Anything else I might try?
RLS diagnosed 2004. I recognize that y'all aren't sleep medicine docs. I'm just looking for ideas. I want to get off Mirapex because of tolerance, possible augmentation, and significant impulsive-compulsive syndrome. I always talk with my sleep medicine physician about alternative treatments.
EDIT: I edited on 4 Oct 2026, 13:35 GMT/UTC, to add a glaring omission (big goal is to get off Mirapex), and add a couple of things I forgot, e.g., getting off Effexor.
Current Treatment - All prescribed by board-certified sleep medicine physician (MD)
- Gabapentin 800 mg
- Methadone 15 mg
- Mirapex (pramipexole) 0.375 mg - I have had to take as much as 3.0 mg but I have been able to reduce over the past several years due to several factors.
- Nidra TOMAC System (Tonic Motor Activation) - helped me reduce Mirapex to 0.375 (from 0.50).
Adverse effects of Mirapex
- Tolerance, possible augmentation
- impulsive-compulsive syndrome: dream-like compulsive overeating at night - I take Mounjaro which has helped me lose 15% of body weight but Mirapex completely cancels the therapeutic effects of GLP-1 at night.
Comorbid conditions
- 2009 - obstructive sleep apnea (mild), use BiPAP religiously although I take off at night while asleep (I've tried all mask types, CPAP & BiPAP); I've had 6 sleep studies over the years.
- 2012 - idiopathic hypersomnia - diagnosed correctly, i.e., polysomnogram (PSG) followed by a daytime Multiple Sleep Latency Test (MSLT)
- 2013 - type 2 diabetes
Note: Year diagnosed.
Tried but did not work at all or only a little - all prescribed by board-certified sleep medicine physician (MD)
- Iron infusion - didn't help but was worth a try
- Tramadol - helped a little, methadone 15 mg is significantly more effective for me
- Lyrica - adverse effects
- gabapentin enacarbil - adverse effects
- ropinirole (Requip) - minimal therapeutic effects
- melatonin - adverse effects
- Klonopin (clonazepam) - didn't help and made me groggy in the morning (it was the lowest starting dose)
Not tried:
- rotigotine patch
Alternative treatments
- THC-9 2.5 mg (gummies) - helps me sleep through the night and don't need as much Mirapex, but I'm too tired during the day
- magnesium supplements - I take highest recommended dose but does not help RLS
- massage therapy - feels great overall but does not help RLS
Exacerbating medications
- Effexor - I did not have RLS until two years after I started taking an SSRI. Research shows SSRIs & SNRIs (like Effexor) aggravate and maybe even cause RLS. My sleep medicine doc, who was also a psychiatrist, helped me wean off Effexor. It took 10 months but I was able to reduce Mirapex by 50%.
Lifestyle changes
- No more than one standard drink 2-3 times/week
- Reduced nicotine - quit cigarettes 2021; vaping helped me quit (along with several other things); I have recently reduced overall nicotine from 60 mg/day to 40 mg day - has helped some, goal is to quit completely
- Reduce caffeine from 1500 mg/day to 400 mg day - definitely helped
- Walk for 40 minutes 5x/week - helps some
- Sleep hygiene - I try hard but it's a challenge b/c I wake up frequently and am tired during day
Goals:
- No nicotine at all
- Keep working on improving sleep hygiene
- Get off Mirapex