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.
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 youve lost interest in activities you once loved or feel numb to whats 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 theyre feeling. You dont have to feel like this.
A note from Cleveland Clinic
Researchers continue to study the sleep-Parkinsons disease relationship. Understanding more about how Parkinsons affects sleep may lead to earlier detection of Parkinsons 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 youre having. Together, you can find a plan that improves your sleep as well as any other challenges Parkinsons disease may create in your life.
Parkinsons Disease And Sleep Problems: Symptoms Treatments
Parkinsons disease and sleep issues affect around 75% of patients. Despite the importance of sleep when dealing with a long-term illness, most people with PD experience sleep issues at some stage of their condition. Sleep problems often occur long before motor symptoms have begun, making them one of the first signs of Parkinsons disease. Some of the most common sleep problems in PD are insomnia, restless leg syndrome and excessive daytime sleepiness. Parkinsons can also cause night-time disturbances such as sleep apnea, bad dreams and frequent night-time urination. Let’s explore Parkinson’s disease and sleep problems in more detail.
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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 .
Limit Lights In Your Room
Minimize your exposure to artificial lights when preparing for bed. Sleep in a cool, dark place. Avoid bright lights when sleeping. You could keep dim night lights if sleeping in complete darkness is uncomfortable.
Avoid watching television and using mobile devices before bed or lying in bed. These devices emit blue lights that could affect your sleeping habits.
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Clinical Features Of Eds
Excessive daytime sleepiness is a chronic or episodic sleepiness seen throughout the day in PD patients . Anxiety and depression, cognitive dysfunction, changes in sleeping habits, changes in circadian rhythm, the side effects of medications that can produce sleep attacks such as dopamine agonists, and concomitant systemic diseases can cause sleepiness . Also these factors can cause fatigue . Studies have reported that EDS is very common in PD. Verbaan et al. found that compared to controls , 43% of PD patients had EDS. One study found that EDS was related to age and male gender . Also, other sleep disorders such as PLMS, and sleep fragmentation which cause the deterioration of night sleep quality may be the other causes of EDS .
Determination Of Neurogenic Orthostatic Hypotension Status
Presence of neurogenic vs. non-neurogenic orthostatic hypotension was determined from a metric validated in similar population of PD patients, and using corroborating physiologic measures,,. Neurogenic orthostatic hypotension was determined from the ratio of heart rate change to systolic blood pressure change from supine-to-standing transition / = HR/SBP, with HR/SBP=< 0.5 most consistently corresponding to neurogenic forms of OH within the physiogically validated cohort. The ratio was calculated only for subjects with orthostatic hypotension, as defined by SBP20 or DBP10 mmHg.
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Sleep Disorders In Parkinson’s Disease
Issue title: Mental Dysfunction in Parkinson’s Disease
Article type: Review Article
Authors: Schrempf, Wiebke | Brandt, Moritz D. | Storch, Alexander | Reichmann, Heinz
Affiliations: Division of Neurodegenerative Diseases, Department of Neurology, Dresden University of Technology, Dresden, Germany | Department of Neurology, Dresden University of Technology, Dresden, Germany | German Center for Neurodegenerative Diseases , Research Site Dresden, Dresden, Germany
Note: Correspondence to: Wiebke Schrempf, MD, Division of Neurodegenerative Diseases, Department of Neurology, Dresden University of Technology, 01307 Dresden, Germany. Tel.: +49 351 458 3876 Fax: +49 351 458 5802 E-mail:
Keywords: Parkinson’s disease, non-motor symptoms, sleep, REM sleep behaviour disorder , restless legs syndrome , insomnia
DOI: 10.3233/JPD-130301
Journal: Journal of Parkinson’s Disease, vol. 4, no. 2, pp. 211-221, 2014
How Are Sleep Problems Treated In People With Parkinsons Disease
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.
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Sleep And Parkinsons Disease
The Palo Alto Parkinsons Disease support group February 2020 meeting featured Dr. Emmanuel During, a Stanford sleep medicine neurologist. During the meeting, Dr. During discusses sleep disturbances that can occur in PD, such as insomnia, restles legs syndrome, sleep apnea, and REM sleep behavior disorder , along with available treatments. There’s a question and answer session.
If You Are Experiencing Sleep Problems You Should 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.
Certain antidepressants, such as mirtazapine may help with sleep while others the SSRIs can make other sleep symptoms worse. Also, if you are unsure, check with your doctor or pharmacist to ensure alerting medications are being taken in the morning and sedating medications are being taken at night.
If urinary frequency keeps you up at night, be sure your doctor rules out causes other than PD. In addition, there are several medications that can be helpful, including oxybutynin , tolterodine , trospium , tofenacin succinate , darifenacin , mirabegron and phenoperidine fumarate . You may be referred to a bladder specialist .
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Sleep Problems At Later Stages Of Pd
In addition to the conditions already mentioned, during the later stages of PD, you also may experience sleep problems related to higher doses of medications, such as hallucinations.
As many as 33% of Parkinson’s patients during mid and later stages of the disorder experience hallucinations, related to medication side effects. Hallucinations tend to occur visually rather than hearing them . They are frequently associated with vivid dreams.
What Types Of Sleep Problems Do People With Parkinsons Disease Have
Parkinsons disease affects every person differently. It also impacts sleep in different ways. People with Parkinsons 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.
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Pathophysiology Of Rbd In Pd
REM sleep is regulated by the brain stem, hypothalamus, thalamus, substantia nigra, basal forebrain, and frontal cortex . The brain stem structures involved in REM sleep include the pedunculopontine nucleus , retro-rubral nucleus, subcoeruleus/sublateral dorsal nucleus, and medullary magnocellular reticular formation . These brain stem structures provide REM atonia by inhibiting the spinal motor neurons through direct and indirect pathways . Thus, these two inhibitory pathways play a role in skeletal muscle atonia during REM sleep . The PPN and the retro-rubral nucleus also act as a phasic generator circuitry . It is well known that the PPN/laterodorsal tegmental nuclei have both cholinergic activity and non-cholinergic activity. So the PPN/LDN also contains glutamatergic and GABAergic neurons . On the other hand, the cholinergic neurons in the PPN/LDN innervate the pontine reticular formation , MRF, and thalamus . Thus, descending projections of the PPN stimulate the inhibitory interneurons via the reticulospinal neurons and inhibit directly the motor neurons in the spinal cord and modulate the activations of the mesencephalic locomotor region . It has been reported that inhibition of GABA activity in the PPN, an important part of locomotion, results in explosive motor behavior . In addition, the ascending projections to the thalamus from the PPN modulate the sleep
Drugs Used To Treat Parkinsons Disease
The common Parkinsons disease medication of carbidopa and levodopa can contribute to insomnia for some people, says Horvat. Thats because its replacing the dopamine that youve lost in Parkinsons disease, she says. Research has shown that dopamine receptors play a role in wakefulness.
Sometimes when people are first started on this medication, they will take a dose right before bed rather than closer to their dinner, says Horvat. Then theyre not able to get to sleep because the dopamine affects the reward center in the brain and gives people a high, she says.
Besides timing the medication further from bedtime, your doctor may suggest taking an extended-release capsule of carbidopa and levodopa, says Horvat. That has a lower peak dose effect, so the stimulation is milder, and it lasts a little longer. It can allow patients to have more of a baseline rather than a peak at night, which can cause the insomnia, she says.
If you suspect your medication is making sleep difficult, tell your doctor dont stop taking the medicine as prescribed, says Horvat. Sometimes we can time the medication in a different way or in some cases we do change the medication but this is not something to try to figure out on your own.
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Sleep Matters: A Review Of Sleep Issues In Parkinson’s
Sleep disorders are present in 66-99% of people with Parkinson’s disease . In this 1-hour webinar Okeanis Vaou, MD, describes common sleep disorders in PD and how to treat them. Disorders described include REM sleep behavior disorder, daytime sleepiness, insomnia, nocturnal motor fluctuations, and restless leg syndrome. Dr. Vaou ends the webinar with tips on how to maintain good sleep hygiene.
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.
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Diagnostic Assessment Of Sleep Disorders In Pd
The history taken from the patient and its neighbors is very important in assessing sleep disorders in PD. The type of sleep disorder should be identified in the history, and information about possible related factors should be obtained from the history. In PD, general and specific scales can be used to investigate the subtype of sleep disorder and to determine its severity. Objective methods can be used to further investigate the diagnosis of these disorders. Further investigative techniques include sleep recording methods such as actigraphy or PSG. Polysomnographic findings of each sleep disorder have been explained in the relevant section. In addition, information about screening scales used in each sleep disorder has been described in the relevant section.
Actigraphy is an electrophysiological device that measures the movements of the patient during sleep by recording from wrist or ankle for many days. Actigraphy evaluates indirectly the circadian sleepwake patterns . It is especially used in circadian rhythm disorders or insomnia and prolonged daytime sleepiness .
Develop A Bedtime Routine
Your bedtime routine should help you prepare for bed. So be sure to follow it every evening. Essential tasks that every bedtime routine must have include:
- Having a Light Snack: Eat only light snacks if you get hungry before bed. Heavy meals before going to bed are unhealthy and can result in weight gain. Also, avoid snacks that might contain stimulant ingredients like alcohol and caffeine.
- Taking a Warm Bath: Bathing in warm water before bed may improve sleep quality. However, be sure not to spend too much time in the bath as it may wake up your body.
- Go to the Toilet: Be sure to finish your business in the bathroom before bed. Minimize your liquid intake at least three hours before bedtime to help avoid nocturia.
- Brush Your Teeth: Brushing your teeth right before bed helps prevent dental problems, including cavities and decay. Although it is indirectly related to better sleep, having this step in a bedtime routine is helpful.
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Excessive Daytime Sleepiness In Pd
Excessive daytime sleepiness is a common symptom in PD and can occur anywhere from 15 to 21% early in the disease course and up to 46% as the disease progresses . A study of early and untreated PD showed that EDS may be related to disease progression and is independent of other sleep disorders, while others have shown that dopaminergic medication appears to increase EDS in a dose-dependent fashion . Some studies have also suggested an association of EDS in PD with depression . Interestingly, patients with PD and EDS appeared to have reduced uptake in the basal ganglia on dopaminergic terminal imaging compared to those without EDS . The PD and EDS groups also have worse scores on motor, nonmotor, autonomic, and cognitive testing . This suggests that more severe disease could be a contributing factor to development of EDS, in addition to dopamine medication levels .
The presence of EDS negatively impacts quality of life in PD. One study evaluated 198 patients with PD using the Parkinsons Disease Questionnaire 39 , a measure of quality of life . This study demonstrated that those with PD and EDS had a significantly lower overall score on the PDQ-39 than those without EDS , as well as individual emotional, social, and physical domains measured by this survey . EDS in PD also represents an additional risk of falling. One study evaluated 120 patients with PD and found that every point increase on the Epworth Sleepiness Scale was associated with a 20% higher risk of falling .
What Causes Sleep Problems In Parkinsons Disease
There are many reasons why Parkinson’s disease and sleep problems are so prevalent, including disrupted routines, medication and chemical changes in the brain . One study by UCLA researchers found that patients with Parkinson’s disease and sleep disorders displayed a deficiency of orexin and hypocretin cells which impacted the brains ability to regulate sleep/wake cycles normally.
Insomnia symptoms can also occur as a result of the motor symptoms of Parkinson’s disease, or as a side-effect of medication. Tremor, stiffness and involuntary movements can all affect your ability to fall or stay asleep comfortably, which is why treating your condition with medication may be vital for good sleep.
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