Do Parkinson Patients Shake During Sleep

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.

Types Of Parkinsons Tremors

Quivering in these parts of the body can be signs of Parkinson’s:

• Finger Twitching Commonly seen among patients in the early stages of the disease, this symptom is also called a pill-rolling tremor because the fingers and hand appear to be rolling a pill-sized object.
• Jaw Tremors This movement in the jaw may resemble a slow shivering and disappear while eating or talking. In some cases, the teeth chatter. Patients may chew gum to stop the trembling.
• Foot Tremors This shakiness may appear while resting, lying down, or dangling the feet. It stops when standing and walking. It can also extend beyond the feet and cause the whole leg to vibrate.
• Tongue Tremors Although far less reported than other types of tremor, quivering in tongue can be a revealing manifestation of Parkinsons, according to an article published in December 2015 in the journal Movement Disorders Clinical Practice. The shaking can also appear in the chin, lips, and face.

While these types of tremors can help doctor identify Parkinsons, about 30 percent of patients do not have these movements, per prior research. Those people who do not have a resting tremor may not get a diagnosis immediately, says Gilbert. If doctors dont see it, they wont necessarily think a person has Parkinsons.

Falling Asleep During The Day

Not getting enough restful sleep at night, some medications, and possibly the disease itself leading to neurodegeneration can lead to daytime sleepiness and even sleep attacks in people with Parkinsons disease.

Excessive daytime sleepiness is one of the most frequent sleep disorder symptoms in Parkinsons disease and can affect a patients quality of life.

Trying to get more restful sleep at night and adjusting medications can help with excessive daytime sleepiness.

A new therapy from Theranexus is also currently being investigated in a Phase 2 clinical trial to help with excessive daytime sleepiness.

Parkinsons 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.

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Memory Or Thinking Problems

Having issues with thinking and processing things could mean your disease is progressing. Parkinsons is more than a movement disorder. The disease has a cognitive part as well, which means it can cause changes in the way your brain works.

During the final stage of the disease, some people may develop dementia or have hallucinations. However, hallucinations can also be a side effect of certain medications.

If you or your loved ones notice that youre getting unusually forgetful or easily confused, it might be a sign of advanced-stage Parkinsons.

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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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.

Increased Feelings Of Anxiety Or Depression

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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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 Parkinsons 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.

Symptoms And Consequences Of Excessive Daytime Sleepiness

Sleep plays an important role in consolidating memory, restoring the immune system, and other vital processes. As a result, a lack of quality sleep may result in a host of symptoms that you may not immediately connect to sleep.

Even if you dont consciously feel sleepy, you may be suffering from excessive sleepiness if youre experiencing any of the following:

• Trouble staying alert
• Slower reaction times
• Risk-taking behaviors

Being sleepy can have wide-ranging effects on health and daily life. Consequences of daytime sleepiness include:

• Increased risk of car and work accidents
• Worse quality of life
• Problems regulating mood and emotions
• Social and relationship problems

Excessive sleepiness may be particularly dangerous for young adults, shift workers, medical staff, and people who drive a lot.

Long-term sleep deprivation has been linked to a higher chance of developing diabetes, obesity, heart disease, and other chronic conditions. Daytime sleepiness in children may affect development, while in older adults, daytime sleepiness heightens the risk for falls and may be a risk factor for cognitive impairment, memory loss, and earlier mortality.

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Insomnia And Trouble Falling Asleep Or Staying Asleep

Some survey respondents said they have a hard time falling asleep, while others have trouble staying asleep. Another group of respondents has trouble with both sleep issues. Research shows that more than 35 percent of people living with PD have insomnia.2

Several respondents shared their experiences with insomnia and trouble staying asleep:

I have no problem falling asleep, but after 3 hours I am fully awake for another 4 hours before I go back to bed. I have never had sleep issues of any kind in the past.

I have a hard time getting to sleep and staying asleep. I am tired but cannot sleep. I fall asleep in the middle of doing other things.

Consider Tremor Along With Other Symptoms

Parkinsons reputation is that it is a tremor disease, and thats how you can identify it across a crowded room, says Rebecca Gilbert, MD, PhD, chief scientific officer for the American Parkinson Disease Association in New York City.

Although tremors bring people to diagnosis in many cases, defining the condition as a tremor disease may have done patients a disservice over the years because there are more severe symptoms that people struggle with. Tremor is just the one that people can see, according to Dr. Gilbert.

Many think if you dont have a tremor everything is fine, she says. That isnt true.

Over time, other disease features, such as cognitive problems, psychosis, blood pressure irregularities, depression, and lack of desire to do things, can be more devastating.

James Beck, PhD, chief scientific officer with the Parkinsons Foundation, also cautions that tremor may not be the first distinguishing feature.

A person may notice a slowness of movement called bradykinesia, he says. Or someone may be walking down the street and one arm doesnt swing. These symptoms may appear before tremor.

While focusing only on tremor may not be advisable, understanding this abnormal movement and treatment options may help patients improve their quality of life.

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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.

The Critical Difference Between Sleepiness And Fatigue

Fatigue is a physical or psychological feeling where people feel weary and exhausted and lacking energy. EDS is about needing and having the urge to sleep.

Fatigue is something that people can experience along with EDS however, people who experience fatigue on its ownthe feeling of being tired and out of energy do not also necessarily fall asleep when sedentary, as people who experience EDS often do.

It is estimated that EDS affects up to 50% to 75% of people living with Parkinsons and fatigue is estimated to affect 40% to 60%. Fatigue, however, is more likely to go undiagnosed.

Because the terms fatigue and sleepiness are so heavily linked, and sometimes used interchangeably, research has concluded that fatigue and EDS should be assessed separately in people with Parkinsons so that we can improve our understanding of their overlapping physiology.

With that knowledge, researchers from the University Hospital of Zurich, Switzerland designed a study to determine the overlap between fatigue and EDS and then associate them with other motor and non-motor symptoms as well as dopaminergic medication.

In their study of 88 outpatients, the researchers found that 72% experienced fatigue or EDS and just under half experienced both. Some of the key findings of the study include:

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Vivid Dreams Nightmares And Night Terrors

Research shows that vivid dreams, nightmares, and night terrors are common in people living with PD. One study found that people with Parkinsons have dreams involving different subject matter than those without PD. Violence, misfortune, and animals are common in the dreams of people with PD. 2

Survey responses show that many community members experience these particular sleep problems:

difficult to get to sleep wild dreams.

vivid dreams that frequently involve fighting, running, hiding. dreams of hunting and being hunted by wild animals, most frequently bears.

How To Stop The Shaking

Drs. Hoffer and Foster suggest that thestep thats missing is:

• Stimulating the production of the bodys protective detox molecule, glutathione, or GSH.

In addition to L-Dopa, the patientshould always be given high doses of antioxidants and the pre-cursors needed to boost the production of glutathione.

This should greatly extend thevalue of L-Dopa, they suggest. 3

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Excessive Daytime Sleepiness And Fatigue

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%31 and fatigue is found in up to 59% of patients.32 The presence of both EDS and fatigue are significantly correlated with more severe disease, more disability, cognitive decline and depression.33

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.34 Other stimulants, such as methylphenidate, may improve EDS and fatigue, though there are no controlled studies addressing this issue.

When To Talk To Your Doctor

You should see a doctor if youre feeling tired all the time, if excessive daytime sleepiness is affecting your day-to-day life, or if you believe it might be a sign of an underlying disorder.

Your doctor will run tests and ask questions about your sleep habits to attempt to pinpoint the reason for your sleepiness. They may also ask your bed partner whether you gasp, snore, or move your legs during the night. If they suspect a sleep disorder, they may refer you to a sleep specialist to run more tests.

Treatment methods for daytime sleepiness depend on the cause. The doctor will likely start by recommending sleep hygiene tips and encourage you to get more sleep. They may adjust the medications you take, and they will also work with you to develop a treatment plan for underlying disorders, which need to be treated in their own right.

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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.