2 replies to this topic

[Mind_Paralysis]

I've finally figured out my life-long sleeping problem.

 

After talking to my previous partners I've come to the conclusion that I most likely have PLMD - Periodic Limb Movement Disorder. I have, upon closer introspection, always noted that I twitch during sleep, but I never figured it had anything to do with my sleeping-issues. My partners described my movements as almost... EPILEPTIC! As if someone had connected electrical wires to random muscle-groups of mine, which then intermittently made my arms or legs twitch and vibrate even.

 

PLMD is often connected to Neurodevelopmental Disorders, primarily Parkinson's Disease and NARCOLEPSY.

 

SCT is a disorder which shares characteristics with both ADHD and Narcolepsy - and I have noted a distinct improvement of Sleep-structure when on low-dose Modafinil - Modafinil has also been proven to have slight Anti-epileptic properties, and has shown efficacy against various forms of Myoclonic twitching.

 

The fact that Gabapentin and Modafinil helps is also CLEAR signs towards this.

 

PLMD can also be exacerbated by trauma and extreme stress - and my life with a Histrionic was certainly traumatic and stressful, so was the event which resulted in my burnout. All in line with my conclusion that I have PLMD.

 

So... what now?

 

 

I know that Dopamine-agonists are the frontline-treatment for idiopathic RLS, but aren't dopamine-agonists also a recipe for disaster? I've been thought that except for D4-selective agonists they cause downregulation which leads to depression, anhedonia and pseudo-parkinsonism - it doesn't strike me as a sustainable treatment.

 

Gabapentin has shown some effect, especially when used in combination with Modafinil, but the research apparently favours Gabapentin Enacarbil (horizant, et c) over regular Gaba-P.

 

 

Should I just drop everything and try to get to trialling Dopamine-agonists?

 

Obviously, I also need to push the health services to give me a Poly-Somnograph to ensure I get the diagnosis, but I feel that I need to start treating it right away, or I'll have no strength to even pursue a diagnosis.

 

 

 

References:

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Periodic limb movement disorder

https://en.wikipedia...vement_disorder

 

The Treatment of Restless Legs Syndrome and Periodic Limb Movement Disorder in Adults—An Update for 2012: Practice Parameters with an Evidence-Based Systematic Review and Meta-Analyses

https://www.ncbi.nlm...les/PMC3397811/

 

Effects of modafinil on pentylenetetrazol-induced convulsive epilepsy.

https://www.ncbi.nlm...pubmed/25869564

 

Modafinil exerts a dose-dependent antiepileptic effect mediated by adrenergic alpha1 and histaminergic H1 receptors in mice.

https://www.ncbi.nlm...pubmed/17681557

 

(no wonder Mirtazapine f*cks with my sleep! the very way which moda treats the twitches, is how Mirtazapine would EXACERBATE it!)

 

Modafinil and its metabolites enhance the anticonvulsant action of classical antiepileptic drugs in the mouse maximal electroshock-induced seizure model

https://www.ncbi.nlm...les/PMC4480820/

 

[Dichotohmy]

You make a compelling case for PLMD here, but you should definitely have a polysomnogram. Get the sleep study to rule out nocturnal epilepsy, alpha wave intrusions, and REM movement disorder as possible alternative diagnoses and comorbidity respectively. A polysomnogram will also verify the severity of your presumed PLMD. If your PLMD index (events per hour) is low, you might not benefit much from treating it, or, the potential side effects of medication could outweigh the effects of a low PLMD index.

Quite frankly, doing a polysomnogram sucks especially if you have ADHD-spectrum problems. The PS is also obscenely expensive if you have to pay out of pocket. Finally, not all sleep study labs are created equal and the competency of the adminstrating sleep tech and neuroligist who interprets results vary wildly. Make sure you vet the sleep lab carefully so you don't get stuck at a glorified CPAP vendor. That said, understanding your sleep architecture and having objective data is invaluable if you are unfortunate to have a non-restorative sleep disorder.

[Mind_Paralysis]

You make a compelling case for PLMD here, but you should definitely have a polysomnogram. Get the sleep study to rule out nocturnal epilepsy, alpha wave intrusions, and REM movement disorder as possible alternative diagnoses and comorbidity respectively. A polysomnogram will also verify the severity of your presumed PLMD. If your PLMD index (events per hour) is low, you might not benefit much from treating it, or, the potential side effects of medication could outweigh the effects of a low PLMD index.

Quite frankly, doing a polysomnogram sucks especially if you have ADHD-spectrum problems. The PS is also obscenely expensive if you have to pay out of pocket. Finally, not all sleep study labs are created equal and the competency of the adminstrating sleep tech and neuroligist who interprets results vary wildly. Make sure you vet the sleep lab carefully so you don't get stuck at a glorified CPAP vendor. That said, understanding your sleep architecture and having objective data is invaluable if you are unfortunate to have a non-restorative sleep disorder.

 

Now that's some good advice!

 

I definitely need more data on this - PLMD-severity is definitively something I need info on, and other disorders as well - especially nocturnal epilepsy, that's a definitive potential issue as well, since the sort of vibrating movements I do seems a bit atypical for classic PLMD.

 

If I do a PolySomnograph I will most likely not have to pay almost anything myself though - here in Scandinavia we have a governmentally subsidised health-care system - we've had the FULL (not the blunted final product) Obama-care here for 60(!) years! :D

 

Almost every sleep-lab here is connected to the public and national health-services, so there are good discounts.

 

We do however NOT have the same expertise as you have in the U.S.A though... many neurologists and Dr's are badly trained regarding these issues, according to the limited info I have found.

 

Well, SOME data should be gleaned from it, but the quality and breadth of data is questionable.

 

 

On another, but related note - I have made a deal with a friend, who has RLS and is being evaluated for ADHD-symptoms, and in return for a Pramipexole sample-pack, I've sent her some Vyvanse to help her out. (my last pills! well, they never helped much anyway) So, I might soon be starting an evaluation of a Dopamine-agonist... On an interesting note, she never felt that Pramipexole actually helped all that much - but rather that the differently selective, yet indirect D-agonist METHYLPHENIDATE helped a lot more. (I've given her some low-dose Ritalin I prepared, to let her trial the effects for sleep - turns out the results were stellar!)