RLS/PLMD During the day

[Ephemera]

Well we now have more nights of sleep in a week, still 2 or 3 without sleep. But getting RLS/PLMD during day more. Do not want to mess with meds as seem to be working. Rather get some sleep than none as it was for so long! Keeping diet the same every day, so no food triggers . Any ideas!!

[ChrisColumbus]

I've forgotten: what RLS meds is hubby on at present - is it buprenorphine or gabapentin? Is he taking magnesium?

[Ephemera in reply to ChrisColumbus]

Hi, he is on 200mg Pregablin at night and 100mg Pregablin in morning and 1mg clonazepam at night. No magnesium

[ChrisColumbus in reply to Ephemera]

Bio-available forms of magnesium can help some of us with RLS, and magnesium (bis)glycinate in particular is both easier on the bowels and can help with sleep regulation and improve overall sleep quality, including addressing insomnia.

Magnesium (bis)glycinate is not generally available retail in the UK, although Holland & Barrett sometimes stock it. It may have to be ordered online.

There are some reports that magnesium should not be taken within 2-3 hours of taking gabapentin (it can impact absorption) and one should probably take the same precaution with pregabalin.

I've just read this on a pharmacy site: "There were no interactions found between Clonazepam and Magnesium. This does not mean the potential for an interaction does not exist, however."

It's just a thought that magnesium (bis)glycinate may help: magnesium only helps some.

[Wordsworth99 in reply to ChrisColumbus]

I’m wondering if magnesium only helps some because perhaps it needs to be taken for quite some time before it helps, and people give up on it to early? Many people are magnesium deficient but because the symptoms are not obvious people won’t know. From my understanding blood tests won’t pick up a deficiency because magnesium is 95% or so located in our bones and inside our cells, not free floating in our blood. I’m thinking that magnesium may later be discovered to be just as important as iron for people with RLS. I’m interested in your thoughts on this, and have been enjoying your posts, and those of all the other regulars, for quite some time now. So much amazing knowledge! 😁

[ChrisColumbus in reply to Wordsworth99]

I was never tested for magnesium levels so can't test your theory on why it doesn't show up as deficient. And measuring for magnesium is not done as routinely as testing for iron, possibly partly because of the erroneous belief that we mostly get enough magnesium from food. This may have been true, and may still be true, where intensive agriculture hasn't depleted soil nutrient levels but I suspect that it's not now true for many of us - in most of the US and Europe at least.

I'm also not sure that magnesium deficiency per se is necessarily the only reason that supplementation helps some RLS sufferers: boosting levels can also help the brain in various ways:

mdpi.com/1422-0067/24/1/223

I'd heard somewhere that magnesium was useful for RLS, tried magnesium oxide tablets and magnesium oil without success. A relative pointed out that while the oxide was high in elemental magnesium it was difficult to absorb. She recommended magnesium citrate which helped immediately, and later the largest health and wellness retail chain in the UK told me that their customers found magnesium citrate much more effective than iron for treating RLS.

[Mg (bis)glycinate is most often recommended in the US: it's just not as widely available retail in the UK. It does however have the added benefit of helping sleep].

I think that there are several reasons why people can find that magnesium doesn't help them, including but not limited to:

1. They use the wrong form of magnesium.

2. They use too low a dose - either because they are ill advised or because they can't tolerate higher doses because of a laxative effect. In the latter case mg glycinate is the better choice.

3. They are taking an RLS trigger - whether in the form of a prescribed or OTC medication or a dietary factor (mine were statins, aspartame and too much sugar) - which 'overwhelms' the effectiveness of magnesium.

4. They have augmented on dopamine agonists, making the ameliorative benefits of supplementation and/or diet changes ineffective.

[Wordsworth99 in reply to ChrisColumbus]

Thanks so much for your reply, it is very helpful for me, and I am so grateful that you shared that mdpi link, I now have the missing pieces to my puzzle. Actually, I believe your post is so helpful, it would be wonderful if all new people to this forum are made aware of those reasons why magnesium may not be helping them, so that they can adjust and persevere! The focus is so much on iron, and rightfully so, however perhaps magnesium needs to share the limelight?!

[Ephemera in reply to ChrisColumbus]

I am interested in how much mag citrate you take and is at night or morning. Want husband to try it. Thanks.

[ChrisColumbus in reply to Ephemera]

Firstly I'd say that - as your husband particularly has trouble with sleep - mg glycinate (also sold as bisglycinate and diglycinate) may be a better choice than citrate as it's said to help combat Insomnia. It's also less likely to have a laxative effect. You may have to order it rather than find it OTC. I've never taken this form so I'm afraid that I don't know the effective dose.

As to when - I think as a precaution you need to take it 2-3 hours away from pregabalin, as it *may* impact on absorption of that.

[ChrisColumbus in reply to ChrisColumbus]

I've just found this for the first time on the H&B website, which contains magnesium bisglycinate plus maritime pine bark extract (which a few have found useful) and various vitamins. As you know I've not tried this form of magnesium and cannot personally vouch for or against any of the other ingredients:

hollandandbarrett.com/shop/...

[ChrisColumbus in reply to Ephemera]

I was only taking magnesium to help with RLS symptoms, not sleep/insomnia, so I was happy with the easier to find citrate.

While the brand I use - Solgar - recommended 400mg a day at mealtimes I found that initially I needed to take 600mg. To get around the potential laxative effects I spread it out - 200mg with breakfast, 200 at lunch, and 200 in the evening.

After a month or two I reduced to 200 with breakfast and another 200 with a later meal.

Again, you need to work around your pregabalin schedule: I've not found anything definitive on mg being problematic with pregabalin (as it's said to be with gabapentin) but just in case...

[Hidden]

It's rather unusual that he's getting more RLS in the daytime. I would have thought the residual effects of both pregabalin and clonazepam would help keep daytime symptoms at bay. Have you tried upping the evening dose of pregabalin? 200mg is only a moderate dose. If that were to work, then you could try dropping the morning dose.

When you say no food triggers as diet is the same, that wouldn't necessarily rule out something within his present diet being a trigger.

[Ephemera in reply to Hidden]

Yes I thought that about his diet but there was a time when he did not have day time symptoms so I wonder if it is the meds.

[Hidden in reply to Ephemera]

Both those meds typically serve to reduce limb movement by increasing GABA in brain. That's why I don't understand his limb movements increasing. Even if there's something else going on eg some form of spasticity, those meds should also control it.