races and thus insomnia. With the exception of methadone, all the opioids cause that problem for me. (Methadone causes extreme sedation.) My experience with pregabalin was that I kept increasing it hoping it would both take care of my PLMD and my insomnia. For me that was a mistake and I had to come down from 300mg at night to 150mg at night. Then I have been paying attention to sleep hygiene issues and get almost a normal amount of sleep, and with carefully monitoring my food triggers (no alcohol, very little refined sugar, no prepared foods to avoid additives, low glutamate foods [no walnuts, parmesan cheese or aged cheeses, careful with too much tomatoes, etc.--you can google "low glutamate foods"]). It is very tricky to eat in restaurants ever unfortunately, although both Mediterranean and Indian cuisines are safer. The pregabalin helps with the shaking and I have been fortunate to be able to develop somewhat normal sleep. I believe it helps me a lot to have low expectations, learn to meditate and enjoy relaxing during the night when I can't sleep.

[halperinchen in reply to wantokporo]

So glad you can develop a healthy sleep hygiene and are able to achieve a good sleep. I heard that insomniacs tend to have elevated glutamate level in the brain. elevated glutamate level keeps your brain in an excitable state therefore patient with this even can take a nap despite of insufficient sleep during the night, I am wondering if there is a drug which can lower the glutamate in the brain. I saw somewhere Gabapentin can lower it but I don't know how much the dosage and how to take it. I may bring it up to Dr B for next visit.Thanks for your reply.

[Elffindoe in reply to halperinchen]

Gabapentin has the same action as gabapentin, they're the same.

[halperinchen in reply to Elffindoe]

do you mean pregabalin has the same action as Gabapentin?

[Elffindoe in reply to halperinchen]

Yes, exactly!

[halperinchen in reply to wantokporo]

I heard Methadone also gives insomnia, how long have you been taking methadone? Do you have any side effects from taking it. I know that Dr. Buchfuhrer is highly recommending this to refractory patients. My concerns is again insomnia. Let me know how is Methadone doing to you? Thanks

[wantokporo in reply to halperinchen]

I took methadone 5mg for less than a month. Worked but I couldn't stay awake during the day because of daytime sedation.

[Joolsg]

Anxiety and panic attacks are common side effects of opioids. I got them after 5 weeks on Oxycontin and after 5 weeks on Buprenorphine.However, if you've been on Oxy for 5 years & they've only just started, there would appear to be another cause.

Have you just started the pregabalin? How long have you been taking it? You shouldn't develop tolerance after 2 weeks.

It might be the pregabalin that's causing the anxiety.

Also, if you're taking pregabalin for sleep, it takes at least 3 to 4 weeks to take full effect.

If the Oxycontin stops your RLS but causes opioid induced wakefulness/alerting, that's also a common side effect.

Is medical cannabis available where you are? I use medical cannabis for sleep and it works really well.

[halperinchen in reply to Joolsg]

Hi, Joolsg, thanks for your replay, I learn that after 5 weeks on oxycontin and Buprenorphine you experience anxiety and panic attacks, How about right now, after a while of taking both of them are your insomnia and panic attacks alleviated completely? Are you still taking them, do you still have insomnia and panic attacks issue?I am also using caanbis with THC to help with my sleep with no effect.

Thanks,

[Joolsg in reply to halperinchen]

Hi, I was advised to take pregabalin to stop the panic attacks so I took 100mg a night with Oxycontin and after 2 nights, the panic attacks and anxiety stopped completely. I then slowly reduced the pregabalin over 9 months and I didn't get any more anxiety/panic attacks.My RLS was still severe so I switched to Buprenorphine in July 2021 and within a few weeks I again developed panic attacks/anxiety. I added a much smaller dose of pregabalin-50mg and again it stopped the atracks within 2 days. I have now reduced the dose to 25mh and still no panic attacks.

Your RLS seems to be under control but you have anxiety and wakefulness.

Pregabalin needs to be taken regularly. Stopping and starting it can cause restlessness.

I'm sorry cannabis didn't help your sleep. Was it a sedating strain?

[halperinchen in reply to Joolsg]

Don't you have insomnia taking oxycontin or Buprenorphine? If I take pregabalin 75 to 150 mg with oxycodone which don't relieve the insomnia somehow. I am taking Delta-8 (contains THC 3:1 CBN) with no effect. Thanks for your reply.

[Joolsg in reply to halperinchen]

No I don't have that side effect. I had panic/ anxiety/ severe nausea/ and sweats but no insomnia.

[ziggypiggy in reply to Joolsg]

Just to clarify. The buprenorphine is helping the insomnia but not the anxiety?

[Joolsg in reply to ziggypiggy]

I don't have insomnia. I never have had insomnia. In the past my severe RLS would prevent me sleeping or wake me from sleep. The Buprenorphine has stopped the RLS.I used pregabalin to counter the panic/anxiety and am now slowly reducing that as my body adjusts to the Buprenorphine.

[ziggypiggy in reply to Joolsg]

Okay. Thanks. I missed that above. I often wonder if some of my anxiety is related to the Oxy I take for RLS.

[Joolsg in reply to ziggypiggy]

Very possible. I started Oxycontin and after 3 weeks developed full blown panic attacks/anxiety for the first time in my life. I emailed Dr. Buchfuhrer ( top US expert) and he said it was common on opioids and suggested adding 100mg pregabalin at night. I did and within 2 days all anxiety/ panic had gone. I spent over 4 years on pregabalin and then slowly reduced over 9 months and the panic attacks didn't come back. My RLS was still very severe on 25mg of Oxycontin so I switched to Buprenorphine after reading of other people's success. After 3 weeks on Buprenorphine I again developed panic attacks but knew pregabalin would stop them. I've been on 50mg for 8 weeks and just starting to reduce and I think my body will have adjusted to Buprenorphine and I should be panic free.Anxiety/panic attacks are a very common side effect- listed in the meds leaflets and in any search.

I suggest you ask for a small dose of pregabalin ( Start with 50mg)and see if it helps. Pregabalin also relieves RLS.

[welschrispy in reply to Joolsg]

Hello again Joolsg,

I am half way to cutting out 6mg of Pramipexole and my new doctor has decided to start reducing my Tramadol! It's a liability issue I gather. This has caused a load of trouble between us and I am close to having no doctor at all.

In desperation I am "collecting" tramadol and Oxycontin from"safe sources" but I will be using the stuff without supervision. ( a ridiculous state of affairs I think!). I have read that Oxycontin is preferred over Tramadol for treating RLS but now I am reading all about how Oxycontin cases insomnia and anxiety.

Well it's 5.30 in the morning and I havens taken any oxycontin yet!In other words I am already insomniac, though some of this might be due to RLS and augmentation. I don't know! What I do know is that I will never increase my Pramipexole dose again!

What should one do? Continue with the Tramadol and hope it doesn't cause augmentation or try the Oxycontin and(if I eat enough humble pie)hope to get a prescription for Pregabalin once I am no longer using pramipexole ? I hear Methadone is the best for people like me but my "safe sources" haven't procured any so far and it has a bad reputation around here.

Any comments, ideas, pointers would be most welcome. No liability of course! Without you and some of the other contributors I would probably have gone mad or killed myself by now.

Many many Thanks,

Chris

PS This is probably a bit off topic for a UK based site but may be worth saying...I think it's most unfortunate for North American RLS sufferers that the respective administrations in both the USA and Canada have decided to get all wobbly about opiates right now . This is a terrible set back for RLS sufferers on this continent.

[Joolsg in reply to welschrispy]

I despair at the dreadful situation over there and here in the UK. The clamp down on over prescription of opioids will hit RLS patients very badly.You will be unlikely to get much sleep while you're still taking Pramipexole but paradoxically, you may find the RLS settles/improves as you get down to a low dose. That happened to me when I reduced from 4 to 2mg of Ropinirole. Then the augmentation ramped up again.

I used tramadol during the last 4 weeks of withdrawal but I honestly don't think it helped that much. Illegal cannabis cigarettes were the best thing during that awful time.

If you can get Oxycontin, I think it would be better than tramadol as it doesn't cause augmentation and is more powerful than tramadol.

Most people start pregabalin about 4 weeks before they drop the last dose of Pramipexole but for most people, it doesn't start to help until the Pramipexole is completely out of their systems ( usually 2 to 3 weeks after last dose). My withdrawal symptoms lasted around 6 months after stopping Ropinirole but I was on a very high dose for over a decade.

Methadone and Buprenorphine are the preferred opioids of Dr. Buchfuhrer and Dr. Winkelman for refractory RLS, especially after bad augmentation and withdrawal from dopamine agonists.

Buprenorphine is getting used more in the UK as we spread the word of how successful it is.

There are side effects to all RLS meds but they are effective at low dose abd don't lead to addiction if there's no history of abuse.

I wish you strength. Withdrawal is brutal but once through it, your RLS will reduce dramatically in intensity and times it affects you.

[welschrispy in reply to Joolsg]

Thank you Joolsg. Thank you for your time and your generosity.This is all very valuable information and I shall keep it closely in the months ahead. Pardon me for putting it so succinctly but you rock, you really do!

[Joolsg in reply to welschrispy]

I wouldn't have made it through brutal withdrawal from Ropinirole if it weren't for the knowledgeable people on this site. Elisse and Pippins and Madlegs helped me through some very dark nights. I now 'pay it forward' but I'm also very, very angry at the total lack of teaching (and hence knowledge) amongst the medical profession. How difficult would it be for doctors to read the information on RLS? If we non doctors can do it, it would be so easy for them to become experts in a day! I think there will be more and more legal actions here in the UK and in the USA as people start to augment and learn why their doctors should never have increased their dose.

[welschrispy in reply to Joolsg]

I hear you'r anger Joolsg and I agree with the important points you make. My doctor admitted knowing very little about RLS. I have since fed her the information she needs. I edited like mad and was careful not to overload her, polite and respectful and so on ......... but I can tell she hasn't read it and she is contemptuous about online help sites. So she knows nothing. And yet she makes decisions effecting my life. Further more none of this would be happening had my previous doctor also known what he was doing and not put me on a 6mg overdose! It's sick is what it is. sick sick sick. and my heart goes out to all those who, like you and me, have suffered so horribly for their doctor's contempt.

[Joolsg in reply to welschrispy]

Oh I forgot to add that Oxycontin doesn't cause insomnia and anxiety for everyone. It's just a case of trying it and seeing what happens. I'm sensitive to opioids so had panic attacks with Oxy, Buprenorphine and kratom. Dr. Buchfuhrer suggested adding pregabalin and a low dose really stopped all anxiety and panic attacks. I see on here that opioids seem to cause alertness/wakefulness for many but again, that may not happen to you. A small dose of pregabalin will also help insomnia as it's sedating.

[halperinchen in reply to Joolsg]

Hi Jooslsg, knowing that you have been on Buprenorpine since 2019, would you please update what your experiences with it so far? I am about to switch oxycodone to Buprenorphine now, but still feel trepidatious about it. Do you still sleep well and no side effects of nausea and anxiety? How do you manage your constipaton issue? It will help me tremendously. Thanks in advance.

[Joolsg in reply to halperinchen]

I've only been on Buprenorphine since July 2021. Only 4 months. It's still working brilliantly. No nausea and no anxiety. I've never had constipation witj opioids luckily but if you do, try magnesium citrate at night and lots of broccoli.