What Helps Parkinson’s Patients Sleep

Sleep Benefit And Positive Effect Of Sleep Deprivation In Patients With Pd

The complex interaction of sleep and motor function is reflected in two interesting phenomena: sleep benefit, i.e. the experience of an improvement of motor function upon awakening , and a positive effect of sleep deprivation on motor function .

Sleep benefit was first described based on patients’ reports, and systematically evaluated in large cohorts of patients with PD with contrasting results. Some groups reported this phenomenon to be common in a subgroup of PD patients with specific clinical characteristics, e.g. with longer disease duration and younger age at onset of disease . This phenomenon has been reported to be so relevant to allow PD patients with sleep benefit to skip or delay medication . A study systematic evaluating motor state a night before sleep and in the morning upon awakening reported a slight motor improvement in the morning in patients with sleep benefit, without polysomnographic differences between the two groups . Another study using PSG reported shorter total sleep times and longer sleep latencies in PD patients reporting sleep benefit .

However, other groups found no actual improvement in motor functioning in PD patients reporting sleep benefit , or only in a small percentage of them , or reported in those patients with PD experiencing sleep benefit no association with the previously reported clinical variables , maybe because of methodological issues.

Professor Wants To Assist Others In Navigating The Cannabis Research Path Guest Contributor

Parkinson’s disease is a neurodegenerative disease that affects 15,000 Coloradans. From feeling fatigued, depressed and anxious, to experiencing uncontrollable muscle spasms and tremors, symptoms can interrupt every aspect of daily life. Maureen Leehey, MD, has worked with Parkinson’s patients for over 30 years and is looking to the booming world of cannabis for a potential treatment.

What Types Of Sleep Problems Do People With Parkinsons Disease Have

Parkinson’s disease affects every person differently. It also impacts sleep in different ways. People with Parkinson’s may have:

• Insomnia, finding it hard to fall asleep.
• Fragmented sleep, waking up many times over the night.
• Excessive daytime sleepiness, finding it hard to stay awake during the day.
• Very vivid dreams, which may cause hallucinations or confusion after waking up.
• Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.

How Medical Cannabis Can Help Parkinsons Patients With Sleep Issues

Every Parkinson’s patient has a unique experience since the disease causes so many different symptoms with varying degrees of severity. So, besides the standard Parkinson’s medicines, doctors must medicate based on the patient’s symptoms.

However, managing so many medications can be incredibly difficult, especially if you take medications that cause dangerous side effects, like dyskinesia. Some medicine, like pain relievers, can damage certain organs or have the potential for addiction.

That’s where medical marijuana comes in. While it still has its own set of negative side effects, cannabis can serve multiple purposes when used correctly by a patient who reacts well to it.

Most importantly, MMJ can treat insomnia and other sleep disorders. Before marijuana was made federally illegal, doctors used cannabis to help insomnia patients get a good night’s rest. Today, many MMJ-legal states consider sleep disorders as a qualifying condition for medical marijuana.

Also, marijuana can relieve the underlying causes of a patient’s sleep problems. MMJ serves as a safer alternative to painkillers. It also has the potential to help with spasticity, or painful muscle tension.

Insomnia And Daytime Sleepiness In Patients With Parkinsons Disease

As outlined above, patients with PD frequently experience insomnia, most often as a disorder of sleep maintenance, but also as a disorder of sleep onset or early morning awakening. The diagnosis of insomnia is always based on subjective symptoms. Patients report difficulties falling asleep or maintaining sleep, early awakening or non-restorative sleep, associated with subjective concern or daytime impairment . Notably, there is sometimes a discrepancy between subjective complaints of insomnia and only subtle disturbances of sleep structure in otherwise healthy people, whereas in patients with PD, in addition to the subjective complaints of insomnia, there is often a significant manifest disruption of the integrity of sleep macro and microstructure.

Joy and co-workers evaluated newly diagnosed levodopa-naïve patients with PD and reported frequent and variable alteration of sleep macro-architecture in these patients . However, Ferreira and co-workers reported poor sleep quality and sleep architecture changes in PD patients, which improved with levodopa following improvement of motor symptoms , but dopamine did not reverse sleep architecture changes .

How Are Sleep Problems Diagnosed In People With Parkinsons Disease

If you’re having problems sleeping, sit down with your healthcare provider to discuss the issue in detail. Your provider will ask you questions to better understand your symptoms.

Be prepared to explain when sleep disruptions happen and how they affect your life. Keeping a sleep journal for a few weeks can help you remember the details.

If your provider suspects you may have a sleep disorder, they may recommend you have a sleep study. This overnight test uses electrodes attached to your skin to track how your body functions when you’re sleeping.

The Pathophysiology Of Parkinsons Disease Related Sleep Disorders

Melatonin is the main hormone associated with sleep. Secreted by the pineal gland from cues of the suprachiasmatic nucleus of the brain, melatonin attaches to receptors on cells and either activates or deactivates time-dependent genes. While the suprachiasmatic nucleus is not affected by Parkinson’s disease, melatonin receptors appear to decrease substantially in areas of the brain associated with Parkinson’s disease. This keeps melatonin from stimulating sleep in people who suffer from PD and leaves the circadian rhythm without one of its main sources of regulation.

Parkinsons & Restless Leg Syndrome: Using Dopaminergic Medication

Because RLS is well-treated by medications that also treat PD, it is likely that some aspect of brain dopamine function is altered in RLS. However, unlike in PD, in which the deficit in substantia nigra dopamine-producing cells can be proven in many ways, no such abnormality has been shown in RLS. For example, studies show that DaTscan results are not abnormal in RLS.

Using dopaminergic medications to treat RLS however can be tricky. In some people they can lead to a phenomenon known as augmentation, in which long term use of dopaminergic medications can worsen the symptoms – making them appear earlier in the day or migrating to the upper body in addition to the legs.

How Are Sleep Problems Treated In People With Parkinsons Disease

Your provider will recommend treatments that address what’s causing your sleeping challenges. Your provider may:

• Change your medication: If a medication could be causing your sleep issues, your provider may decide to adjust your treatment plan. Reducing the dose or switching medicines may solve the problem.
• Prescribe a new medication or therapy: If you have a sleep disorder, your provider will discuss your options. In some cases, your provider may recommend a new medication. If you have sleep apnea, wearing a special oral appliance can help. The device enables you to get a steady flow of oxygen, so your body doesn’t gasp for air.
• Suggest lifestyle changes: Your daily habits and sleeping environment can help or hurt your sleep efforts. Setting regular sleep and wake times, keeping the room dark and avoiding electronic screens at bedtime may improve how well you sleep. If you have REM sleep disorder, your provider will discuss options for how best to protect you while you sleep.

Treatment Of Sleep Disorders In Patients With Parkinsons Disease

From the manifold clinical manifestations and underlying pathomechanisms of sleep disorders in patients with PD outlined above, it is obvious that treatment needs to be tailored individually according to the predominant clinical symptomatology and underlying specific sleep-related diagnosis. However, a major problem is the sparsity of randomized, controlled trials for sleep disorders in PD.

For treatment of insomnia in patients with PD, hypnotics are sometimes indicated, but the caveats of potential worsening of daytime sleepiness or sleep-related breathing disorders should be kept in mind. Clinically, quetiapine is sometimes used, and in cases of very severe insomnia clozapine—with the usual treatment caveats—have been used. Melatonin treatment is not specifically indicated for insomnia in PD, but is often used for RBD . Rotigotine has been reported to improve sleep quality and continuity in PD patients by promoting sleep stability and increasing REM . However, in general, there is insufficient evidence on drugs to treat insomnia in PD patients, although eszoplicone and melatonin are considered “possibly useful”. Some authors maintain that cognitive behavioral treatment for insomnia, as in patients without PD, may be useful . To treat daytime sleepiness in PD, caffeine , and modafinil can be used.

Deep Brain Stimulation In The Treatment Of Sleep Disorders In Pd

Studies investigating the effect of DBS in the treatment of sleep disorders in PD patients showed that DBS improved the sleep scales and quality . Baumann-Vogel et al. found that subthalamic nucleus DBS-enhanced subjective sleep quality, reduced sleepiness measured by the Epworth sleepiness scale, and reduced sleep fragmentation shown by actigraphy recordings. However, the authors observed that subthalamic DBS was not improved REM sleep features . Similarly, Cicolin et al. reported that RBD symptoms did not benefit from STN DBS. On the other hand, Chahine et al. reported that STN DBS improved significantly symptoms of RLS in PD patients. The effect of PPN DBS on sleep disorders in PD has been investigated in several studies . One study showed that PPN DBS improved sleep quality and reduced EDS; however, it caused a reduction in REM latency and a relevant increase in REM sleep . In another study, it has been reported that PPN DBS improved the total duration and rate of REM sleep . As a result, DBS seems to be beneficial in the treatment of sleep disorders in PD because it seems to be useful in improving sleep quality. However, large-scale prospective studies are needed to understand the benefits of DBS in the treatment of sleep disorders in PD.

Hallucinations And Rem Sleep Disorders In Parkinson’s Disease

At timestamp 1:58 in this recording of Thrive: HAPS 2020 Caregiver Conference, you will find a one hour talk by neurologist Joohi Jimenez-Shahed, MD.  In it she delves into what REM sleep behavior disorder is and is not, and the distinctions between hallucinations, delusions, and delirium.  Managment options for RBD and hallucinations are included.

Parkinsons Disease Natural Treatment & Remedies In 5 Steps

April 17, 2018

• Precautions

Parkinson’s disease is a degenerative illness of the nervous system that results in loss of intentional movement and impaired motor functioning. Parkinson’s disease symptoms affects smooth, natural movements of the body, and can make it hard to perform everyday tasks like speaking properly, walking, swallowing and sleeping.

With Parkinson’s, the area of the brain that controls muscular movements receives less dopamine than usual. Dopamine is an important chemical necessary for not only coordinating proper body movements, but also things like learning, increasing motivation and regulating moods.  This is one reason why depression and other mood changes often affect those with Parkinson’s.

What causes Parkinson’s, and is it curable? There is no specific known cause, but some aggravating factors include exposure to certain chemicals and toxic water, plus inflammation of the brain. While there is no cure for Parkinson’s , there are medications available to boost dopamine in the brain and help manage symptoms.

A 2016 study by researchers at the University of Saskatchewan also found a possible way to stop the progression of Parkinson’s. Researchers created caffeine-based chemical compounds — which also contained nicotine, metformin and aminoindan — that prevented the misfolding of alpha-synuclein, a protein necessary for dopamine regulation.

What Else Can I Do To Sleep Better With Parkinsons Disease

Practicing healthy “sleep hygiene” habits may also promote more restful sleep.

Do:

• Get outside during the day. Bright light tells your body it’s time to be awake.
• Keep your body moving during the day. Even if all you feel up to is a short walk or two, all physical activity offers benefits.
• Try at-home remedies, such as massage or a warm bath. Relaxing your mind may help your body fall asleep.

Don’t:

• Take long naps during the day.
• Use stimulants, such as caffeine, within six hours of bedtime.
• Use your bedroom for activities other than sleeping. Go to another room to read, watch TV or work.

Parkinsons Disease And Sleep Disorders: Can Melatonin Help

May. 29, 2015

People who live with Parkinson’s disease quickly find that even routine tasks become difficult as the disease progresses. It is common for Parkinson’s disease and sleep disorders to go hand in hand. New research in chronobiology suggests that melatonin, particularly timed-release melatonin, may not only help people with Parkinson’s disease to get the sleep they need but also slow the course of this devastating disease.

Periodic Limb Movement Disorder And Restless Legs Syndrome

Do you often feel the irresistible urge to move your legs around during the night in order to get comfortable? If so, you might have restless legs syndrome . This condition can be associated with PLMD . PLMD causes slow rhythmic movements of the legs and feet, whereas restless legs syndrome causes more twitchy unpleasant sensations in the legs. Naturally, if you are frequently moving your legs, you are likely to wake up throughout the night, limiting your ability to get a good night’s sleep. Periodic limb movements are quite common in older adults as well as those with Parkinson’s. Restless legs syndrome frequently affects middle-aged and older adults in addition to people with PD.

Sleep Disorders In Parkinson’s Disease By Amer G Aboukasm

Although the daytime clinical manifestation of Parkinson’s disease have been well recognized for almost two centuries, the nocturnal symptoms, which occur in as many as 75% of patients and the associated sleep disorders were not studied until the 1960s. A variety of psychological and physiological processes can lead to disruption of the normal rhythm of the sleep-wake cycle in patients with Parkinsonism. First, the degenerative process in Parkinson’s disease affects the neurophysiological and neurochemical systems responsible for sleep organization, thus results in disruption of sleep. Second, the motor, respiratory and behavioral phenomena accompanying the disease may produce nocturnal symptoms. Third, the medication used in its treatment may induce new symptoms, such as nightmares or nocturnal movements. All these effects on sleep have implications for treatment planning.

Eat Plenty Of Protein But Not With Levodopa Medications

If you’re taking a levodopa medication, your doctor may tell you to avoid protein when taking your meds. Both animal and plant protein can interfere with the absorption of levodopa medications.

But you should still eat plenty of protein. Just be strategic with the timing. “Don’t take levodopa medications with meals,” Dr. Gostkowski says. “It’s best to take it on an empty stomach — either 30 minutes before your meal or an hour after eating.”

If you get nauseous from the medication, eat a small amount of starchy food with it, such as crackers. Make sure whatever you eat with your medicine doesn’t have protein. “It’s a misunderstanding that people with Parkinson’s should avoid protein,” Dr. Gostkowski says. “You definitely need protein in your diet. Just don’t eat it when you’re taking your levodopa medication.”

Can Melatonin Treat Other Symptoms Of Parkinsons Disease

People with Parkinson’s disease who take melatonin tend to have fewer symptoms of less severity than those who do not take it. For a long time, this was attributed to the restorative nature of adequate sleep. However, we now know that melatonin is not only a sleep-inducing hormone but a neuroprotective one as well. Although it is still being researched, melatonin’s neuroprotective qualities are believed to actually slow the progression of PD, delaying the neurological damage that causes the progressive loss of neuromuscular function.

The circadian rhythm, or the body’s roughly 24-hour cycle, is also an important factor to consider in the timing of administration of other medications taken by people with PD. COMT inhibitors, for example, are a common drug class used to treat Parkinson’s disease. These absorb in far higher levels when taken in the morning, thus offering more therapeutic effect. Because the treatment of PD is complicated, it is important to take drugs at times when they will be most effective.

Studies in the field of chronobiology are offering new treatments for some of mankind’s most difficult diseases. People with Parkinson’s disease may soon get the sleep they need to function as well as more effective treatments due to a better understanding of this disease’s effects on the circadian rhythm.

Tips For Getting Rest And Sleep With Parkinsons Disease

The physical symptoms of Parkinson’s disease can often prevent those who live with the condition from getting a good night’s sleep and adequate rest. The restorative effects of sleep can improve health and help those with Parkinson’s disease better manage the disease on a daily basis, so ensuring they get enough quality sleep is essential.

MORE: Using exercise to help combat Parkinson’s disease symptoms

The National Parkinsons Foundation has published some tips on how to get a good night’s sleep including:

• Have a bedtime routine. Establishing a bedtime routine is one of the keys to a successful night’s sleep. Try to do the same relaxing things each night prior to going to bed, whether this is having a warm bath, reading a book, or watching a TV show is up to you. Try to go to bed and wake up at the same time each day to establish a regular sleep schedule.
• Avoid things that may disturb sleep. Stimulants such as caffeine, alcohol, and nicotine are best avoided for an hour or so before bedtime. Likewise, limit the number of liquids you drink so that you’re not waking up in the middle of the night to visit the bathroom.
• Exercise. Exercising during the day will help you sleep better at night. However, it’s best to avoid exercising just prior to retiring for the night.

Classification Of Sleep Disorders In Parkinsons Disease

Sleep disorders in PD may occur during the day or at night. In PD, sleep disorders can be classified into three major categories such as abnormal behaviors and events during or around sleep , inability to sleep , and EDS . These three categories of sleep disorders can be seen separately or together .

Sleep And Circadian Disruption As A Risk Factor For Pd

The discovery of the glymphatic system has added to the hypothesis that sleep and circadian disruption may cause, or accelerate, age-related brain diseases. Other mediators of the relationship between sleep and brain health may include oxidative stress, inflammation, blood brain–barrier integrity and biological ageing. Prospective studies have demonstrated a link between sleep disruption and incident cognitive impairment , but there is now emerging evidence related to PD.

A recent study by Sohail et al. suggested that sleep disturbances other than RBD may predate the onset of PD motor symptoms. 269 older adults without PD were assessed for sleep fragmentation during their life and followed up until death. The median time between actigraphy data and death was 1.4 years. The study found that individuals with sleep fragmentation had a higher presence of Lewy body pathology and substantia nigra cell loss on post-mortem examination .

In a recent study by Noyce et al., mendelian randomisation was used to highlight a potential causal association between being a “morning person” and subsequent increased risk of developing PD , although the precise mechanisms behind this are not clear.

The Relationship Between Parkinsons Disease And Sleep

It’s unclear whether poor sleep causes parkinsonian symptoms to worsen or whether worsening parkinsonian symptoms cause poor sleep. In many cases it’s likely a case of bidirectionality, with each one exacerbating the other.

Fragmented sleep and sleep deprivation appear to leave the brain more vulnerable to oxidative stress, which has been tied to the development of Parkinson’s disease. Parkinson’s disease is not usually diagnosed until individuals have developed sufficient motor symptoms, by which time a significant portion of brain cells have already been damaged. If poor sleep quality or having sleep disorders foreshadows the development of parkinsonian symptoms, these could be useful in early diagnosis of the disease.

More research is needed to clarify the multifaceted relationship between Parkinson’s disease and sleep. A better understanding of this connection may offer medical experts the unique opportunity to screen at-risk individuals and perhaps delay the onset of the disease.

Meds That Improve Some Symptoms Can Exacerbate Others

SAN ANTONIO — Roughly three out of four people living with Parkinson’s disease also have sleep disorders, and there is growing recognition that sleep problems are greatly complicated by the disease, its symptoms, and the many medications used to treat it.

“Sleep disorders are among the most common non-motor symptoms in PD, and sleep is something clinicians have to continually monitor when considering medication dosing,” Scott Kutscher, MD, of Stanford School of Medicine in California, told MedPage Today.

“Sleep issues can appear years before the classic motor symptoms of Parkinson’s, but it has only been relatively recently that sleep has become part of the diagnostic workup of the disorder,” he added.

Insomnia, excessive daytime sleepiness, sleep fragmentation, circadian rhythm disorders, restless leg syndrome, and rapid eye movement behavior disorder are all common in patients with Parkinson’s disease.

Although there is some debate about whether having PD increases the risk for obstructive sleep apnea , a recent review of the literature found an increased frequency of OSA and other sleep-disordered breathing conditions associated with the neurodegenerative disorder.

One mechanism suggested for this association is that upper airway musculature may be affected by involuntary movements characteristic of the disease, resulting in abnormal spirometry and upper airway obstruction.

Pathophysiology Of Excessive Daytime Sleepiness In Pd

It has been reported that there are three main causes of sleepiness in PD; deterioration of night sleep quality, neurodegeneration of sleep–wake-related brain regions, as a result of disease pathology, and the side effects of antiparkinsonian medications . However, many of the abovementioned causes may be related to EDS. For this reason, it is necessary to consider these causes in the diagnosis and treatment of EDS.

Assessment Of Sleep Disturbances In Patients With Pd

In general, a comprehensive sleep history is often a very useful first step to narrow down the type of sleep disorders in patients with PD. It should start with the time when the patient goes to bed and gets up and also include planned daytime naps. It should involve the perceived sleep latency, perceived awakenings . The Epworth sleepiness scale or other scales can be used .

Specifically, the evaluation of insomnia should rule out sleep hygiene or circadian disorders. Patients should be questioned specifically about the presence of impulse control disorders and nighttime activities, particularly in case of suspected circadian rhythm disturbances. If a circadian disorder, such as delayed or advanced sleep phase syndrome or non-24-h sleep–wake disorder is suspected, assessments with actigraphy or dim light melatonin onset may prove useful .

For patients with prominent daytime sleepiness, polysomnography should be used in every case , but a multiple sleep latency test is also warranted .

Respiration questioning should at least include snoring and witness apneas, positional dependence, breathing pauses, intensity of snoring, nocturnal hypertranspiration or nocturia. In specific cases stridor should also be assessed. If underlying sleep disordered breathing is suspected, cardiorespiratory polygraphy or polysomnography should be performed .

Support For Other Researchers Interested In Cannabis

Leehey wants other researchers at CU Anschutz who are interested in cannabis to have support in their endeavors.

“CDPHE gave out a few grants for cannabis research,” she said. “We came together and navigated this research path.”

The awardees have since created a group called the Colorado Cannabis Research Consortium, the C2RC.

“Anyone who is really into cannabis research can be a part of this group,” said Leehey. “A lot of researchers get started and then run into problems. We have been there. We want to use this experience to mentor others and really get this research going.”

If you are interested in participating in Leehey’s study, please contact Ying Liu at 303-724-8288 or ying.3.liu@CUAnschutz.edu.

If you are interested in joining the Colorado Cannabis Research Consortium , please contact Kirk Hohsfield at kirk.hohsfield@CUAnschutz.edu.

Guest contributor: Blair Ilsley

Whats The Relationship Between Parkinsons And Sleep

Parkinson’s disease and sleep are connected in complex ways that not even scientists completely understand quite yet.

Sometimes, Parkinson’s disease directly causes sleep problems. According to one study, sleep-related symptoms may be one of the earliest signs of Parkinson’s disease. These signs may include things like thrashing while you’re asleep.

Other factors can also play a role. One thing is clear: For many people with Parkinson’s disease, a restful night’s sleep can be hard to find.

Parkinsons Sleep Problems: Diagnosis And Treatment

Parkinson’s disease is chronic and progressive, meaning it tends to get worse over time. However, there are treatment options that can help manage symptoms and allow patients to get more restful sleep.

The simplest way to start sleeping better with Parkinson’s disease is by adopting healthy sleep habits. Sleep hygiene tips for Parkinson’s disease sufferers include:

• Sticking to regular bedtimes
• Following a consistent bedtime routine with soothing activities such as listening to music or reading a calming book
• Getting regular exercise, preferably early in the day
• Getting adequate exposure to light, whether outdoors or through light therapy
• Avoiding long naps and naps late in the day
• Creating a cool, dark, and comfortable sleeping environment
• Restricting bedtime activities to sex and sleep only
• Turning off screens an hour before bedtime
• Reducing liquid intake before bedtime
• Avoiding caffeine, alcohol, and tobacco
• Eating a healthy diet and avoiding large meals at night

Light therapy, exercise, and deep brain stimulation have been successfully used to improve overall sleep quality and to treat specific conditions, such as REM sleep behavior disorder, in patients with Parkinson’s disease. Cognitive behavioral therapy for insomnia has proven effective at reducing insomnia in healthy adults, although further research is needed on the effects of CBT in patients with Parkinson’s disease.

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Does Having Rls Increase The Risk Of Developing Pd

Since RLS affects as much as 4-10% of the US adult population, it is clear that the vast majority of those with RLS do not ever develop PD.

Despite this, it still might be the case that RLS increases the risk of subsequently developing PD. There have been many studies trying to figure this out – with conflicting results. Some studies show that there is no increased risk and others show that having RLS confers about a two-fold increased risk of developing PD over the general population.

Why Do Parkinsons Patients Have Trouble Sleeping

Despite having daytime tremors, Parkinson’s patients do not shake in their sleep. However, both Parkinson’s disease itself and the medications used to treat it can give rise to a number of sleep problems that lead to insomnia and excessive daytime sleepiness.

Patients with motor symptoms may have trouble adjusting sleeping positions to get comfortable.  Others may experience distressing nocturnal hallucinations when trying to fall asleep. These may be a result of medications or cognitive impairment.

In turn, excessive daytime sleepiness may occur as a consequence of sleeping poorly at night. It may also be triggered by medications. Parkinson’s patients who suffer from EDS may be at a higher risk of accidents and unable to safely carry out activities such as operating a motor vehicle.

Since insomnia frequently goes hand-in-hand with anxiety and depression, it may be a contributing factor to sleep problems in people with Parkinson’s disease. For that reason, doctors often look for mental health disorders in people with Parkinson’s disease who have sleep problems.

Evaluation Of Sleep Hygiene Program: Sleep Diary

Monitoring the effectiveness of behavior changes is best done by keeping a diary.  The table below depicts a sample diary that could be kept by the bedside and filled out upon arising by the patient or caregiver.  If daytime sleepiness and napping are problems, items can be added to record the number, time, and duration of napping episode. The diary can be carried with the patient.

How Does Parkinsons Disease Cause Sleep Problems

Researchers have yet to uncover every nuance of the Parkinson’s and sleep connection. So far, medical experts believe several causes may contribute:

• Chemical changes in the brain: Ongoing research shows that Parkinson’s disease may disrupt sleep-wake cycles. Changes to certain brain chemicals may cause people with Parkinson’s to get less sleep.
• Medication: Some drugs that treat Parkinson’s disease may make it harder to fall or stay asleep. A medication may also disrupt your sleep patterns by making you drowsy during the day .
• Mental health challenges: People with Parkinson’s commonly deal with mood disorders, such as anxiety or depression. Any mood disorder may keep you up at night or make you sleep less soundly.
• Parkinson’s symptoms: Pain, waking up at night to pee or other Parkinson’s symptoms can make restful sleep harder to come by. Sleep apnea can also disrupt sleep.

Deep Brain Stimulation Of The Subthalmic Nucleus

Long-term STN-DBS may improve sleep quality through decreased nocturnal mobility and reduction of sleep fragmentation . Therefore, STN-DBS seems to be an effective therapeutic option for the treatment of advanced PD because it improves the cardinal symptoms and also seems to improve sleep architecture.