I have been struggling forever with insomnia caused by taking opiods for RLS. Like many of you here it's worth it because the relief from RLS is so wonderful. I recently added Olanzapine 5mg at night for sleep. I know it's on the naughty list as it tends to increase RLS symptoms.
I decided to go ahead and give it a try anyway with hope that my opiod dosage would cover any increased symptoms.
Two weeks in I can't describe how well it's working. I have not noticed any additional RLS symptoms so far. As for sleep, I went from 3 to 4 hours of sleep to over a doubling of that averaging around 8 hrs. It helps with falling asleep and also more importantly I can fall back asleep fast after waking up for bathroom breaks.
I'm hoping this continues. I have noticed an increase in appetite. I can live with that. I was so frustrated with taking and trying everything under the sun to get some sleep. I haven't needed to use any benzos and I'm considering dropping my clonidine as well.
It's night and day for my energy level and mood level when you get quality sleep night after night.
I'll try to follow up in couple months and see if I'm still happy with it.
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ziggypiggy
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Ativan definitely can help with sleep for some. But if you are taking opiods they can be a deadly combination especially if you have any respiratory heath related issues. Both drugs sedate and suppress breathing. I was only allowed ten ativan a month to use for sleep while on opiods for this very reason when allowed to try the two together. If you live in an assisted medical facility you may be allowed more as there is someone around to keep an eye on you. You may get more leeway if all your meds are under one doctor. My opiods come from my sleep doctor. All my other psychotropic meds are under my psychiatrist. They communicate but neither one feels comfortable or knowledgeable taking on the responsibility and care of all my meds.
I found the ativan helpful for falling asleep but not so much for falling back asleep after awaking. But I couldn't take it every night as my supply was limited.
I had the same experience when I tried Ambien. Limited supply and didnt last long.
Also, my insurance company started to complain about using Ambien long term as well.
Ziggy... Dipyridamole is an off-label treatment option for RLS that affects adenosine in the opposite manner as do Opioids. As I recall, its the adenosine imbalance caused by Opioids that is responsible for the insomnia side effect. So, my suggestion is to ask your doctor for combination therapy of the two. If you lead with the insomnia angle I'm willing to bet the doctor rejects the concept, but if your argument is better control of the RLS you might prevail. This combo therapy has worked for me, but it could be placebo effect. The other, more conservative option, is to move to a partial Opioid like Buprenorphine, which may/may-not have less an insomnia side effect.
I also deal with mental issues. I am also seeing a positive effect with olanzapine that I'm monitoring. Not sure if it's a direct effect or because I'm getting good sleep which plays a huge part in reducing anxiety and depression. I'm so lucky that my sleep doctor and psychiatrist actually communicate with each other to help me out.
My sleep has almost been too good. I may actually try reducing my olanzapine in half to 2.5 and see if it still works. Unfortunately it has a very long half life so I'm dealing with some daytime sleepies.
Yes. I take 15 mg of oxycontin twice daily. I started out 20 years ago taking just 10 mg once at night. About seven years ago I upped to 15mg once at night. About 3 years ago I added the second dose during the day. I do cut them in half so I can have more flexibility with it. Works great, though from the beginning I've always had trouble getting and staying asleep. Combined with anxiety induced insomnia it's been a tough go at getting quality sleep.
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RLS and sciatica
oxycodone-induced insomnia
Happy legs but busy mind. Opiate-induced insomnia 
