RLS generally responds well to medication, but since it may occur sporadically with spontaneous remissions, the continuous use of medications is generally recommended for symptoms occurring at least three nights per week. Sleep experts use three types or classes of medications for RLS and PLMD:
- Dopaminergic agents: This class enhances a brain chemical known as dopamine. Mirapex and Permax have become first-line medication, over older drugs like L-Dopa with Sinemet.
- Benzodiazepines are generally sleep experts' second-line medication. They must be used carefully due to the potential for addiction and the negative impact on sleep. This class includes such drugs as diazepam (Valium, Diastat), Klonopin, Restoril, and Halcion.
- Opioids represent the third-line of preferred medication generally and is reserved for those with more severe symptoms. They may be used alone or in conjunction with other medications. This class includes codeine (active ingredient in Tylenol #3), oxycodone (active ingredient in Percocet), Darvon, and methadone (in very severe cases only).
As one would expect, all of these medications are available by prescription only and should be taken only while under a doctor's care.
Falling asleep spontaneously may indicate the syndrome of narcolepsy. Excessive daytime sleepiness is typically the first symptom. It's the overwhelming need to sleep when you prefer to be awake. Narcolepsy is associated with cataplexy, a sudden weakness or paralysis often initiated by laughter or other intense feelings, sleep paralysis, an often frightening situation, where one is half awake yet cannot move, and hypnagogic hallucinations, intensely vivid and scary dreams occurring at the onset or end of sleep. One may also experience automatic behavior, in which one performs routine or boring tasks without full memory later.
There are both behavioral treatments and medications for this situation, which can make life livable again.
General behavioral measures include:
- Avoiding shift work
- Avoiding heavy meals and alcohol intake
- Regular timing of nighttime sleep
- Strategically timed naps
Medications typically involve stimulants in attempt to increase the level of alertness and antidepressants to control the associated conditions noted above. The effects of stimulant medications vary widely and their dosing and timing must be individualized.
- Provigil is a relatively new medication that improves alertness but does not act as a stimulant for other body systems. It has few side effects and low abuse potential.
- Stimulants include dextroamphetamine sulfate (Dexedrine, Dextrostat), methylphenidate hydrochloride (Ritalin, Concerta, others), and Cylert.
- Antidepressants include: