That realpatch_cache tip is a new one to me. I had never heard of it before. Is there any way to see how full the cache is at the moment? (Or what it contains?)
There's no way to currently inspect the cache, without tapping into the internal PHP API as far as I know. I wonder how difficult it would be to create a PECL package to extend it or if it's necessary at all to care about what's inside of the cache. RAM is cheap, so boosting it up should be all you need to care about.