Thursday, June 16, 2022
Thursday, June 16, 2022
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Does Parkinson’s Tremor Occur During Sleep

How Are Sleep Problems Treated In People With Parkinsons Disease

Sleep Disorders In Parkinson’s Disease – Dr. Gary Leo

Your provider will recommend treatments that address whats 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 doesnt 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.

Diagnosis Of Excessive Daytime Sleepiness In Pd

In patients describing the symptoms of EDS, it is very important to determine the level of sleepiness. The Epworth Sleepiness Scale is widely used in the evaluation of EDS. Thus, ESS is a useful scale for the subjective assessment of sleepiness in patients with EDS .The ESS contains eight items, and each item is rated as maximum three points. A higher score means more sleepiness level. In addition, there are objective tests such as multiple sleep latency test and maintenance of wakefulness test for assessment EDS. The MWT is evaluation used as a polysomnographic measurement of EDS. The MSLT is measured after a PSG performed in the night to assess nighttime sleep quality and quantity . One study found that the risk of traffic accidents increased in PD patients with an ESS score greater than 7 .

Here Are Some Sleep Hygiene Tips:

  • Be mindful of what you eat for dinner. High-protein foods may interfere with the absorption of medications for Parkinsons . This may make the medication wear off prematurely, causing symptoms to return in the night.
  • High-protein foods, particularly meat and dairy, also take longer to digest. This could lead to reflux and other issues that could interfere with sleep.
  • Reduce liquids a couple of hours before bed to try to reduce the number of times you need to get up in the night to use the toilet.
  • Although regular exercise is associated with better sleep quality, its important to avoid strenuous activity too late in the evening as it may increase alertness and interfere with sleep.
  • Avoid sources of blue light.
  • Computers, tablets, smartphones and televisions emit light in the same spectrum associated with daylight . Spending time with these blue-light sources in the evening can sometimes fool your sensory system, tricking the brain into thinking that it is daytime and making it harder to fall asleep.
  • Watching stimulating or exciting content such as a movie or television program can also interfere with sleep. Its a good idea to avoid watching high-energy content in the hour or two before going to bed. This will also reduce your exposure to blue-light sources.
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    Tips For Better Sleep

    • Keep a regular sleep schedule go to bed at the same time and get up at the same time.
    • Choose your bedtime based on when you want to get up. Plan to spend seven to eight hours a night in bed.
    • Make a bedtime routine for example, snack, bath, tooth-brushing, toileting and follow it every evening.
    • Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 p.m.
    • If you cant get outdoors, consider light therapy sitting or working near a light therapy box, available at drug stores and department stores.
    • If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 p.m.
    • Sleep in a cool dark place and use the bed only for sleeping and sexual activity.
    • Do not read or watch television in bed.
    • Use satin sheets and pajamas to make moving in bed easier.
    • Minimize drinking liquids for three hours before bedtime to avoid frequent nighttime urination.
    • Go to the bathroom immediately before retiring.
    • Place a commode next to the bed, to minimize the effort, and light to get up during the night.
    • Avoid:
    • Alcohol, caffeine and other stimulants such as nicotine
    • Heavy late-night meals
    • Heavy exercise within six hours of bedtime
    • Thoughts or discussions before bedtime about topics that cause anxiety, anger or frustration
    • Clock watching
    • Screen time television, phones, tablets one or two hours before bed.

    Deep Brain Stimulation In The Treatment Of Sleep Disorders In Pd

    Parkinson

    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.

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    Clinical Features Of Insomnia

    Insomnia is defined as difficulties initiating sleep , sleep maintenance problem or early awakening . In studies, it has been reported that the frequency of insomnia in patients with PD varies from 27 to 80% . It has been reported that the most common types of insomnia in PD patients are sleep fragmentation , and early awakenings . It has been reported that insomnia may occur alone or accompany comorbid mental or systemic illnesses, and it is associated with disease duration and female gender . Sleep fragmentation is defined as a deterioration of sleep integrity , and it leads to a lighter sleep or wakefulness . In studies, it has been reported that sleep fragmentation is the most common sleep disorder in patients with PD .

    How Do I Prevent Falls From Common Hazards

    • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
    • Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
    • Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
    • Kitchen: Install non-skid rubber mats near the sink and stove. Clean spills immediately.
    • Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
    • Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

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    What Is The Outlook For Persons With Parkinsons Disease

    Although there is no cure or absolute evidence of ways to prevent Parkinsons disease, scientists are working hard to learn more about the disease and find innovative ways to better manage it, prevent it from progressing and ultimately curing it.

    Currently, you and your healthcare teams efforts are focused on medical management of your symptoms along with general health and lifestyle improvement recommendations . By identifying individual symptoms and adjusting the course of action based on changes in symptoms, most people with Parkinsons disease can live fulfilling lives.

    The future is hopeful. Some of the research underway includes:

    • Using stem cells to produce new neurons, which would produce dopamine.
    • Producing a dopamine-producing enzyme that is delivered to a gene in the brain that controls movement.
    • Using a naturally occurring human protein glial cell-line derived neurotrophic factor, GDNF to protect dopamine-releasing nerve cells.

    Many other investigations are underway too. Much has been learned, much progress has been made and additional discoveries are likely to come.

    Parasomnias In Parkinsons Disease

    REM sleep behaviour disorder in Parkinson’s

    In PD, parasomnias are quite common, and REM parasomnias are more common than those in NREM . As REM parasomnia in PD, RBD can be seen in near two-thirds of patients . In PD, non-NREM parasomnias can include sleepwalking, confusional arousals, and sleep terrors. However, NREM parasomnias are not a frequent cause of sleep disorders in PD .

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    Are My Tremors Associated To Parkinsons Disease

    Several neurological conditions can cause tremors and having tremors does not necessarily mean you have Parkinsons disease.

    Tremors associated to Parkinsons disease are resting tremors, which occur when the body part is inactive. This typically starts in one hand, fingers, or a foot. Tremors can also affect the jaw or tongue, which can lead to communication difficulties.

    As with stiffness, Parkinsons tremors mainly affect one side of the body.

    If you think you have resting tremors, consult your doctor. They will perform tests to exclude any other condition often confused with Parkinsons disease.

    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.

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    What Sleep Issues Do People With Parkinsons Face

    Research shows that sleep disorders are a major issue for people living with PD, affecting up to 75 percent of those with the condition.1,2 In our survey, 47 percent of the respondents reported trouble sleeping and/or insomnia as a symptom that they have experienced in the last month.

    Experts have found that many people with PD also experience:1-3

    • Leg movements, jerking, and cramping, or restless leg syndrome
    • Worry or anxiety

    Numerous survey respondents said they have a combination of sleep issues, leading to frustration about rest. Here is a look at some of the sleep challenges they frequently experience.

    Increased Feelings Of Anxiety Or Depression

    Do Tremors Come And Go With Parkinson

    Anxiety and depression have been linked to Parkinsons. In addition to movement problems, the disease can also have an impact on your mental health. Its possible that changes in your emotional well-being can be a sign of changing physical health as well.

    If you are more anxious than usual, have lost interest in things, or feel a sense of hopelessness, talk to your doctor.

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    What Is Parkinsons Disease

    Parkinsons disease is a nervous system disease that affects your ability to control movement. The disease usually starts out slowly and worsens over time. If you have Parkinsons disease, you may shake, have muscle stiffness, and have trouble walking and maintaining your balance and coordination. As the disease worsens, you may have trouble talking, sleeping, have mental and memory problems, experience behavioral changes and have other symptoms.

    Signs And Symptoms Of Body Tremors At Night

    While night tremors can occur in people in prime health, they are typically the symptom of a disease. Night tremors begin as sleep starts, sudden jolts as a person starts to fade into sleep. The tremors then begin in the first stages of the sleep cycle. Tremors can manifest as spasms, normally in the arms or legs. In more severe cases, night tremors will cause the sufferer to wake up feeling exhausted. Their muscles can be sore and potentially even pulled, and they will feel as though they have been exercising.

    People may have truly devastating body tremor at night. Some individuals cant eat because the tremor resists them from getting a utensil or glass into the mouth. Since the body tremor takes place by means of being driven by the central nervous system and is caused by the involuntary movement of the body, it can affect particular parts of the body. Hands can be frequently affected by body tremor. However, some other organs such as legs, chin, or head can be involved with the entire process of body tremor at night. This indisposition can occur to the voices of people as well.

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    How Is Tremor Diagnosed

    Tremor is diagnosed based on a physical and neurological examination and an individuals medical history. During the physical evaluation, a doctor will assess the tremor based on:

    • whether the tremor occurs when the muscles are at rest or in action
    • the location of the tremor on the body
    • the appearance of the tremor .

    The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain.

    Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup. Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.

    The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.

    Excessive Daytime Sleepiness And Fatigue

    REM Behavior Disorder & Sleep with Parkinson’s. Dr. Maria Christina Ospina. PMDAlliance

    Tiredness during the day is one of the more common difficulties experienced by people with PD. EDS should be differentiated from fatigue . While it can be difficult to clinically distinguish fatigue and tiredness, the distinction is possible with Multiple Sleep Latency Test done in a sleep lab. Estimates of the occurrence of EDS range from 1550% and fatigue is found in up to 59% of patients. The presence of both EDS and fatigue are significantly correlated with more severe disease, more disability, cognitive decline and depression.

    Treatment may also include a variety of environmental and behavioral approaches that, while not studied in PD, have been found to be helpful in other populations. Regular mild exercise is a mainstay of the treatment of fatigue and should usually be recommended. A stimulating daytime environment and exposure to intense light in early morning may be of use. Stimulant medications should be considered in refractory situations. Small controlled trials of modafinil have found a modest effect on EDS in PD patients. Other stimulants, such as methylphenidate, may improve EDS and fatigue, though there are no controlled studies addressing this issue.

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    How Does Parkinsons Disease Cause Sleep Problems

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

    • Chemical changes in the brain: Ongoing research shows that Parkinsons disease may disrupt sleep-wake cycles. Changes to certain brain chemicals may cause people with Parkinsons to get less sleep.
    • Medication: Some drugs that treat Parkinsons 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 Parkinsons 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.
    • Parkinsons symptoms: Pain, waking up at night to pee or other Parkinsons symptoms can make restful sleep harder to come by. Sleep apnea can also disrupt sleep.

    How Is Tremor Treated

    Although there is no cure for most forms of tremor, treatment options are available to help manage symptoms. In some cases, a persons symptoms may be mild enough that they do not require treatment.

    Finding an appropriate treatment depends on an accurate diagnosis of the cause. Tremor caused by underlying health problems can sometimes be improved or eliminated entirely with treatment. For example, tremor due to thyroid hyperactivity will improve or even resolve with treatment of thyroid malfunction. Also, if tremor is caused by medication, discontinuing the tremor-causing drug may reduce or eliminate this tremor.

    If there is no underlying cause for tremor that can be modified, available treatment options include:

    Medication

    Focused Ultrasound

    A new treatment for essential tremor uses magnetic resonance images to deliver focused ultrasound to create a lesion in tiny areas of the brains thalamus thought to be responsible for causing the tremors. The treatment is approved only for those individuals with essential tremor who do not respond well to anticonvulsant or beta-blocking drugs.

    Surgery

    When people do not respond to drug therapies or have a severe tremor that significantly impacts their daily life, a doctor may recommend surgical interventions such as deep brain stimulation or very rarely, thalamotomy. While DBS is usually well tolerated, the most common side effects of tremor surgery include dysarthria and balance problems.

    Lifestyle changes

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