Spasms and tender shin muscles with RLS/PLM?

[coldfeet7]

I wake in the evening with spasms (a charlie horse) in my lower leg. Here is how chatGPT describes them.

"The muscles on the outside of the lower leg, along the shins, are called the lateral compartment muscles of the leg. These muscles include the fibularis longus and brevis muscles, which are responsible for plantar flexion and eversion of the foot. The lateral compartment muscles are important for maintaining balance and stability while standing, walking, and running. In addition to the fibularis muscles, the lateral compartment of the leg also includes the peroneus tertius muscle, which is responsible for dorsiflexion and eversion of the foot."

Based on the description, I am guessing my Periodic Limb Movements (PLMs) at night are exhausting the muscles (over use). Too bad I can't switch off the signals at night. The tenderness is so bad on my right leg that they can ache during the day after a rough night.

The blood iron levels don't appear to be a problem (TSAT 42, Ferritin 406 and Transferrin 214) based on discussions I have heard here. By giving up coffee (caff and decaf) I have been able to reduce some of the PLMs since I am remembering dreams (my polysomnogram revealed 80+/hr during REM) now.

Any suggestions on how to get rid of the spasms? (I have tried pregabalin and gabapentin but can't handle the itching and other side effects before getting to a helpful dose). Perhaps a massage gun? I just remembered I have pneumatic compression boots. It would be cool if they could activate in the evening if they sensed overuse.

[Joolsg]

If your PLMD is controlled, the spasms and pain in the day should reduce.What drugs are you on for PLMD & what dose?

[coldfeet7 in reply to Joolsg]

I am not on any drugs at the present (other than a triptan for migraines). I was put on pramipexole and that RAPIDLY (in less than three months) turned into augmentation with a capital A. I had no idea how bad RLS could be. It was hellacious and I gained a new understanding of what the extreme cases suffer. It was like I was being shocked with high voltage. My legs violently jerk without any warning. I was beside myself, especially as it exploded on the scene over a two-day period.

I tapered off while adding pregab and later switched to gabapentin. The itching was still too intense and so I tapered off.

My Wellue ring measures movement and by dropping coffee I noticed a substantial reduction in the PLMs registered in my thumb (there were usually two bursts in a night of about 30-60 minutes duration). I know most often PLMs are expressed in the legs, but can be in shoulders, arms, etc. I am conjecturing that the reduction measured on my ring could also be happening in my legs.

[Joolsg in reply to coldfeet7]

If you want to stay off medications, have a look at my previous posts. I posted 2 weeks ago about paeonia alba, a plant that has shown good results.Also check your bloods. Raising serum ferritin above 100, preferably 200 can resolve the majority of RLS/PLMD cases.

[SueJohnson]

Some things that can make RLS symptoms worse for some people are alcohol, nicotine, caffeine, sugar, carbs, foods high in sodium, foods that cause inflammation, ice cream, estrogen, dehydration, MSG, collagen supplements, electrolyte imbalance, melatonin, stress and vigorous exercise. Some things that help some people include caffeine, moderate exercise, weighted blankets, compression socks, elastic bandages, masturbation, magnesium glycinate, low oxalate diet, selenium, 5 minute shower alternating 20 seconds cold water with 10 seconds hot water finishing with hot water for another couple of minutes, hot baths, distractions, applying a topical magnesium lotion or spray, doing a magnesium salts soak, vitamins B1, B3, B6, B12, D3, K2, if deficient, and potassium and copper if deficient, massage including using a massage gun, using a standing desk, listening to music, meditation and yoga. Many medicines and OTC supplements make RLS and PLMD worse. If you list them here I can tell you if this is so and may be able to provide a safe substitute.

[SueJohnson]

Medicines used to treat PLMD include benzodiazepines - especially clonazepam although it can make you sleepy the next day and baclofen (Lioresal). Have you been tested for sleep apnea?

[coldfeet7 in reply to SueJohnson]

Oh yes to sleep apnea. My home study AHI was 53 with SpO2 nadir of 75%. I later had two PSGs that reported PLMs of 82/hr in REM with 22/hr arousals as a result. That started me down the drug treatment pathway.

My BiPAP (after enduring an APAP for a year because of Medicare rules), has reduced my AHI to a range of .5 to 2 a night, but these low numbers can be deceiving. I import the data from the BiPAP and the Wellue ring into OSCAR every 3-4 days so I can observe flow waveforms, leaks, etc. I have done this now for about 22 months (though I only glance at them now as they are pretty consistent and my SpO2 rarely drops below 90).

The side effects and issues related to benzodiazepines is too concerning. I am really intent on finding a drug-free solution.

[coldfeet7]

I take B12. My magnesium glycinate ran out recently, so I have some coming soon.

I have switched to a very low carb diet over the last 6 weeks, so perhaps diet changes are making it worse.

[FluteE]

For me the bottom line for getting rid of the spasms was simply water. I thought I was drinking enough. No other liquid counts. Simply drink about 4oz water with a sprinkle of Celtic salt every hour that you are awake (I set a timer on my phone to remind me). Spasms gone…. As long as I stay hydrated! Your whole body will thank you!!

[DicCarlson in reply to FluteE]

That is a good idea! I used to have muscle cramps nightly somewhat associated with my RLS. Drinking a 20oz bottle of water with 1/4 tsp of sea salt during the day seems to be the key to keeping the cramps away.

[coldfeet7]

This year I had my first kidney stones (going for a scan soon). My urologist was shocked when she saw the stone and said that would usually require surgery if it was stuck. Guess I was lucky.

I have started drinking two liters of water a day with some lemon juice in it. I didn't have any cramps last night, so I'll monitor it for a few days and see if that helps!

Thanks for the suggestion!

P.S.

I'll need to drink this much everyday to reduce the likelihood of more stones and now there are more reasons to do it!