A week ago I titrated from the very successful 0.6 mg Buprenorphine sublingual I’d been on for 9 months during which time my PLMS disappeared completely. But they returned 7 days or so back so with my doctors’ reluctant support the dosage was increased to 2 x 0.4 tablets = 0.8. Five nights at the increased dosage were successful.
But tonight it has gone crazy. I’d taken 2 Zopiclone of the new course of sleeping tablets that I need to counteract the Bupe side effect of insomnia. Normally I just take one, but the insomnia was resisting their effect so I’d returned briefly to one half of a Zolpidem from my previous course , which had been completely successful.
I then lay in bed watching a video. Normally with tiredness I would switch it off, put on my CPAP mask (I also have sleep apnea) and settle down to sleep.
Tonight I just suddenly dropped off and woke abruptly with weak but clear PLMs in my left leg and no recollection of the cut-off point between sudden tiredness and the option of sleep. I walked the PLMs off quickly and then got back into bed to write this. Nothing like this has happened throughout the entire wonderfully successful Bupe course so I’m presuming that the sudden PLM attack indicates that the titration has simply been to small and that I require a dosage of up to 1 mg. If so, this is very disappointing after the 9 months of total release from a condition that had wrecked my sleep architecture. And I’ll have a dosage battle on my hands with my tremulously cautious GP practice.
Any observations, insights, suggestions and direct advice will be very welcome. Now I have to get through tonight hoping desperately that the next wake-up isn’t accompanied by PLMs.