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Soldier in mid 30's came in 2 weeks ago with some anxiety who had been seen recently by neurologist. She diagnosed him with RLS and prescribed pramipexole. He was having numbness and tingling which would start on his thighs and go down. He would also have same in upper extremities. This would not only occur at bedtime but anytime he sat in one position for 15 minutes or so. He would then get the urge to move.
Over the last 7 years he started having sleep problems including initial insomnia. He would kick and thrash around so much in bed that he would eventually wind up on the couch so he wouldn't hurt his spouse. One of the movements he described as raising both legs straight up while lying on his back, then slamming them down. He knows this because his wife has video taped him. He does not remember any dreams and doesn't make any vocalizations other than talking in his sleep.
He has had bruxism since childhood, so severe that by mid-20's had a full set of dentures.
He had not yet started the primipexole so I told him to go home and try it and return in 2 weeks. He came back today and said it did nothing for him. He had been denied 3 sleep studies, the last one a few weeks ago. I had told him I know how to word the referrals, and he now has a consult with sleep medicine next week.
I don't think he has RLS, but REM sleep disorder is high on my radar, even though he doesn't remember any dreams. He has some mild DJD in lower back but denies any pain there or in his neck, and has no physical limitations. I started him on Klonopin 1 mg qhs till he sees the sleep doc next week.
Any thoughts?
Over the last 7 years he started having sleep problems including initial insomnia. He would kick and thrash around so much in bed that he would eventually wind up on the couch so he wouldn't hurt his spouse. One of the movements he described as raising both legs straight up while lying on his back, then slamming them down. He knows this because his wife has video taped him. He does not remember any dreams and doesn't make any vocalizations other than talking in his sleep.
He has had bruxism since childhood, so severe that by mid-20's had a full set of dentures.
He had not yet started the primipexole so I told him to go home and try it and return in 2 weeks. He came back today and said it did nothing for him. He had been denied 3 sleep studies, the last one a few weeks ago. I had told him I know how to word the referrals, and he now has a consult with sleep medicine next week.
I don't think he has RLS, but REM sleep disorder is high on my radar, even though he doesn't remember any dreams. He has some mild DJD in lower back but denies any pain there or in his neck, and has no physical limitations. I started him on Klonopin 1 mg qhs till he sees the sleep doc next week.
Any thoughts?
