Question:
I was diagnosised with PLMD (Periodic Limb Movement Disorder) about 2 months
ago.
I was told that this could add to my depression, because I am not getting a
proper nights sleep.
I was put on mirapax for a month, and it did nothing, but make my sleep
worse, so my docotor and I decided to stop it.
I am still fatiuged in the day time, and I am wonder how impornt this is to
treat, and if Mirapax is a the proper treatment for this, or if there are
some better choices or natural choices?
I guess from what I understand, this is mainly related to a lack of
dopimine.
So what choices do I have both prescription and natural? And how big of a
deal do you think this PLMD really is? Mean, how much do you think it is
really affecting my daytime wakefullness? Presumably I have had this for a
long time, so how would I even really know what a good nights sleep is like?
How do I judge?
How much could this be contributing to my depression?
Answer:
Geeeeeezzz man, youve got problems. You have been screened for obstructive
sleep apnea right? I would only assume in that overnight sleep study they also
assessed you for sleep apnea? I say that cause OSA can really mess your mood up
and cause anxiety, as well as cardiovascular problems of all sorts.
I dont know much about PLMD, but I do know the basics of movement disorders.
They use dopamine agonists a lot for movement disorders as well as
anti-cholinergics as well as benzodiazapines and even muscle relaxants like
baclofen.
You need to be using specialist Neurologists for things like PLMD, NOT
psychiatrists! As in a Neurologist who is a specialist in sleep medicine. Some
psychiatrists might even take your PLMD dx and twist it around and make you out
to be a "somaticizing" patient! Basically calling you a hypochondriac! Ive seen
it happen man.
You should definitely get the PLMD treated as that can directly affect your
sleep and the quality of your sleep can directly affect your mood and anxiety
state.
Yea, I know what you are saying, its fucked up though because, one nurlogist
sleep specialize says take mirapex, and I say it fucks up my sleep and I
feel worse, and he said take it anyway, then the second sleep specialist, a
pulomonlogist, says, to stop taking it, and he said that it is proboly not
causing me any problems.
Melatonin seems to work. See:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&...
The trick to using melatonin, though, is in finding the right dose. There are a
number of unique biochemical parameters which will influence just what proportion of
the oral dose actually makes it to the brain. The standard tablets I see are 3 mg
dose. I use about 1/3 to 1/2 of a tablet each night. I find that even 1/6 of a
tablet has a beneficial effect.
If you saturate the melatonin receptors, i.e. if you take too much melatonin for
your own body's capacity to handle it, the receptors actually shut down. That will
disturb your sleep, as the brain will not fully let go of consciousness. You are
better off starting at a lower dose, and working up, if the efficacy is not there. I
have a friend who take 6 mg/night. For me, 0.5 mg is effective. Your brain will
vary.
Also, PLMD is associated with low vitamin B12/folate status, and magnesium
deficiency. SSRI antidepressants tend to make the disorder worse, and if you
followed an earlier post that connected SSRI adverse effects with folate status, you
may see the link. SSRIs increase folate requirement, by some unknown mechanism. This
makes folate deficiency symptoms come to the forefront.
No, it is possibly a defect in a single dopaminergic pathway deep in the brain, that
connects the SCN and the cortex. It's really a coincidental finding that some
dopaminergic medications can improve this disorder. As you discovered, however, the
treatments can also cause sleep disturbances, all by themselves.
