RLS

Doc Bruce will chime in at somepoint my GUESS and its just a guess is that the issue may more be with the meds used to control it. But wait to hear what Bruce Says.
 
FAA Source: http://www.faa.gov/about/office_org...guide/app_process/exam_tech/item35/amd/apnea/

For ALL classes of medical it will require an FAA decision AFTER your doctor does the following:

Submit all pertinent medical information and current status report. Include sleep study with a polysonogram, use of medications and titration study results, along with a statement regarding Restless Leg Syndrome
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As suggested above, some of the drugs used to control it are disqualifying.
 
Ok, a follow up. Is RLS tied to Sleep Apnea? I don't see the connection.
 
The only med allowed is sinemet. Requip and Mirapex are verboten.

No connection between RLS and Sleep Apnea, though sleep apneics have more more more leg motions until the SA is controlled.
 
The FAA has taken issue with both RLS and the medicine as a means to be as unreasonably prohibitive as possible. I have been told it is because of the side effect, but no one seems to be able to give me a consistent answer on what those side effects are. I have heard hallucinations, seizures, and sleepiness. I have had no instance of hallucinations or seizures and they will not hear anything I say or my doctor.

Does it cause sleepiness? Sure it does, just like benadryl, Tylenol PM, or alcohol. The FAA has targeted the most effective medications for RLS and prohibitted them because we cannot be trusted with medications for it even thought they trust everyone to use Tylenol PM (and others) with responsibility. Makes no sense, but sense is not what it is about. It is about being prohibitive.
 
I tried Sinemet. Didn't work, but it made me extremely drowsy and I saw colors in the bathroom when I got up at night. But the FAA will allow it!!!
 
Unregistered said:
The FAA has taken issue with both RLS and the medicine as a means to be as unreasonably prohibitive as possible. I have been told it is because of the side effect, but no one seems to be able to give me a consistent answer on what those side effects are. I have heard hallucinations, seizures, and sleepiness. I have had no instance of hallucinations or seizures and they will not hear anything I say or my doctor.

Does it cause sleepiness? Sure it does, just like benadryl, Tylenol PM, or alcohol. The FAA has targeted the most effective medications for RLS and prohibitted them because we cannot be trusted with medications for it even thought they trust everyone to use Tylenol PM (and others) with responsibility. Makes no sense, but sense is not what it is about. It is about being prohibitive.
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I can't help with this. Policy is determined by Dr. Arlene Sanger at AAM 200, in Washington DC. She is about fifteen pay grades above me.

Officially, it is about Central Nervous system side effect profile. And Requip and pramipexole are NOT relatively good actors.
 
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I would imagine coordinated flight would be difficult with RLS.
 
Mason said:
Carry a bicycle in the back of the plane, pedal away when the RLS strikes.
If you can't afford a bike, we could take up a collection.


OOPS.
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Which is inconsiderate and cruel thing to say to someone with a health issue that is not thier fault. Do you harass poeple in wheelchairs the airport too?

Anyway, RLS is only a night time thing. Coordinate flight is not difficult because I have done it. It is not uncontrolled or involuntary muscular movements like Parkinson's disease. And, I am told, there is no a connection between RLS and Parkinson's. One does not lead to the other. It is an urge to move your leg when at total rest....like trying to sleep. Any movement or activity while awake makes it unnoticable even to the person who has it.
 
Bruce, thanks for the info. I am going to try Sinemet again along with some diet changes. I know a really good Chinese medicine/acupunture doctor who told me years ago she could stop RLS with diet changes. She had a lot of really good suggestions on diet issues that I should change for overall health improvements. We shall see.

Upon going back the FAA, what should I expect? How long will they want me to be off Requip? How many first born children will need to be sacraficed to satisfy the FAA?
 
Long enough off the requip for the doc to be able to write with a straight face, "stable on Sinemet 5/100 qid" or the like, with the "performance statement" we noted before. ?14 days?
 
Unregistered said:
Bruce, thanks for the info. I am going to try Sinemet again along with some diet changes. I know a really good Chinese medicine/acupunture doctor who told me years ago she could stop RLS with diet changes. She had a lot of really good suggestions on diet issues that I should change for overall health improvements. We shall see.

Upon going back the FAA, what should I expect? How long will they want me to be off Requip? How many first born children will need to be sacraficed to satisfy the FAA?
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Hi, I just recieved my "rejection letter" from the FAA on Monday. I'm a newer student pilot. A 41 year old female with a long family history of RLS. I've been on Requip for 7 yrs and I have to say that the drug just about saved my life. I was so misserable before it. I have no symptoms of any side effects. I did a little research to share. I emailed the same question to the medical guys on the AOPA website. They were kind enough to get back with me saying:

HI Ms. Russell,

As you discovered, requip is not allowed by the FAA. You would need to discontinue the medication and be off the medication for 30 days and have a letter from your treating physician stating that you no longer take the medication. I suggest that you talk to your Dr. about using sinemet. It is another medication used for Parkinson's but it works well with RLS. Talk to your Dr. and if he wants to switch you, simply have him write the letter advising the dosage, frequency, and that you are having no side effects and send that letter back to the FAA and ask for reconsideration.



So that's that one. A second FAA doc gave me the same advice. I'm begrudgingly calling my Doctor for an appointment and ask to be switched.

I can let ya know how that plays out. I wish I could find some kind of reference letter to take with me. He has no idea what to write to the FAA and neither do I. If you can find that kind of information I'd love to see it.

Good luck to you. I am soooo not happy about switching either but what else are we going to do. Chins up:mad2:
 
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I wanted to give an update. I picked up my Sinemet Friday but didn't take until Saturday. I was flying Saturday morning and did want the change affecting me before a class. I took my Sinemet along with 1mg of requip. My doc suggested that I "wean" myself off of the requip. I woke up with no side affects. I did wake several times during the night but I'm pretty sure it was my body wanting it's requip. I actually felt a little more clear headed. This morning the same. I had been taking it for so long I hadn't realized that the requip was causing a brain fog. So, two nights down and so far so good. I think I'll keep adding the 1mg of requip for the next few nights and then be off of it all together. I'm hoping that my leg pain will stay away. Hope you find this helpful. I hate to say it but the FAA might have done me some good here (lol) We'll see.
 
I have a question for anyone that has had to ask for reconsideration for their airman medical. Both myself and my DO., (general practitioner) have no idea what to write. Is there a standard form we should use or is there an example letter I could use as a reference? Any help would be greatly appreciated
 
See my post #13. Add, "has no impediment to normal motions of daily living...."

Dawn, this is exactly the sort of stuff that I do- but I don't want to "hold out" here. I'm plenty busy.

If you are interested, email me from this site. Where are you geographically?
 
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Thank you Dr. I did send an email.
One more question? Do you think they will require me to do a sleep study
 
Hi Dawn, keep us posted on your progress. I hear you on the Requip. It just about saved my life too when I started it in 2005.

It would be intersting to compare your FAA denial letter to my denial letter In my letter, they rejected not only the medicine, but also my medical condition. And they gave no course of action to get approval either....just F-you...and hope you die soon. And they wonder why everyone is so dissatisfied with the federal govt. I should take this letter down to the Social Security administration and claim disability. The federal govt has declared me disabled, but I am sure they have "different standards". Different means double.

I found on an aviation medical website that Requip was allowed for awhile on a case-by-case basis. Now it is fully banned. It did not say what lead to either of those decisions. It did state the reason it was banned was because it "may metabolize into methamphetamine". This is the first official reason I have found. I called Glaxo Smith Kline, who developed and tested the medication, and they disputed that saying that was never observed in the testing. Furthermore, the FDA does not list that side effect either. I dont know where the FAA is getting thier information.
 
Unregistered said:
I should take this letter down to the Social Security administration and claim disability. The federal govt has declared me disabled, but I am sure they have "different standards".
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I dont make the connection... not being able to hold a flight medical does not mean you are disabled... it just means you aren't able to hold a flight medical.
 
Dawn, what's the current status? I started flying as a student a month ago, & thought all was great. Then I went for my medical today, have RLS, got the same result - Requip a nonstarter. I have an appt to see my dr Tues to get switched to Sinemet, but wanted to know what your results have been.

Anybody else have any news on this one? Need all the info I can get! Thanks!
 
I have been taking Sinimet for a while. I have disclosed RLS and Sinemet on my medical. My doc suggested switching up with another med-Tramadol. I asked my attending physician to contact my AME to ask about it. She did and was told that we should report it on the medical form. 4 months later I reported the prescription change. My AME called the FAA and they told him to advise me not to continue Tramadol and to issue the 2nd class medical. I did as directed and didn't take Tramadol from that point. 20 days later I received a letter requesting documentation from my attending physician on the current status and treatment for my RLS. I supplied the required documentation. The next letter I received asked for my medical to be returned due to my use of Tramadol! What??? Apparently they don't read any correspondance nor do they take notes when an AME calls their office.

I immediately hired an attorney and wrote a letter requesting reinstatement. I have now in my possesion (as of today) an authorization for a "special issuance" of my second class medical. Thats still unacceptable to me. RLS symptoms have never shown up during flying duties for me. Tramadol produced a drowsiness in me, but never after 8 hours did I feel a thing. After some research, I agree that while it did a great job on the symptoms that it isnt a drug that I want to continue anyway. Sinemet has absolutely NO side effects for me. I have learned that diet and no caffeine after 10 am along with excersise is really good at helping as well.

I will try to keep my progress posted.
 
The only reason you are tired of FAA is that you didn't have someone competent guiding the application and controlling the infomration. That didn't require an attorney, it just required a good AME..... sigh.
 
bbchien said:
The only reason you are tired of FAA is that you didn't have someone competent guiding the application and controlling the infomration. That didn't require an attorney, it just required a good AME..... sigh.
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How do AMEs keep up with all of the rules? Is it that a good AME simply has more experience in dealing with the FAA and can predict what they will require?
 
You have to think like an Occupational Medicine doc.

Many moons ago when I did my first week long course at OKC, all we wanted to do after was to get out and go eat supper....the then favorite was Cattlemen's. Bricktown didn't exist then.

But if you were really compulsive, you stayed in the hotel, read the serialized copy of the internal positions on every conceivable illlness....it's not published because it's a live document and changes rapidly, and it's like reading the Funk & Wagnalls. They do publish updates.

If you haven't read the whole thing (nobody will copy it; every page said, "DO NOT COPY"), then the updates don't make sense (without the underpinings).

That was then. I don't know how you would it ab initio, today. The last time I saw the book was Feb 2010, when I was there for a week.....and some chapters had changed. It's the difference between doing ab initio training, and "update/difference" training. The latter is not a big deal, the former is a BIG deal.

And I have no idea how the surgical specialists do it. I'm an internist first, and it sure helped.
 
Tired, why did you switch from Sinemet to Tramadol (aka Ultram)? Especially if it was working? I talked to some other folks who took Sinemet and it resulted in insomnia and anxiety. To me this is worse for a pilot than sleeping all night on Requip and flying rested the next day. One person said they ended up on Lorazepam for awhile as a result of trying Sinemet. They can thank the FDA/FAA for this.

Researching Tramadol, I can certainly understand why you would not want to stay on that. AOPA has a database of medications. Tramadol is a very powerful pain medication with awful side effects....worse than Requip. Yet it appears to be allowed. It requires 48 hours after the last dose before flying so I dont think it is going to work for RLS. RLS is an every night thing.....or at least if it isn't now....it will be. Mine started sporadic and eventually went to every night within a few years.

I have researched this issue a great deal. I have learned that the FAA gets its medication information from the FDA which makes complete sense. If the FDA can modify its position on Requip, the FAA will follow suit. I first learned online that the FAA did not allow Requip because it metabolized into methamphetamine. I dont think that was good information. The rub is that Requip is suspected of causing poeple to fall asleep during daytime activities. That resulted in a "black box" warning. What I dont know yet is how the FDA determined this and what the circumstances were. I cant believe Tramadol, and a bunch of other allowed medications, wont do the same thing. We need to get to the bottom of the FDA's position.

Tired, you probably did not need a lawyer, but your US Senator might have been able to cut through some red tape. Best wishes to you and keep us posted. I really wish we could hear back from Dawn Russell on her progress.
 
bbchien said:
The only med allowed is sinemet. Requip and Mirapex are verboten.

No connection between RLS and Sleep Apnea, though sleep apneics have more more more leg motions until the SA is controlled.
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I have both OSA and restless legs. This was told to me by both my wife and the male sleep doctor. One knows by being kicked by me. The other by watching the video of me sleeping and from evaluating the impulses of the electrodes attached to almost every inch of my body when doing the sleep study.

I was taking Mirapex which Dr. Bruce said is not allowed. So I went cold turkey on that and two other meds for the past three months. Submitted all of required info to the FAA and waiting for good news.

The FAA required me to be off Mirapex plus two other prohibited meds for three months. Heard from the AOPA today that I got my med approved, but will not celebrate until I am piloting a plane by myself. Oh, that's scary.
 
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Sac Arrow said:
I would imagine coordinated flight would be difficult with RLS.
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According to both my wife and sleep doctor, I have restless legs which per them are pretty active. However, this does not occur unless I am asleep. I am 73 and since maintaining a very positive BI-PAP machine compliance, My wife says my legs are not so restless. I went cold turkey off Mirapex on October 27, 2011 which was my 49th wedding anniversary. Good luck.
 
bbchien said:
The only med allowed is sinemet. Requip and Mirapex are verboten.

No connection between RLS and Sleep Apnea, though sleep apneics have more more more leg motions until the SA is controlled.
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Controlled? Dr. Bruce can you explain how one reduces restless legs by controlling OSA? As you know, I have both conditions. I improve my sleep quality with the Bi-Pap machine and went "cold turkey" to meet FAA requirements to for the medical. With those meds I was sleeping better and taking Mirapex practically eliminated my thrashing legs. As I no longer take those meds, I am sleeping OK, - not as well as when on the Colinozapan and Edular, but OK however off the Mirapex, my wife says my legs are moving again while asleep.
 
comanche said:
Controlled? Dr. Bruce can you explain how one reduces restless legs by controlling OSA?
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Nope. I'm not worthy of the nobel prize. But it has to do with more time spent in REM as opposed to phase 1 sleep, and clearly it doesn't work for everybody. It you are low on dopamine in your substantia nigra, REM sleep won't help the legs.
As you know, I have both conditions. I improve my sleep quality with the Bi-Pap machine and went "cold turkey" to meet FAA requirements to for the medical. With those meds I was sleeping better and taking Mirapex practically eliminated my thrashing legs. As I no longer take those meds, I am sleeping OK, - not as well as when on the Colinozapan and Edular, but OK however off the Mirapex, my wife says my legs are moving again while asleep.
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Each is an individual. I know it's hard to not be resentful of the system, and everyone is a doctor, but that's just how it is :(
 
Well, I found out some interesting news. The FAA cites a "black box" warning from the FDA on Requip....and probably Mirapex too. This is the reason for the ban. I called FDA myself, twice, and the Requip manufacturer to determine there is no such "black box" warning on Requip. Sent this information back to the FAA, but they still wont budge on thier prohibition.

Commanche, good luck. I dont know how you just stop taking the medication. If you can live without it, you didn't need it anyway. Or you are not sleeping good and going through life fatigued. That is scary for a pilot.

I think the FAA is all wet on this one. Pilots, in all class of medicals, are going to avoid treating RLS because they know the top two medications are verboten. RLS typically develops in middle aged people so likely the individual is already a pilot and knows the implications. And the AMEs cannot catch it if the pilots dont disclose it. The result is pilots with insufficient sleep which is probalby the biggest medical issue for commerical pilots today. They are shooting themselves in the foot by prohibiting medications that enable pilots to treat their medical conditions.
 
No comments on this for many months. I guess the applicants, who have RLS, have figured out that honest is NOT the best policy with the FAA. Future applicants are doing what I should have done.....dont disclose anything!
 
Unregistered said:
No comments on this for many months. I guess the applicants, who have RLS, have figured out that honest is NOT the best policy with the FAA. Future applicants are doing what I should have done.....dont disclose anything!
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That's pretty stupid. Then when you have a "deal", the investigation will show in about 10 minutes, the Rxs, the diagnosis codes, and you will lose your PILOT certificate for lying. Of course if your're the sort of person who will then fly anyway....then who cares?

The trouble with RLS meds is the side effect prfile- co-ordination and concentration take a hit when you are on them....

Treat with sinemet at night, which is 40 years old, cheap, approved, and works. The other two are only "top" because of big pharma marketing.

Lying, yeah, that's the ticket........not.
 
bbchien said:
That's pretty stupid. Then when you have a "deal", the investigation will show in about 10 minutes, the Rxs, the diagnosis codes, and you will lose your PILOT certificate for lying. Of course if your're the sort of person who will then fly anyway....then who cares?

The trouble with RLS meds is the side effect prfile- co-ordination and concentration take a hit when you are on them....

Treat with sinemet at night, which is 40 years old, cheap, approved, and works. The other two are only "top" because of big pharma marketing.

Lying, yeah, that's the ticket........not.
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Not to beat a dead horse but there are two other medications that work quite well for RLS. Unfortunately, one is verboten by the FDA and can only be used to treat malaria. Fortunately, it is available in liquid form with the sodas and without a prescription. Tonic water(Quinine water) often helps the syndromes of RLS. Also I have had a number of patients do well with Lyrica. I do not know the FAA standing on either but would discuss it with both your PMD, and AME.

As for lying, it is not real difficult for the FAA or for that matter almost anyone who is interested to fnd out what medications you have taken in the past, and make some educated conclusions about your diagnosis. I do a fair amount of workmans's compensation, and these guys find everything out about their clients, even thing the clients have forgotten about. I would liken lying on your FAA physical to VMC into IMC. You may get away with it, but the chances are you will not and if you get caught the results will be catastrophic.

Doug
 
Looks like this thread is a little dated, but I found it extremely helpful.

I am on the verge of a RLS diagnosis pending a few extra tests trying to determine a cause for these symptoms.

My doctor gave me CLONAZEPAM to get some much needed sleep after suffering from extreme sleep deprivation. It works very well, and for about 5-6 hours it allows solid continuous sleep. It has no effect or relief for the symptoms, but has provided some much needed rest.

My doctor plans to start me on test period of GABAPENTIN, this week.
What determines if one should try this, or the REQUIP treatment?

Yes I know these are all non FAA approved, and I have removed myself from all flying duties and just want to make life enjoyable again :)

Any further recommendations or advice would be appreciated.

Thanks,

Sean
 
Unregistered said:
Looks like this thread is a little dated, but I found it extremely helpful.

I am on the verge of a RLS diagnosis pending a few extra tests trying to determine a cause for these symptoms.

My doctor gave me CLONAZEPAM to get some much needed sleep after suffering from extreme sleep deprivation. It works very well, and for about 5-6 hours it allows solid continuous sleep. It has no effect or relief for the symptoms, but has provided some much needed rest.

My doctor plans to start me on test period of GABAPENTIN, this week.
What determines if one should try this, or the REQUIP treatment?

Yes I know these are all non FAA approved, and I have removed myself from all flying duties and just want to make life enjoyable again :)

Any further recommendations or advice would be appreciated.

Thanks,

Sean
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You need the advice of an experienced AME. Unfortunately Dr. Bruce does not live here any more. You might be able to reach him through the AOPA forum or by email. His address is around here somewhere.
 
Sean, as a person that has suffered with rls for most of my adult life i thought i would share my experiences.
6 months ago i decided that i would like to learn to fly and decided to work on passing the medical first. I had been taking sinemet for years and this medication was approved by the faa.
When i first started looking into this issue about rls and the faa on the internet this thread was just about the only useful info i could find.
I contacted Dr. Bruce about this matter and his guidance help me with my medical.

Sinimet is the only medication allowed by the faa and it will require a SI on you medical.
This medication is pretty weak in my opinion but it produces results.
In the time that i have been taking sinemet i have developed a few rules.
1) don't take it to stop an attack,it has no effect.
2) I don't take it on a full stomach. It works better if you get it into your system fast.
3) I take it 1 hour before i want to go to sleep. I wait for about 20 minutes after i take the medication then i move around the house for about 20 minutes.
I don't know why but if you take the med and just sit around the med seams to have little effect. Moving around seems to work the med into your body where it is needed.
 
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