Why Is It So Hard To Sleep Now That I Have Parkinsons
Parkinsons can impact sleep in a number of ways, ranging from trouble falling or staying asleep at night to excessive sleepiness during the day. A good sleep boosts everything from your mood to your ability to think and process to your physical movement. Understanding sleep problems and Parkinsons is often the first step you can take to enhance your sleep.
In this post, we help you learn more about sleep problems in Parkinsons and how you can improve your quality of sleep.
Parkinsons can affect sleep in many different ways, including trouble falling or staying asleep, vivid dreams, waking up frequently during the night and excessive sleepiness during the day. Like other non-motor symptoms, sleep problems can appear before the more recognized motor symptoms, like tremor or stiffness.
People with Parkinsons typically experience some combination of;insomnia; and;sleep fragmentation;. Studies have shown people with Parkinsons have different sleep patterns and that their deepest periods of sleep during the night are shorter and interrupted more often than people without Parkinsons. Often this is made worse by medications that may wear off during the night, causing painful stiffness, difficulty moving in bed or other symptoms to return and disrupt sleep.
Icipating In The Study
To be eligible for this study people must be:
- Aged over 30 years
- Diagnosed with Parkinsons Disease by a neurologist
- Experiencing sleep difficulties, particularly getting to sleep.
If you are already on melatonin, you can still join the study.
Please note that all patients will require a referral from their doctor to participate,;this can be organised through us if required.;
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 Parkinsons disease, melatonin receptors appear to decrease substantially in areas of the brain associated with Parkinsons 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.
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Other Potential Benefits Of Melatonin In Parkinsons Patients
The beneficial effects of melatonin are not limited to sleep only. Researchers think its intake may also improve other complications associated with Parkinsons, including both motor and non-motor.
But research in this regard is still in the preliminary stage, and therefore large numbers of control clinical trials are needed to fully establish its therapeutic effects on other symptoms besides sleep.
Are There Treatment Options
Vivid dreams are generally normal and not concerning.2 However, some people find vivid dreams disturbing or find that they make it difficult to sleep. Many report that sleep troubles affect their day-to-day life. Sleep disturbance is also linked to depression and poor quality of life. Improving sleep could go a long way towards improving these issues.3
Melatonin is a molecule that your brain naturally makes. It helps regulate your sleep-wake cycle. It can be found as an over-the-counter drug in most pharmacies and stores. Some people have found that taking melatonin nightly reduces their dreams and helps them sleep.2
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Are There Any Common Themes In Dreams Linked To The Condition
Dreams among people with Parkinsons tend to involve more aggressive subject matter overall, theyre described as vivid, action-filled and nightmarish. Dreams can involve being chased or defending oneself from animal attacks including dogs, snakes, lions and bulls. These can be accompanied by typical nocturnal behaviours that include talking, yelling, gesturing, punching and kicking.
Rem Sleep Behavioral Disorder
Rapid eye movement, or;REM, sleep is a normal part of the sleep cycle when people dream. Usually the only part of the body that moves during REM is the eyes, thus the name.
- People with;rapid;eye movement sleep behavior disorder; do not have the normal relaxation of the muscles during their dreams. Therefore, they act out their dreams during;REM;sleep.
- People with RBD may;shout, kick their bed partner or;grind their teeth. Sometimes, in moderate to severe RBD, people;may have aggressive, violent behaviors, like getting out of bed and attacking their bed partner.
- About half of people with PD suffer from RBD. It;may develop after or along with the disease,;but in most cases, it precedes the PD diagnosis by five to 10 years.
RBD Treatment
- Consider making environmental adjustments to protect the person with RBD and bed partner from injury. This may include padding the floor, using bed rails or sleeping in separate rooms.
- Clonazepam has been shown in large case series to improve RBD in 80 to 90 percent of cases. The dose of clonazepam required is low, usually from 0.5 mg to 1.0 mg. The adverse effects of clonazepam include nocturnal confusion, daytime sedation, and exacerbation of obstructive sleep apnea, if present. It is in generic form and not expensive.
- Talk to your doctor about the over-the-counter sleep aid Melatonin. Doses up to 12 mg at night one hour before can improve RBD. ;
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Side Effects Of Melatonin In Parkinsons Patients
Clinical trials conducted on Parkinsons patients showed that melatonin intake is safe and well tolerable even at a dose of 50 mg .
Only one study reported some side effects such as morning headaches, morning steepness, and delusion or hallucinations. But these problems disappeared with decreased dosage .
What Is The Link Between Parkinsons And Dreams
Sleep disturbances are very common in people with Parkinsons and can comprise the entire spectrum of sleep disorders. Studies suggest that rapid eye movement sleep behaviour disorder, or RBD, can be one of the first symptoms of Parkinsons disease occurring years before motor symptoms and clinical diagnosis.
RBD is a sleep disorder characterised by the acting out of dreams that are vivid, often intense and frightening. People with this disorder do not experience the normal temporary paralysis of limbs during REM sleep, and have been known to yell, carry out conversations or hit themselves or their bed partner while asleep. These are known as dream enactment behaviours.
Vivid dreams are typically present in people with Parkinsons and RBD. The content of dreams, namely dreams with negative emotions, seems to predict long-term cognitive decline in people with Parkinsons.
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What About Its Beneficial Effects In Patients
There have been conducted some clinical trials where the beneficial effects of melatonin were tested in Parkinsons patients. Most of the results obtained as yet indicate that it is useful in improving the sleep quality in patients.
A study involving 40 patients with Parkinsons showed that 5 mg of melatonin improved the overall sleep disturbance when used for 2 weeks. In the same study, melatonin concentration of up to 50 mg was shown to be well tolerated.
In another study, the efficacy of melatonin was compared with a widely used sleeping drug clonazepam in 38 patients with Parkinsons. The patients were given either 3 mg melatonin or 2 mg clonazepam at night for 6 weeks. Both drugs were able to reduce sleep disorders in their respective group. However, the clonazepam using patients showed daytime sleepiness, which was absent in the melatonin-treated group. In this study, the melatonin treatment also improved neuropsychological performance, which was assessed by the Mini-Mental state examination.
It is still uncertain whether it can treat other symptoms of the disease. The research in this regard is still in the preliminary stage and its too early to suggest its beneficial effects beyond sleep.
Melatonin A Multitasking Molecule
Melatonin is a well-known hormone of our body that was discovered in 1917. It is mainly produced in the brain, specifically in the pineal gland region .
It can also be found in other regions of the body including skin, eye, gastrointestinal tract, blood, and bone marrow.
Soon after its synthesis, melatonin absorbs into the bloodstream and enters into the cerebrospinal fluid to reach the brain and perform its sleep-promoting function .
Besides sleep, this remarkable molecule also has many other physiological functions in the body such as regulation of immune mechanisms, seasonal control of reproductive processes, control of the gastrointestinal system, regulation of circadian, and inter-organ communication, e.g. between gut and liver .
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Why Do The Study
Melatonin is used to help sleep, but this scientific study will determine whether there is a true effect in individual people with Parkinsons Disease. By recording individual symptoms in a sleep diary and using a special watch to record sleep patterns, we will be able to identify individual responders and non-responders to melatonin. This will have positive impacts on health and quality of life for both people with Parkinsons Disease and their family members .
Anxiety Depression And Other Psychological Issues
Anxiety, depression, apathy and other psychological symptoms of Parkinsons can significantly impact your quality of sleep. Have a conversation with your doctor if you are experiencing these or other psychological effects of Parkinsons. Improving these symptoms will not only enhance your overall quality of life, but it may also help you sleep better too. In addition, some medications for these types of issues can cause drowsiness which may improve sleep quality, particularly if taken at night.
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What Treatment Options Exist For Those Experiencing Sleep Disturbance And Bad Dreams
Bad dreams are a perfectly normal occurrence and can be triggered by many factors, including stress, anxiety, sleep deprivation and medication. However, when bad and vivid dreams are accompanied by dream-enacting behaviour, people with Parkinsons can take some simple steps to minimise injury.
A safe sleeping environment is essential, so modifying sleeping arrangements should be the first step to treat REM behaviour disorders. Placing a mattress on the floor, padding corners of furniture, protecting windows and removing potentially dangerous objects from the bedroom are all simple and practical steps. Its also best to avoid alcohol intake, as this can trigger or aggravate RBD.
Two medications commonly prescribed to treat RBD are clonazepam and melatonin. Clonazepam should be used with caution in patients with dementia and gait disorders. Melatonin may have the advantage of fewer side effects and a longer-acting version, but in certain cases, only higher doses of melatonin will work.
Medical Specialists Can Help Prioritize Sleep
If you have PD, you likely have a complicated relationship with melatonin and should probably avoid taking this over-the-counter therapy if you cant sleep at night.
Instead, if you struggle to get good quality sleep or encounter periods of intense sleepiness during the day, its a good idea to talk about these problems with your specialist. They can help you find better sleep through medications or non-drug alternatives. Suggestions for improved sleep hygiene also support easy, low-cost ways to prioritize sleep.
Finally, they might refer you to the services of a CBT-i practitioner.4 This medical professional specializes in cognitive behavioral therapy for insomnia. CBT-i can help people with PD learn ways to reset their circadian systems to make way for more and better sleep.5
The therapy is widely available in telehealth applications which allow you to safely participate from the comfort of your own home.
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Parkinson’s Disease And Sleep
Approximately two thirds of people with Parkinsons Disease experience one or more sleep-related symptoms, with insomnia being the most common. The neurodegenerative process in the brain, disturbances of the sleep-wake cycle, the effect of symptoms of Parkinson’s Disease on sleep, and having another sleep disorder such as restless legs syndrome, all contribute to sleep disturbances in people with Parkinson’s Disease.
Sleep disorders often cause major discomfort in Parkinsons Disease. Not only is the persons health and quality of life affected, but so are their family members, especially if they are also carers. ;And we have little evidence to suggest that current practices work for long-term treatment of sleep-related problems in people with Parkinsons Disease. Despite the recognised impact of sleep disturbance in Parkinsons Disease, there have been few studies in this area.
Sleep Disorders In Parkinsons Disease
Sleep disorders affect PD patients frequently and impact negatively on quality of life . Insufficient sleep interferes with routine activities and can also aggravate motor symptoms in PD. Some of the most frequent disorders are RBD, insomnia, restless legs syndrome and periodic limb movement disorder, circadian rhythm sleep disorders , nocturia, sleep disordered breathing and excessive daytime sleepiness . In the following paragraphs we will review the essential aspects of each condition.
RBD is a REM parasomnia characterized by movements occurring during REM sleep, in the context of dreaming . Somatic muscle atonia occurs normally during REM sleep, which is lost in RBD. RBD prevalence in PD ranges between 39 and 46% . In some instances, RBD may precede the diagnosis of PD, but PD patients may also develop this condition after receiving the clinical diagnosis. For establishing the diagnosis of RBD, a history or visualization of dream enactment along with polysomnographic evidence of REM sleep without atonia is required . Dream enactment can be assessed by means of screening questionnaires, but they demonstrate low specificity.
PLMD refers to the presence of periodic limb movements during sleep , which lead to significant impairment of sleep and/or functioning . The diagnosis of PLMD requires >15 PLMS per hour. While PLMS are frequently seen in patients with RLS; they can also be seen in isolation in the elderly population .
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What Can I Do To Improve Sleep
People respond to different medications differently. Sedatives may not be the best choice for everyone. Whether you are or are not taking drugs to reduce your vivid dreams, improving your sleep hygiene may help.4
Sleep hygiene refers to the behaviors we have around sleeping. Setting yourself up for the best sleep that you can have may reduce the likelihood of vivid dreams. It may also reduce excessive daytime sleepiness. Here are some more tips:4
- Follow a regular sleeping schedule. Ideally, 7 to 8 hours of sleep per night is best. It is also helpful to wake up and fall asleep around the same time every night. This helps your brain to get into a schedule.
- Try to keep your bed as a place only for sleeping and intimacy. Other activities like reading or watching TV should happen in other rooms.
- Napping during the day may feel helpful if you experience excessive daytime sleepiness. However, naps longer than 30 minutes may make it difficult to get a full nights sleep.
- Our brains respond to the amount of light that we see during the day, especially daylight. Spend as much time in daylight as possible. Then, ensure your bedroom is dark when you go to sleep. This can help regulate your sleep.
If you or a loved one is experiencing vivid dreams that are upsetting or that are disrupting your quality of life, speak to your doctor about treatment options.
Basic Biology Of Melatonin Relevant To Parkinsons Disease
Chronobiotics are drugs that synchronize or increase the amplitude of circadian rhythms, melatonin being its natural prototype . The essential role of melatonin as a chronobiotic is defined by its prominent light/dark rhythm in circulation. Melatonin inhibits the wakefulness-facilitating activity of the SCN in the late afternoon, triggering sleep . As the secretion of pineal melatonin is proportional to the length of the night, it provides the neuroendocrine apparatus with fundamental information on the time of year regulate ng seasonality .
Although more than 90% of circulating melatonin derives from the pineal gland there is ample evidence that it is synthesized locally in most cells, tissues, and organs . Indeed, the idea is held that that melatonin is produced in all animal cells that have mitochondria and that a mitochondrial protective function is critical for cytoprotection .
Melatonergic receptors are responsible for the chronobiotic function of melatonin. Both receptors are members of the superfamily of membrane receptors associated with G proteins . A third member of the melatonin receptor family, GPR50, displays high sequence homology with MT1 and MT2 but rather than binding melatonin or any other known ligand, it forms homo and heteromers with MT1 and MT2 as well as with other GPCRs .
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People With Pd Struggle With Disrupted Sleep
The studys findings matter in one specific way for people with PD. Of the many roles the circadian system plays in human health, its most recognized is sleep regulation.
People with PD struggle with disrupted sleep. These disruptions can include insomnia, excessive daytime sleepiness, fragmented sleep patterns, and inadequate sleep.
Meanwhile, when people with PD do achieve a good night of sleep, they tend to report improvements in their daytime symptoms.
Alterations In Biological Rhythms In Parkinsons Disease And Its Relevance For The Neurodegenerative Process
There is abundant evidence pointing out to the existence of disturbances in biological rhythms in PD. In one study, bilateral nigrostriatal lesions with 6-hydroxydopamine in rats disrupted heart rate, temperature and activity rhythms . Lesioned animals showed significantly decreased mean daily values and a phase advance of circadian rhythms. Decreased amplitude was also observed in heart rate rhythms. Abolition of heart rhythms was also observed in another study in 6-OHDA-lesioned rats . However, alterations in biological rhythms were not observed after 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine lesions in C57bl/6 mice maintained in light: dark 12:12 ) or in non-human primates . Notwithstanding, in the latter, locomotor activity and hormonal rhythms alterations in become evident when animals were challenged by exposure to constant light . Administration to rats placed in L:D 12:12 of rotenone, a pesticide with toxic effects in dopaminergic neurons, produced a reduction in the mean value and amplitude of the circadian locomotor activity and body temperature rhythms . Lower interdaily phase stability, and higher rhythm fragmentation were also observed in rats.
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