PLMs after 12am (Circadian Rhythm?)

[Ganadaramabasa]

I have PLMD without RLS.(I can rule out other sleep disorders from sleep tests and etc. I know I have PLMD from sleep test and also self-recordings during sleep).

I go to bed at 9pm and almost everday wake up at 12am. After 12am until 5am, I have fragmented sleep, frequently waking up from PLMs.

Is anyone else experiencing this as well?

My main guess would be the sleep cycle. PLMs occur mostly during N1 and N2 stages. For the first sleep cycle (the first three hours), my body is too tired and is not awakened by the PLMs. As my body enters the second sleep cycle however, I wake up from the PLMs since my body recovered partially from the first sleep cycle, and therefore more likely to be awakened by the PLMs.

But this reasoning, is just my best guess.

If it's not the sleep cycle, could it be the circadian rhythm? I have no idea how it could possibly affect my PLMD, but I read online it could be pertinent. I just find it very odd why I wake up daily after a three hour sleep.

Or could it be any other reason apart from the above two?

Any inputs would be greatly appreciated. Thank you

[Amrob]

I generally sleep through my PLMs, except sometimes early morning (6am-ish) they may wake me. Generally I go back to sleep. This is the case without medication and with medication.

[Ganadaramabasa in reply to Amrob]

That's great for you, it means you are able to have a good night sleep (without medication) which I have now realized, is a true blessing

[Amrob in reply to Ganadaramabasa]

Not the case unfortunately....I don't get restorative sleep without medication. Without medication I can sleep 8 hours straight and still awaken feeling as though I've had 3 hours.

[Ganadaramabasa in reply to Amrob]

What medication are you on?

[Amrob in reply to Ganadaramabasa]

Pregabalin

[Ganadaramabasa in reply to Amrob]

How much Pregabalin are you taking?

So, with Pregabalin you are saying you get non-fragmented 8 hour sleep correct?

I am going to meet my doctor today and ask for Pregabalin and I really hope it works for me. I've tried Mirapex and Clonazepam but they don't seem to work for me.

Thank you

[Amrob in reply to Ganadaramabasa]

Yes, i get restorative sleep on pregabalin most of the time (80% thereabouts). Both pramipexole (Mirapex) and clonazepam worked for me also. I do experience considerable daytime sedation on pregabalin and when i take clonazepam so they aren't perfect. Pramipexole was the best medication i took but had to stop it due to augmentation.

I have also very recently introduced a very small dose of clonidine to my regime (in addition to 300mg pregabalin). This helps me get to sleep because after more than 8 years on pregabalin, the pregabalin is no longer effective in getting me to sleep. The clonidine works very well in this regard.

I have also found that combining two meds seems to work better. Eg. pregabalin plus clonazepam or pregabalin plus clonidine.

[Amrob in reply to Amrob]

After trying different meds for PLMD for over ten years, and also trying different ones with my young son, and having experienced approx 8 overnight sleep studies for us both, i'm not even sure that the limb movements need to be stopped. I think that anything that promotes deep sleep may be sufficient on its own.

[Ganadaramabasa in reply to Amrob]

It must be tough on your young son. I hope the best for him.

Have you tried weighted blanket? I am using it at the moment. Can't say it is life changing, but I can feel I have deeper sleep on days with weighted blanket. Perhaps it helps ignore some of the milder PLMs.

As for the dose increase to 300mg, I often, and by what dose did you increase?

From my understanding the pregabalin pill comes in 75mg, meaning it can only be increased every 75mg.

But I read in other posts, it is recommended to be increased every 25mg.

[Amrob in reply to Ganadaramabasa]

Thank you. I haven't tried a weighted blanket. Good to hear it may be helping somewhat.

I started pregabalin approx 9 years ago (with a break for pregnancy). From memory the starting dose was around 75 but I increased quite quickly to 150mg. I then increased slowly to 300mg over a couple of years (as needed) and have now been on that dose for some time.

In Australia pregabalin is available in 25, 75, 150 and 300mg strengths.

It's always best to start low and increase slowly. Some people say to give pregabalin 6 weeks to have full effect but I noticed it's effects straight away.

[SueJohnson in reply to Ganadaramabasa]

Yes it comes in 25 mg

[Munroist]

I think you are basically right. Firstly PLMD and RLS are associated with a drop in dopamine which is why dopamine agonists work, because it makes it appear like you have more dopamine. Your dopamine levels vary through the day according to the circadian rhythm with the levels decreasing through the evening reaching low point during the night and then increase during the day. I have restless legs and PLMD and the restless legs will normally kick in after midnight if I'm awake although depending on activity and what I've eaten it can happen as early as 10pm. Once asleep I find that I'm very restless from midnight until about 5 and that restless PLMD will wake me up several times in the night and I'll have get up and walk around to settle it. I think you are probably right that if you are very tired you may sleep through some of the PLMD and as you become more rested through the night it's a balance between being less tired which might allow you to wake and having more dopamine which will reduce the severity of the PLMD

[Ganadaramabasa in reply to Munroist]

Thanks for your input Munroist

[CsiguZ]

You can try to start sleeping later around 12AM, to test if your theory is right. In my case my PLMs occurs always between 12AM and 4AM, regardless the time I fall asleep.

[Ganadaramabasa in reply to CsiguZ]

Sure I will give it a try, thanks

[Hidden in reply to Ganadaramabasa]

Serum iron (not ferritin) has a nadir of 12am. Dopamine has a nadir of 3am and I believe also 3pm. No matter how high your ferritin is everyone’s serum iron plummets in the evening. Iron infusions tend to increase a hormone called hepcidin which is an anti-iron substance and lowers that all precious “serum iron.” I’m always amazed when people’s RLS is not worse in the days and weeks following an infusion. You might be far enough out where you can successfully take 25 to 50 mg of ferrous bisglycinate on an empty stomach when you go to bed at 9pm. It should work that very first night for one whole night. If it doesn’t then I’ve wasted your time and I apologize in advance 🫣

[Ganadaramabasa in reply to Hidden]

No need for an apology, I am keen on trying everything that could help. Thanks

[Eryl]

It's probably what you have to eat and drink in the evenings

[Ganadaramabasa in reply to Eryl]

I read that alcohol and sugar at night worsens plmd.

How about skipping dinner?

Can you share what helps you?

[Eryl in reply to Ganadaramabasa]

I avoid refined csrbs and refined seed oils sll the time and vonsume foods high in antioxidants.