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.
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.
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.
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.
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.
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 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.
- 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.
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.
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.
The National Parkinsons Foundation has published some tips on how to get a good night’s sleep including:
Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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.
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 .
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.
- Was this article helpful?
How About Using Supplements In Parkinsons Disease
Some patients prefer using food supplements. Nutrition supplements like coenzyme Q10, fish oil, and vitamin D have been linked to reducing disease progression and some studies suggest that taking these supplements may benefit the patients. However, research in this direction is still limited and we can’t advise you to take any supplements at this stage. We recommend you discuss it with your healthcare provider first before considering any supplements.
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.
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.
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.
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.
Restless Legs Periodic Limb Movements And Sleep
Both drug-naïve and drug-treated PD patients may develop a syndrome of nocturnal restlessness resembling RLS and periodic leg movements during sleep, whereas RLS has been reported to occur in PD at a rate twice the normal prevalence of RLS in general population .
Sleepy PD patients may also have day-time somnolence because of sleep-disordered breathing, and formal polysomnography will identify sleep apnoea in a considerable number of such patients . Obstructive sleep apnoea may occur in up to 50% of patients with PD with resultant daytime sleepiness and tiredness. Sleep apnoea may co-exist with RLS or PLM or RBD . This is important to diagnose as these patients need specific and targeted treatment.
Nighttime Hallucinations Psychosis & Confusion
Nighttime hallucinations and confusion may result from any combination of cognitive impairment, dopaminergic medications, age and PD-related vision changes and lack of sleep. Psychosis may first appear after infection, trauma, surgery or prolonged hospitalization. Symptoms may range from a sensation that someone or something is standing at the side of or behind the person, to very detailed and often frightening visions. Delusions may occur as well.
Treating Parkinson’s Psychosis
The first-line approach to treatment of PD psychosis involves simplification of the anti-PD medication regimen and adjusting dose timing , treating other sleep disturbances, providing a consistent and familiar sleep environment , and in more severe cases, the use of atypical antipsychotic drugs.
Most of the available anti-psychotics are always avoided in PD psychosis because they block dopamine receptors and can cause significant problems with movement. However, two anti-psychotic medications, quetiapine and clozapine, are sometimes used as they have less of an ability to worsen motor symptoms. However, data for the use of quetiapine is limited and clozapine requires the patient to undergo frequent blood draws to monitor blood counts. A newer medication pimavanserin, was approved by the FDA to treat PD psychosis. It has a different mechanism of action, and does not block the dopamine system, but rather the serotonin system, and therefore does not increase motor symptoms.
Tips To Help You Sleep Well With Parkinson’s
If you have Parkinson’s, your sleep may be disrupted. This may happen if your movement symptoms make it hard to turn over in bed. You may also find it more difficult to sleep well if you experience bladder and bowel problems or pain.
Below are 10 sleep hygiene ‘rules’, recommended by psychologists, to help you get a good night’s sleep with Parkinson’s.
1 Don’t have caffeine before you go to bed
This includes tea, coffee, chocolate and cocoa. Many soft drinks also contain caffeine, so check the labels.
Caffeine is a stimulant, which means it can make you feel more awake. Its effects can last for 3 to 4 hours. If caffeine is affecting your body at bedtime, it can increase the time it takes you to get to sleep and make sleep lighter and more restless.
It is also important to limit the total amount of caffeine you drink during the day too.
2 Avoid drinking alcoholic drinks 4 to 6 hours before bedtime
Alcohol can make you feel sleepy. But as its effects wear off we get what’s called ‘withdrawal’ and that has the opposite effect. Although alcohol can help you get to sleep, the withdrawal effect can lead to restlessness and waking up during the night.
Another effect of drinking alcohol at night is nocturia – the need to get up and go to the toilet, which will also disturb your sleep.
3 Try not to smoke around bedtime or when awake during the night
Like caffeine, nicotine is a stimulant and the effects are similar, even if you feel smoking relaxes you.
Sleep And Depression In Parkinson’s Disease
Depression is seen in approximately 40% of PD patients in the course of their disease. Most persons with depression, including PD patients, also will experience problems with sleep. In depression, sleep does not refresh you like it used to, or you wake up too early in the morning. Dreams for depressed people are different, too–they are rare and often depict a single image.
Increased Feelings Of Anxiety Or Depression
Anxiety and depression have been linked to Parkinson’s. In addition to movement problems, the disease can also have an impact on your mental health. It’s 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.
When Should I Call My Healthcare Provider
Reach out to your provider if trouble sleeping harms your quality of life. Always call your healthcare provider if you experience symptoms that worry you, especially if they could put you or those around you in danger.
Sometimes, a sleep disturbance could be a sign of depression related to Parkinson’s disease. If you’ve lost interest in activities you once loved or feel numb to what’s going on in your life, reach out to a provider you trust. Some people feel better after starting a new medication or talking to someone about what they’re feeling. You don’t have to feel like this.
A note from Cleveland Clinic
Researchers continue to study the sleep-Parkinson’s disease relationship. Understanding more about how Parkinson’s affects sleep may lead to earlier detection of Parkinson’s disease and more effective treatments. Even now, you have plenty of options to treat sleep problems. Be open with your provider about any sleep issues you’re having. Together, you can find a plan that improves your sleep as well as any other challenges Parkinson’s disease may create in your life.
Sleep Disturbances In Parkinson’s Disease
In general, research seems to indicate that people with Parkinson’s disease have more sleep disruptions than similarly aged people without the disease. The most commonly reported sleep-related problems are the inability to sleep through the night and difficulty returning to sleep after awakening, generally referred to as maintenance insomnia. Unlike many older adults, patients with Parkinson’s disease often find that they have no trouble initiating sleep, but often wake up within a few hours and find sleeping through the rest of the night to be difficult. People with Parkinson’s disease also report daytime sleepiness, nightmares, vivid dreams, nighttime vocalizations, leg movements/jerking while asleep, restless legs syndrome, inability to or difficulty turning over in bed, and awakenings to go to the bathroom.
Although all the reasons for these sleep changes are unknown, potential explanations include reactions to/side effects of medications and awakening due to symptoms such as pain, stiffness, urinary frequency, tremor, dyskinesia, depression and/or disease effects on the internal clock.
How To Take Action And Improve Your Sleep
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.
Low Blood Pressure And Getting Out Of Bed
A sudden or abnormal fall in your blood pressure when standing up quickly can make you feel lightheaded. For example, when getting out of bed to go to the toilet.
If this happens, take care and move slowly. This is where ownership of a Theraposture Rotoflex turning bed can provide a huge difference. As this solution rotates and profiles you and your mattress in a fully upright seated position, with your feet on the floor, a sit-to-stand transfer is safer. This is enhanced by the Rotoflex’s vertical lift in the seated position which means you have a higher level platform to leverage from without being tipped forward. This functionality means your ‘nose remainsbehind your toes’ until you feel confident and safe to stand. Inferior copies of the Rotoflex or rise and recliner chairs have a different mechanism which will slope the seating surface forward which could increase the risk of falls if you have balance and strength inconsistencies.
Medication Not Working The Way It Used To
In the early stages, taking medicine works well to get rid of symptoms. But as Parkinson’s progresses, your medication works for shorter periods of time, and symptoms return more easily. Your doctor will need to change your prescription.
Dr. Valerie Rundle-Gonzalez, a Texas-based neurologist, says to pay attention to how long your medicine takes to kick in and when it stops working. She says you should feel like symptoms significantly improve or are almost gone while on medication.
Why Do Parkinsons Patients Sleep So Much
Parkinson’s patients experience difficulties with their sleep due to the disease itself and the medications that treat it. This can lead to increased sleepiness during the day.
Parkinson’s disease can cause problems with sleep, and the medications used to treat it can cause even more. Difficulties sleeping during the night can cause daytime sleepiness, and the medications can also cause drowsiness. This disruption to the circadian rhythms can lead to more frequent, lower quality sleep.
Good Night: Sleep And Parkinsons Disease
Lack of good sleep can worsen Parkinson’s 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.
Impact Of Diet On Parkinsons Medications
Taking certain foods may interfere with the efficacy of drugs used in Parkinson’s disease. This is especially true for high-protein foods. Their consumption may affect the body’s ability to absorb levodopa, which is the most prescribed drug in Parkinson’s disease. It’s therefore good to take levodopa 30 – 60 minutes before eating the high-protein foods.
However, for some patients it causes nausea, and taking levodopa on an empty stomach might not be a good idea. In that case, taking levodopa with a small snack can enhance the absorption of the drug in the blood.