Why Do Parkinsons Patients Have Trouble Sleeping
Despite having daytime tremors, Parkinsons patients do not shake in their sleep. However, both Parkinsons 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. Parkinsons 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 Parkinsons disease. For that reason, doctors often look for mental health disorders in people with Parkinsons disease who have sleep problems.
Medications Used For Treating Psychosis
Antipsychotic agents are designed to balance abnormal chemical levels in the brain. Up until the 1990s, the use of antipsychotics in PD was controversial because the drugs used until that time work by reducing excess dopamine. This alleviated psychosis but caused dramatic worsening of PD motor symptoms.
Fortunately, medications that are better tolerated by people with PD are now available. Today, there are three antipsychotic medications considered relatively safe for people with PD: quetiapine , clozapine and the newest agent, pimavanserin . They cause limited worsening of PD while treating hallucinations and delusions.
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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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The Different Stages Of Sleep
- Rapid eye movement sleep
- Non-rapid eye movement sleep
The lightest stage of sleep is NREM, after which comes deeper sleep states. As people move back through to the lighter stages, they enter the REM state. If awoken during REM sleep, the sleeper will often report a dream.
Tips For Better Sleep
The best place to start is with your doctor, who may be able to change or adjust your Parkinsonâs medications so that they interfere with sleep less. In some cases, you might be able to take a medication that helps you stay awake during the day so you sleep better at night.
If you have a sleep disorder or depression, other medications may help. Be sure to ask your doctor before taking any over-the-counter sleep medications. Many contain an antihistamine, which can actually make Parkinsonâs symptoms worse.
There are also sleep strategies you can try for yourself:
Stick to a regular sleep schedule. Getting up and going to bed at the same time every day, even on weekends, can help regulate your sleep cycle.
Avoid caffeine for at least six hours before bedtime. That means chocolate as well as coffee, tea, and sodas with caffeine.
Stay active during the day and avoid taking naps. The energy you expend during the day will leave you more tired at night. Complete your exercise regimen at least 3 hours before bedtime to optimize pre-sleep relaxation.
Get outside for some exercise every day. Morning sunshine helps set your biological clock.
Limit fluids in the evening. Avoid drinking a lot of fluid in the hours before bed to cut down on the need to urinate in the middle of the night.
Try a relaxation routine. Get in the habit of treating yourself before bed to a relaxing activity such as a hot bath or shower or a gentle massage.
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S You Can Take To Reduce Fatigue
If you are feeling fatigued and exhausted all the time, what can you do about it?
First and most importantly, speak to your doctor about how much the fatigue disturbs you. Does it undermine your daily activities? Does it make it more difficult to attend clinic visits or rehabilitation appointments? Does it feed into your emotional life? Does it undermine your coping ability? Once you speak to your doctor about your fatigue, your doctor might also recommend the following steps:
- Engage in regular physical exercise, including the use of weights to increase muscle strength. Studies show that physical exercise combats both physical and mental fatigue.
- Consider taking anti-depressant medication. Although fatigue is not caused by depression, depression can worsen fatigue . Treating depression if it is present might allow you to overcome fatigue with exercise or some other treatment.
- Consider trying stimulants like Ritalin , normally prescribed for attention deficit-hyperactivity disorder or Provigil , prescribed for sleep apnea, as an adjunct for depression and as a palliative treatment in end of life care. Some doctors have reported that these drugs may help certain Parkinsonâs patients.
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.
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Sleep And Depression In Parkinsons 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, tooâthey are rare and often depict a single image.
Why You Struggle To Sleep
The stiffness, , rigidity, and tremors of make it hard to get comfortable in bedjust rolling over to find a more comfortable position can be a chore. But that’s not all you have to deal with. Here are some other Parkinson’s symptoms that can keep you up at night:
. You may have a hard time simply falling asleep.
Nightmares. Vivid nightmares are common in people with Parkinson’s. They can seem so real that they cause you to act out your dreams.
Sleep disorders. Some disorders that interfere with sleep are more common in people with Parkinson’s. These include restless legs syndrome, periodic leg movement disorder, and .
Nocturia. means having to urinate at night. People with Parkinson’s disease have a decreased ability to hold their urine. That could mean interrupting your sleep to get to the bathroom.
Depression. This is another condition that is more common in Parkinson’s. Depression can make you sleepy during the day and give you insomnia at night.
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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.
Are You A Carer
Sleep and night-time problems are almost twice as common among carers of people with Parkinsons than in the general population.
If you are caring for someone with Parkinsons, these sleep disturbances may lead to an increased risk of depression and stress.
It may be difficult sometimes, but if youre a carer its important to have good sleeping habits. This will help improve your health, wellbeing and general quality of life.
Much of the advice on this page applies to you as a carer as well as the person you care for.
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What Treatments Are Available For Parkinsons Psychosis
Your doctor may first reduce or change the PD medication youre taking to see whether that reduces psychosis symptoms. This is about finding a balance.
People with PD may need higher doses of dopamine medication to help manage motor symptoms. But dopamine activity shouldnt be increased so much that it results in hallucinations and delusions. Your doctor will work with you to find that balance.
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.
- Cartwright, R. . Dreaming as a mood regulation system. In: Principles and Practice of Sleep medicine. 4th edition, pps 565-572.
- Kumar, S., Bhatia, M., & Behari, M. . Sleep disorders in Parkinson’s disease. Mov Disord, 17, 775-781.
- Larsen, J. P., & Tandberg, E. . Sleep disorders in patients with Parkinson’s disease: epidemiology and management. CNS Drugs, 15, 267-275.
- Olson, E. J., Boeve, B. F., & Silber, M. H. . Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain, 123 , 331-339.
- Pappert, E. J., Goetz, C. G., Niederman, F. G., Raman, R., & Leurgans, S. . Hallucinations, sleep fragmentation, and altered dream phenomena in Parkinson’s disease. Mov Disord, 14, 117-121.
- Stacy, M. . Sleep disorders in Parkinson’s disease: epidemiology and management. Drugs Aging, 19, 733-739.
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What Causes Fatigue In Parkinson’s
The precise mechanisms that cause fatigue are unclear but research suggests that any neurological disorder which involves the basal ganglia area of the brain is likely to be associated with significant fatigue. This includes Parkinsons.
In some cases Parkinsons medication may be a factor, for example dopaminergic medications may affect sleep and so add to fatigue. Dosage and timing of medication may also affect energy levels.
Fatigue may be linked to other Parkinsons symptoms, for example depression. With depression there is usually also fatigue, as well as loss of motivation, a general lack of interest and difficulty in sleeping. It is important that these symptoms are recognised as they are very treatable, and overcoming them can reduce fatigue.
If you experience tremor, rigidity or dyskinesia your muscles will have to work harder in order to carry out simple movements or tasks which can mean muscles fatigue more quickly and easily. Slowness of movement may also increase fatigue by making activities and tasks more prolonged and effortful.
You may have sleep problems and poor quality sleep tends to lead to excessive day-time sleepiness and a tendency to nap. Although sleepiness is a separate symptom to fatigue, it clearly adds to the problem and fatigue is hard to overcome if you are sleepy.
Why Do Parkinsons Patients Sleep So Much
Parkinsonâs 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.
Parkinsons 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.
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Delusions From Parkinsons Disease
Delusions affect only about 8 percent of people living with PD. Delusions can be more complex than hallucinations. They may be more difficult to treat.
Delusions often start as confusion that develops into clear ideas that arent based on reality. Examples of the types of delusions people with PD experience include:
- Jealousy or possessiveness. The person believes someone in their life is being unfaithful or disloyal.
- Persecutory. They believe that someone is out to get them or harm them in some way.
- Somatic. They believe they have an injury or other medical problem.
- Guilt. The person with PD has feelings of guilt not based in real behaviors or actions.
- Mixed delusions. They experience multiple types of delusions.
Paranoia, jealousy, and persecution are the most commonly reported delusions. They can pose a safety risk to caregivers and to the person with PD themselves.
PD isnt fatal, though complications from the disease can contribute to a shorter expected life span.
Dementia and other psychosis symptoms like hallucinations and delusions do contribute to increased hospitalizations and increased rates of death .
One study from 2010 found that people with PD who experienced delusions, hallucinations, or other psychosis symptoms were about 50 percent more likely to die early than those without these symptoms.
But early prevention of the development of psychosis symptoms may help increase life expectancy in people with PD.
How Can I Help Myself
The general rule is to keep as mentally and physically active as possible. The following suggestions may be helpful:
- Plan your most vigorous activities around when your medication is most effective. You may find keeping a diary to track your symptoms and medication helps with timing when you are likely to be more mobile and energetic.
- Learn how to pace yourself, taking regular short rests and periods in which to relax throughout the day.
- If tasks are complicated or likely to take time, break them down into smaller stages so that you can rest between each stage. Share tasks if you live with someone and make use of labour saving devices such as a dishwasher or microwave.
- Recognise your limitations, identify the priorities of the day and get to know your energy reserves.
- Plan your major activities in advance and ensure that you have time for recovery afterwards. For instance, if you have a big social function such as a wedding, rest more in the days leading up to the event and also plan to have a few restful days afterwards.
- if you work, talk with your employer to see if you can take regular short breaks, even if its only to make a drink or talk with colleagues
Diet and exercise:
Sleep and rest:
Content last reviewed: May 2018
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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 Parkinsons 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.
The Relationship Between Parkinsons Disease And Sleep
Its unclear whether poor sleep causes parkinsonian symptoms to worsen or whether worsening parkinsonian symptoms cause poor sleep. In many cases its 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 Parkinsons disease. Parkinsons 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 Parkinsons 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.
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