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Restless Legs Syndrome

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Stimulant Medications for Excessive Daytime Lethargy

ircam2112 profile image
11 Replies

I’m considering taking a stimulant due to Extreme Daytime Sleepiness (EDS), which many of us with RLS or PLMD struggle with. I’m concerned that some stimulants (like Ritalin) may aggravate symptoms so wonder what people’s experiences are. I’ve taken Modafinil and Armodafinil in the past and, while they didn’t increase symptoms, they were only effective maybe 25% of the time. Plus, I developed tolerance to them. Anyone else who’s tried other stimulants, either good or bad experiences?

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11 Replies
Madlegs1 profile image
Madlegs1

I'm not an expert, but my initial reaction would be to have concerns about "seesaw" medication.I would rather try and address the primary problem of getting enough sleep.

ie-- controlling the RLS.

What medications have you tried so far?

What has been tested so far? Triggers, iron status , contraindicated medications?

Good luck.

ircam2112 profile image
ircam2112 in reply to Madlegs1

It would be a temporary measure during the process of reducing and eliminating as many of my medications as possible as I believe I have built up tolerance to my medications - Clonazepam, Pregabalin and Gabapentin. I’ve dc’d the Pregabalin and have almost discontinued Gabapentin but severe PLMD symptoms are returning and creating severe EDS. We’re working towards a rotational medication regime so until we add Pregabalin and gabapentin into a rotation schedule, I feel I need a stimulant as I’m sleeping 13-18 hrs/day at this point, losing muscle mass and aching hips, back and shoulders. In addition, it’s Spring and the house and yard need me.

ircam2112 profile image
ircam2112 in reply to Madlegs1

Ferritin is 173 with 40% saturation.

SueJohnson profile image
SueJohnson

I agree with Madlegs1. However if you do try stimulate medications, take them early in the morning and make sure the stimulant effects have worn off by evening as they can exacerbate RLS symptoms.

LotteM profile image
LotteM

I have tried ritalin/methylphenidate. At a low dose, as my doctor was reluctant to prescribe it, and not for long for the same reason. 5mg didn't help noticeably, 10mg did a bit, but also made me feel jittery initially. I didn't get enough stock to see if that would settle after a while. I didn't push, because the effect was not much, and like the others have said, I don't like combatting the problems of one medicine with another. Although I don't feel the same about the macrogol to help with constipation.

Based on my experience, I wouldn't expect wonders. Currently I use (white) kratom low dose to cut the edges of the lethargy. It helps a little, need to redose after about 4h.

In my case the lethargy is associated with opioid use, even at an extremely low dose.

ircam2112 profile image
ircam2112 in reply to LotteM

Thank you for sharing your experience. Found out today that my doctor is prescribing me methylphenidate which, given your experience, is concerning esp. since my #1 concern was that she prescribe something that would not cause the jitters specifically because I’m going to start the long process of discontinuing Clonazepam which will cause significant anxiety. However, I will give it a shot. It could be an insurance issue - that you need to begin with lower cost meds before trying others although I’d think there’s adequate medical necessity to avoid jitter causing medications.

LotteM profile image
LotteM in reply to ircam2112

Hi ircam, see how it goes. The jittery feeling I had was weak, a bit like too much coffee, and may settle soon. I noticed it, but didn't find it distressing. I just want to try to explain it better as I get the impression you took my description as far more serious than intended. Keep me/us posted. I will probably ask for a new and more serious trial of methylphenidate at my next doctors appointment next week.

SueJohnson profile image
SueJohnson

Clonazepam has a half-life of 40 hours so that may be the cause of your daytime sleepiness. Xanax which has a half-life of 11 hours would be a better choice.

LanaCSR profile image
LanaCSR

I would check with your doctor before trying the Xanax. There are many options out there, and your doctor can advise you and put you on the best regime for whatever you try, not just "take them early in the morning". Some of these meds have specific times of day that they should be taken and your doctor will help adjust the dosage and timing in order to best help you get the relief you are seeking.

I wish there was something i could take to keep me awake the next day my meds make me drowsy the next day even if i have had a bad night , sometimes all i do is sleep the day away and my meds are low doses. 😕

ircam2112 profile image
ircam2112

Thanks for your input. However, Clonazepam has actually had the opposite effect for me of lessened EDS since it decreases my PLMD so significantly. Subsequent increases have had the same effect of decreased EDS. The longer acting benzodiazepines are generally a better choice for long-term therapy since you don’t experience the roller-coaster effects which can lead to needing the medication more often to avoid withdrawal symptoms and, they last throughout the night. Because of the ups and downs of shorter-acting benzodiazepines (and opioids), there’s also a much greater chance of addiction.

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