Why Sleep Disorders May Precede Parkinsons And Alzheimers
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.
Pathophysiology Of Excessive Daytime Sleepiness In Pd
It has been reported that there are three main causes of sleepiness in PD deterioration of night sleep quality, neurodegeneration of sleepwake-related brain regions, as a result of disease pathology, and the side effects of antiparkinsonian medications . However, many of the abovementioned causes may be related to EDS. For this reason, it is necessary to consider these causes in the diagnosis and treatment of EDS.
When To Talk To Your Doctor
If nausea persists or is accompanied by other symptoms, consider contacting your doctor. Symptoms such as vomiting longer than 24 hours, vomiting blood, abdominal pain, headache, or signs of dehydration may indicate a more serious medical condition.
If sleep deprivation is chronic or unmanageable, ask a doctor or trusted health professional for help . A doctors visit to discuss sleep issues and nausea may include:
- A full medical history
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Parkinsons Disease Linked To Sleep Disorders Sleep Disturbances
Parkinsons disease has been linked to sleep disorders and sleep disturbances. Parkinsons disease is characterized by the loss of brain cells that control movement. Symptoms of Parkinsons disease can include tremors, stiffness, slowness of movements, as well as balance and coordination problems. Memory problems, depression, and sleep problems can all occur in Parkinsons disease, too.
Sleep problems and sleep disorders may occur as an early sign of Parkinsons disease, even before motor symptoms have started. Common sleep disorders experienced in Parkinsons disease include insomnia, excessive daytime sleepiness, nightmares, sleep attacks, REM sleep behavior disorder , periodic leg movement disorder, restless leg syndrome, sleep apnea, and nocturia, which is frequent nighttime urination.
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.
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Nighttime Trips To The Bathroom
Waking up frequently during the night to use the toilet is called nocturia and is common among people with Parkinsons. These interruptions in the sleep cycle can have a significant impact on your overall quality of sleep.
If you find yourself getting up more than once during the night to use the toilet, discuss with your doctor to see if there are certain medications that might be helpful. Sometimes this can be corrected by working with an incontinence specialist . Limiting the amount of liquid you drink a couple of hours before bed may help with nocturia as well.
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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Diagnosis And Treatment Of Parkinsons Sleep Problems
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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Sleep And Dementia Prevention: Improving Brain Health
How does poor sleep increase the risk for Alzheimers? Does lack of sleep cause Parkinsons dementia? Discover the impact of sleep on brain health.
Lack of sleep doesnt cause Alzheimers disease, but it can increase your risk. Especially if you deprive yourself of sleep for long periods of time.
Appropriate amounts of sleep are important for brain health. In fact, sleep disturbances can increase the risk for cognitive decline and brain diseases, like Parkinsons and Alzheimers.
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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.
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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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 .
Excessive Daytime Sleepiness And Pdss Scores In Parkinsons Disease
Excessive daytime sleepiness and unintended sleep episodes are increasingly being associated with motor vehicle and occupational accidents, impaired work performance, and possibly reduced quality of life. In Parkinsons disease, this issue has received much attention lately, owing to controversy surrounding a report by Frucht et al of sleep attacks, or unintended sleep episodes, leading to road traffic accidents in nine patients with Parkinsons disease taking non-ergot dopamine agonists. Rye and colleagues, however, have suggested that there is increased arousal and paradoxical alertness in patients with Parkinsons disease complaining of poor sleep. Thus the impact of nocturnal sleep disruption on excessive daytime sleepiness in Parkinsons disease is far from clear, and several reports have suggested the need for controlled studies addressing this issue. Our study indicates that poor PDSS scores, and in particular poor scores on item 15, are correlated strongly with high scores on the ESS. This is consistent with subjective reporting of patients who had poor nocturnal sleep and felt tired and sleepy during the daytime.
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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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I am a very active person, but deep fatigue must be addressed with rest. Taking a day to rest is not in my nature. It makes me feel like a sloth. Yet, when deep fatigue hits me, the best remedy is to do just that take the day off! I limit myself to one day of physical rest, very rarely two days . I also find that the mind must rest with the body. Getting the mind to a quiet place is the practice of meditation, in whatever form suits the moment. At the height of deep fatigue, meditation can be very difficult, but not impossible. At times, it has taken me four hours to quiet my mind and body to get rejuvenating rest.
But there is a caution here: Be wary of using rest as an excuse to procrastinate. In another column, Ill address the link of scenario looping to set-shifting issues and difficulty initiating new tasks. Basically, getting off the sofa can be problematic if I stay there too long. Perhaps this seems contradictory to my history as a highly active person, but that is the nature of PDs nonmotor effects. Once off the sofa, I make myself shift into a physical task, followed by a short rest and then some type of mental task. There is always some resistance to overcome to do this to get off the sofa but the rest is absolutely necessary to stop the deep fatigue.
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Tips For Coping With Fatigue
- Eat well.
- Stay hydrated.
- Exercise: walk, do tai chi, dance, cycle, swim, do yoga or chair yoga whatever you enjoy. Fatigue may make it hard to start exercising, but many people say it makes them feel more energetic afterward. If you find it difficult to get going, consider exercising with another person or a group.
- Keep a regular sleep schedule. If you have difficulty sleeping because of tremor or stiffness, trouble rolling over, or needing to use the bathroom, talk to your doctor about these issues.
- Take a short nap after lunch. But avoid frequent naps throughout the day, or napping after 3:00 PM.
- Stay socially connected.
- Pace yourself: plan your day so that you are active at times when you feel most energetic and have a chance to rest when you need to.
- Do something fun: visit with an upbeat friend, or pursue a hobby.
- At work, take regular short breaks.
Note: Fatigue has been identified by the Parkinsons community as an unmet need through the PDF Community Choice Research Awards. In response, PDF is investing in research to understand and solve fatigue in Parkinsons.
Content for this article was derived from Fatigue, and Fighting Fatigue on PDF.com
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Anxiety Depression And Other Psychological Issues
Anxiety, depression, apathy and other psychological symptoms of Parkinsons can significantly impact your quality of sleep. Have a conversation with your doctor if you are experiencing these or other psychological effects of Parkinsons. Improving these symptoms will not only enhance your overall quality of life, but it may also help you sleep better too. In addition, some medications for these types of issues can cause drowsiness which may improve sleep quality, particularly if taken at night.
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How Does Sleep Deprivation Impact Your Body
Sleep is necessary for virtually all the bodys systems to function properly. In addition to affecting the digestive system, sleep deprivation can raise the risk of heart problems, high blood pressure, diabetes, obesity, and other chronic conditions. Sleep deprivation can also affect the immune system and leave a person more vulnerable to infection.
Furthermore, not sleeping well can take a toll on mental and emotional health. Studies have linked sleep deprivation to cognitive impairment, including problems with attention, critical thinking, judgment, and problem solving. Without enough sleep, a persons moods, emotions, and sex drive may suffer as well.
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.
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Are You Getting Enough Sleep
It can often be difficult to tell whether youre getting enough sleep. However, Walker offers a few simple questions and their corresponding answers about your sleep habits.
If the answer is yes, you are likely not getting sufficient sleep quantity and/or quality.
If the answer is no, then you are likely self-medicating your state of chronic sleep deprivation.
If so, you need more sleep than you are giving yourself.
This is often a sign of a fatigued, under-slept brain.
Simple distraction is often the cause, but a lack of sleep is very much another culprit.
Even with all this research on the importance and function of sleep, many people still are unaware of the myriad effects that poor sleep has. Especially for seniors, Walker notes that elderly individuals fail to connect their deterioration in health with their deterioration in sleep, despite causal links between the two having been known to scientists for many decades. Far more of our age-related physical and mental health ailments are related to sleep impairment than either we, or many doctors, truly realize or treat seriously.
Sleep Disorders Related To Parkinsons Disease
Poor sleep quality can decrease a persons overall quality of life. For those diagnosed with Parkinsons disease , cognitive decline may contribute to sleep disturbances, which affect alertness in the morning and the ability to fall asleep.
Whether you or your loved one has PD and trouble sleeping, lets learn about the relationship between the two in this article.
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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: