Good Night: Sleep And Parkinsons Disease
Lack of good sleep can worsen Parkinsons symptoms. ;In this 45-minute lecture, Dr. Rafael Zuzuárregui addresses causes of sleep loss and the latest treatments for: insomnia, restless leg syndrome, REM sleep behavior disorder, nocturnal urination, hallucinations, wearing off of medication, dystonia and sleep apnea.
Prodromal State Of Rbd
Nonviolent behaviors are observed in 18%of RBD patients , including jerky, simple, and minor movements of the limbs that are common in RBD patients . It is possible that nonviolent mild motor behaviors may occur in the early phase of RBD or precede full-blown RBD. As a prodromal state of RBD, REM sleep behavioral events , involving seemingly purposeful motor behaviors and vocalizations with increased tonic and phasic electromyographic activity during REM sleep that do not fulfill the RBD criteria, have been proposed . RBE was found in half of de novo PD patients , and in early PD patients, 38%of patients with RBE developed RBD within two years .
Sleep Disorders In Parkinsons Disease
In this 17-minute lecture Dr Gary Leo discuses sleep challenges caused by the neurochemical changes, medications and mood disturbances of Parkinsons disease, and normal changes of aging. ;He discusses possible causes and treatment options of sleep maintenance insomnia, REM Sleep Behavior Disorder, daytime sleepiness, sleep apnea, and restless leg syndrome, ending with some tips for good sleep.
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What Causes Parkinson’s Disease
Parkinson’s disease occurs when nerve cells, or neurons, in an area of the brain that controls movement become impaired and/or die. Normally, these neurons produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems of Parkinson’s. Scientists still do not know what causes cells that produce dopamine to die.
People with Parkinson’s also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying-down position.
Many brain cells of people with Parkinson’s contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons disease and Lewy body dementia.
Changes In Sleeping Patterns
As Parkinsons progresses, you can also develop problems with sleep patterns. These may not happen in the early stages, but can be noticeable later. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Another common sleep disturbance for people with Parkinsons is rapid eye movement sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable if someone is sharing your bed. Dr. Rundle-Gonzalez says many times a bed partner will be the one to notice sleep problems.
REM sleep behavior disorder can also happen in people who dont have Parkinsons. However, if this isnt something youve dealt with before, its likely related to your disease. There are medications your doctor can prescribe to help you sleep comfortably through the night.
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Parkinsons Sleep Problems: Diagnosis And Treatment
Parkinsons 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 Parkinsons disease is by adopting healthy sleep habits. Sleep hygiene tips for Parkinsons 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 Parkinsons 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 Parkinsons disease.
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Study Design And Participants
We performed a multicenter, observational, outpatient-based, cross-sectional study entitled, Nocturnal symptoms and quality of life in patients with Parkinsons disease in Shanghai . From June to November of 2019, the study recruited 1006 PD patients from the clinics of 40 hospitals in Shanghai. Patients had been diagnosed with PD according to the Movement Disorder Society PD Criteria. Patients with secondary Parkinsonism, stroke, brain tumor, or an alternative cause for parkinsonism symptoms were excluded. Written informed consent was obtained from all participants, and the study was performed with the approval of the Ethics Committee of Xinhua Hospital affiliated to the Shanghai Jiao Tong University School of Medicine and the Research Ethics Committee of each site in the SHAPD study group.
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Vivid Dreams And Parkinsons
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Parkinsons disease affects neurons in the brain that release a molecule called dopamine. Dopamine helps to regulate our movements, emotions, and sleep. Damage to these neurons can affect your motor function, the way you think, and the way you sleep.1
More than 75 percent of those living with Parkinsons report having issues with their sleep. There is a lot of variation, but common issues include broken sleep and vivid dreams. This difficulty sleeping can affect daytime function too. Those living with Parkinsons often report excessive sleepiness during the day.1
Potential Ways To Reduce Excessive Daytime Sleepiness
- Assess the underlying cause
- Improve nocturnal sleep through medications, cognitive behavioral therapy, diet, light therapy and more
- Evaluate all medicines being takensome have hypersomnia as a side effectand adjust as needed
- If taking dopaminergic medications, consider dose adjustment
- Watch consumption of alcohol or sleep-inducing foods/ingredients
- Experiment with caffeine
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Conflict Of Interest Statement
GL received honoraria for participation in clinical trial as sub-investigator from UCB Pharma; PC received honoraria for speaking engagements or consulting activities from Allergan Italia, Lundbeck Italy, UCB Pharma S.p.A, Chiesi Farmaceutici, AbbVie srl, Eli Lilly and Company, Zambon; FP received honoraria for speaking engagements or consulting activities from Sanofi and Bial. The other authors declare no conflict of interest.
Why Sleep Disorders May Precede Parkinson’s And Alzheimer’s
When the bodys biological clock goes awry, insomnia and related disruptions may be an early sign of pending cognitive decline;
Some people literally act out their dreams. Their bodies fail to undergo the normal paralysis that accompanies REM sleep, the stage most associated with dreaming. Their bodies may quake violently, pantomiming the scenes unfolding in their heads. This dream state often is a sign of larger health problems to come.
More than 80 percent of people with rapid eye movement sleep behavior disorder , as the condition is known, go on to develop certain neurodegenerative maladies such as Parkinsons disease, multiple system atrophy or dementia with Lewy bodies, studies have found. Autopsies of RBD patients have revealed that clumps of proteins deep in the brain, known asalpha-synuclein aggregates, congregate in the regions that regulate rapid eye movement sleep.
In a review published in Science last month, Erik Musiek and David Holtzman of Washington University School of Medicine in Saint Louis, discussed the evidence for a link between sleep and neurodegeneration and the mechanisms by which disruption of the bodily clocks may influence diseases of later life.
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Sleep: A Mind Guide To Parkinsons Disease
This 36-page booklet explains normal sleep patterns, the body clock, how much sleep we should get, challenges to sleeping well, tips for good sleep hygiene, and sleep in normal aging before discussing symptoms, diagnosis and treatment of sleep disorders, including insomnia, REM sleep behavior disorder, sleep apnea, restless leg syndrome, and daytime sleepiness.;
Why Do Parkinsons Patients Have Trouble Sleeping
Despite having daytime tremors, Parkinsons patients do not shake in their sleep. However, both Parkinsons 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. Parkinsons 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 Parkinsons disease. For that reason, doctors often look for mental health disorders in people with Parkinsons disease who have sleep problems.
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What Are The Primary Motor Symptoms Of Parkinsons Disease
There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.
It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.
Tremors
Rigidity
Bradykinesia
Postural Instability
Walking or Gait Difficulties
Dystonia
Vocal Symptoms
What Else Can I Do To Sleep Better With Parkinsons Disease
Practicing healthy sleep hygiene habits may also promote more restful sleep.
- Get outside during the day. Bright light tells your body its 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.
Dont:
- 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.
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Potentials Ways To Reduce Fatigue
- Exercise. It may seem counterintuitive get moving if youre feeling fatigued; however, the right kind and the right amount of exercise can significantly reduce fatigue. Experiment. Sometimes just getting out the door for a walk in the fresh air can reduce fatigue.
- Talk to your doctor if you think you may be depressed. Its possible that an anti-depressant could reduce fatigue.
- Plan your time. Identify when you tend to have the most energy throughout the day and plan to get your most important jobs done then.
- Be realistic, but still do something. If youre feeling extra exhausted on a certain day, dont put pressure on yourself to accomplish everything you planned. Do somethingbecause accomplishing something will give you an energy boost but be realistic about what youre capable of doing.
- Delegate. Its not easy. You may have concerns about being a burden to others. Most people will be thrilled to help. Let them.
- Organize and declutter. Opening up spacephysically, emotionally, mentally and logisticallycan help you reduce stress and as a result reduce feelings of fatigue.
- Connect with others. We know that when you feel wiped out that the last thing you want to do is attend a support group meeting or event, but connecting with others in a positive way has the potential to not only make you feel supported and encouraged and loved, but it may very well give you the exact bump in energy that you need.
What Causes These Issues
Several studies have investigated the causes of these sleep disturbances and have found that a combination of motor symptoms, iatrogenic issues, dysfunction of the autonomic nervous system and neurodegeneration come together to disrupt normal sleep patterns. In addition, certain medications can cause vivid dreams and nightmares, which become worse in conjunction with RBD. Some of these issues can also be caused by pain, muscle cramping, nocturia or non-Parkinsons causes like exercising too late in the day, drinking caffeine and alcohol or too much light in the bedroom. These symptoms can be addressed through certain lifestyle changes or in some cases by medications. However, before trying any of these methods, its important to talk to your doctor.
Unfortunately, while sleep disturbances are common symptoms of Parkinsons and can have severe impacts on quality of life, insufficient studies exist about treatments. Though many medications are in existence, they are not applicable across the board and often can have unfortunate side effects. More research is necessary to find better solutions, and your participation in clinical trials can be instrumental in working to find these solutions.
Sleep hygiene is the set of habits and behaviors that help you sleep well on a regular basis. Below, we offer some general and Parkinsons-specific sleep hygiene tips to hopefully help improve your sleep.
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Identifying Sleep Apnea In Someone With Parkinson’s
We already know that PD is linked to the parasomnia known as REM sleep behavior disorder .
If a person with PD presents symptoms that resemble sleepwalking, they are urged to have an overnight test in a sleep lab. Not only is this important for treating RBD, but research suggests that, in severe OSA, its symptoms may mimic those in RBD .
Nocturnal polysomnography , more commonly referred to as an overnight sleep study, is the gold standard diagnostic assessment used to identify OSA.
If someone with PD is diagnosed with OSA, the go-to treatment is a form of noninvasive ventilation, usually along the line of therapies known as PAP, or positive airway pressure. Current research continues to support the long-term use of PAP therapy to treat OSA in people with PD. Kaminska et al found that PAP therapies improved the overall non-motor symptom burden of PD .
Treatment Of Excessive Daytime Sleepiness In Pd
The first step in the treatment of EDS should be the correction of underlying conditions . For example, it may be useful to treat the conditions that disturb sleep quality at night or to arrange medications that cause daytime sleep episodes. After that, pharmacological treatment options for EDS should be considered. Nonpharmacological treatment approaches can be performed in the treatment of mild to moderate EDS cases . Modafinil is widely used for the symptomatic treatment of EDS, which appears to stimulate catecholamine production . Common side effects of modafinil are insomnia, headache, dry mouth, dizziness, nausea, nervousness, and depression . A review has reported that sodium oxybate and methylphenidate have inadequate evidence that they are effective in the treatment of EDS in PD . Amantadine and selegiline are reported to have an alerting effect . Thus, amantadine and selegiline may be preferentially used in PD patients with EDS.
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How Does Parkinson Affect The Nervous System
What Is Parkinsons?Parkinsons Effect On The Nervous System And Dopamine.The Two Types Of Parkinsons Related To The Nervous Systemdistinct subtypesAutonomic Nervous System And Parkinsons
How To Keep Your Nervous System Healthy?Here are some important recommendations:
What You Can Expect
Parkinson does follow a broad pattern. While it moves at different paces for different people, changes tend to come on slowly. Symptoms usually get worse over time, and new ones probably will pop up along the way.
Parkinsonâs doesnât always affect how long you live. But it can change your quality of life in a major way. After about 10 years, most people will have at least one major issue, like dementia or a physical disability.
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Daytime Tips For Better Sleep
- Wake up at the same time every day, using an alarm if you have to.
- Get out of bed right after you wake up. Too much time spent in bed can lead to more waking at night.
- Eat regular, healthy meals, and eat at the same time every day. Three to four small meals are better than 1-2 large meals.
- Limit daytime napping to a 40-minute NASA nap . Too many or too-long naps can make sleep at night more difficult.
- Do not drink coffee, tea, sodas, or cocoa after noon. They contain caffeine and can interfere with normal sleep.
- Do not drink alcohol after dinner. It may help you fall asleep faster, but makes sleep shallower later in the night. Alcohol can also make snoring and sleep apnea worse.
- Use caution when taking headache and cold medicines. Some contain stimulants that can affect sleep.
- Stop smoking. Cigarette smoking stimulates the body and makes sleep difficult.
- Increase or start doing daily exercise. Regular exercise helps to deepen sleep. Avoid heavy exercise 2 hours before bedtime.