I registered on this site in hopes of finding some help for my husband. He suffers with severe refractory RLS as a result of Ropinirole augmentation. We finally found our way to a specialist at a teaching hospital who has provided guidance to our primary care physician, and since early 2023 his RLS has been managed by taking 10 mg hydrocodone in the early evening. Our concern is the insomnia that seems to have developed as a result of the hydrocodone, he's not had a good night for months now, and becoming more exhausted by the day. He sees a sleep specialist for mild sleep apnea, and she's prescribed Ambien, Ambien ER, Quviviq, Sonata, Lunesta, none of it helps much at all. We'd appreciate any experiences you all might share along with any suggestions you all might offer. Thank you.
Hydrocodone insomnia?: I registered on... - Restless Legs Syn...
Hydrocodone insomnia?
I'm surprised the lunesta didn't work. There are 3 sizes - 1, 2, and 3 mg. I take it for something else and was originally prescribed the 1 mg which didn't help.
A small dose of pregabalin has been suggested but I didn't find that helpful, although you could try. Another suggestion is trazodone although again I doubt it is as effective as 3 mg of Lunesta. Then there is clonazepam, but it has a long half life of 40 mg so can leave him sleepy the next day.
Thanks, Sue. The sleep specialist increased the Lunesta to 3 mg at this last refill and it hasn't seemed to help much at all. The Hydrocodone seems to hype him up. He can be miserably exhausted and barely able to hold his head up but within an hour of taking the Hydrocodone he says he feels perfectly normal. It doesn't make him hyper, but he says it's as if the sleepiness and exhaustion disappears.
Possibly try to take it earlier say 4 hours before bed and then add the Lunesta if you have any left at night.
Yes, he takes the Hydrocodone between 5:00 and 5:30 pm, and then the Lunesta 9:30-10:00 pm.
Darn - I'm out of ideas!
We appreciate any and all input, so thank you very much and please chime in if another thought occurs to you.
Taking hydrocodone in the evening, and not again in the morning, will lead to withdrawals during the day-- which will cause his tiredness etc.
He should ask for 5mg to take in the morning , and se if that helps.
Thank you, Madlegs1. We hesitate to ask for more Hydrocodone after the difficulty obtaining it it the first place, but that may be what it comes to. We wonder if the Hydrocodone is disrupting his sleep patterns. A recent sleep study showed little time spent in non-Rem sleep. He says he feels he's dreaming constantly but never completely asleep.
Has he stopped Ropinirole completely?Assuming he has stopped Ropinirole and his RLS is controlled by hydrocodone- he could try to control the insomnia with a small dose of pregabalin (say 100mg) or medical cannabis.
Yes, he's been off the Ropinirole for a few years now. We're in the USA, and medical cannabis hasn't come about yet here in KY. Hemp gummies helped for a while, but they've become less effective and he seems to notice a great deal of anxiety the following day. We've never discussed pregabalin, we could ask about that at next appointment.
That can be a catch22 of the use of opioids. They are usually highly effective for RLS, but some people experience opioid-induced insomnia.
Yet another suggestion:
Would it be a possibility to discuss trialling different kinds of opioids, to see whether the other types do not give your husband insomnia? Methadone (around 10mg) and buprenorphine (around 0.5mg) both have a long half life and seem most effective for RLS in the long run. Buprenorphine is supposed to have the lowest incidence of side effects due to its slightly different mode of action compared to other opioids.
I hope you find a solution.
Thank you, LotteM. We've asked tentatively about a trial of other opioids but so far haven't gotten anywhere. We will see how it goes at our upcoming appointment. I've been reading about Buprenorphine, from what I gather it may be impossible to obtain without a substance abuse diagnosis. We're in a rural area, it's been up to us to do the research for the most part. Thank you again.
A common side effect of Buprenorphine (Bupr) is insomnia. I had terrible insomnia from Bupr for years and always blamed it on something else. Once I discovered the research on Bupr and why it causes insomnia I changed my dosing schedule to earlier in the day. But that too was a problem due to Bupr's variable half life. Even though I currently take 6 mg of Bupr per day, if I take it in the evening then I'm wide awake all night. And if I take it early in the day, I can't get through the night without RLS symptoms returning around 0400. So I take it midday and get about 5 hours of sleep at night and that's the best I can get from 6 mg of Bupr. So, if you work hard to get Bupr, you might also get worse insomnia. However, it really knocks out the Bupr symptoms and I'd rather lose some sleep than have severe RLS symptoms again.
A common side effect of Buprenorphine (Bupr) is insomnia. I had terrible insomnia from Bupr for years and always blamed it on something else. Once I discovered the research on Bupr and why it causes insomnia I changed my dosing schedule to earlier in the day. But that too was a problem due to Bupr's variable half life. Even though I currently take 6 mg of Bupr per day, if I take it in the evening then I'm wide awake all night. And if I take it early in the day, I can't get though the night without RLS symptoms returning around 0400. So I take it midday and get about 5 hours of sleep at night and that's the best I can get from 6 mg of Bupr.
The thing is that we all react differently to medicines. For example, many people get (temporary) nausea when they start with buprenorphine and very many get constipation on all types of opioids. I got neither. But it does affect my ability to concentrate yielding a kind of mental fatigue. Ergo: it is worth a try if you can get your doctor on board.
I am 68 and have had RLS for about 15 years, its turned severe in last 6-12 months currently taking pramepaxole and gabapentin. 7:00pm 1 -.25mg pram. and 3- 100mg gab. 9:00pm 2- .25mg pram. And 3- 100mg gabapentin, fall asleep between 9-10pm. This dose keeps me asleep until about 4:00am and can most nights fall back to sleep here and there. Any change to dose or time seems to throw a wrench into entire evening and things get crazy. Also the over the counter melatonin product called midnight most nights helps to get back to sleep. Its pretty fast acting so doesn't give legs a chance to settle into their violent movements. Similar to your situation anything I take typically stops working after a period of time. The one thing that did work is tramadol 600mg a day. Was taking it all day and night. New PCP , old retired, will not prescribe opioids for RLS. Having a hard time finding anyone that will. Good luck.
I am also in the States and take Oxycodone for RLS. For sleep I take CBD 100mg from hemp and also a 25 mg Delta 9 THC gummy ( Indica not Sativa ) from hemp. I alternate with 50 mg of Delta 8 THC gummy. Because all from hemp they can be mail ordered unless you are in a State that restricts companies from mailing to you. I know you tried medical cannabis but it may not have had enough THC / CBD.
insomnia
Insomnia on Gabapentin.
Buprenorphine insomnia
Insomnia 
