Sunday, July 21, 2024

How Do You Sleep With Parkinson’s

Beating The Lockdown Blues

Sleep Problems and Parkinson’s Disease

Did you knowBodily functions are heavily influenced by biological clocks which are distributed throughout your body . Your clocks primary role is timing and orchestrating your bodys everyday vital functions and aligning these to geophysical and social schedules. Disruptions to your daily routine derail your clock which reflects negatively on your mood, energy, sleep, digestion, heart and immune system, just to name a few!

With COVID-19-related lockdowns causing unanticipated disruptions to our routine, Researchers at the University of Queensland have developed some guidelines to stay on a schedule to improve sleep and support your health and wellbeing.

Tremor In Other Conditions

While tremor is a common symptom of Parkinsons, it can also be a symptom of other conditions, most notably essential tremor. The main difference between Parkinsons tremor and most other types of tremor is that in Parkinsons resting tremor is most common. Other conditions are usually characterized by action tremor, which tends to lessen at rest and increase when youre doing something, like trying to make a phone call or take a drink.

Tremors of the head and voice are also common in essential tremor but rare in Parkinsons.

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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Diagnosis Of Excessive Daytime Sleepiness In Pd

In patients describing the symptoms of EDS, it is very important to determine the level of sleepiness. The Epworth Sleepiness Scale is widely used in the evaluation of EDS. Thus, ESS is a useful scale for the subjective assessment of sleepiness in patients with EDS .The ESS contains eight items, and each item is rated as maximum three points. A higher score means more sleepiness level. In addition, there are objective tests such as multiple sleep latency test and maintenance of wakefulness test for assessment EDS. The MWT is evaluation used as a polysomnographic measurement of EDS. The MSLT is measured after a PSG performed in the night to assess nighttime sleep quality and quantity . One study found that the risk of traffic accidents increased in PD patients with an ESS score greater than 7 .

The Different Stages Of Sleep

How To Sleep Better With Parkinson
  • 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.

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Insomnia And Motor Symptoms Of Pd

Nocturnal motor symptoms of PD frequently contribute to insomnia and can occur in over 60% of patients . This includes symptoms of tremor, dystonia, akinesia, and restlessness. One study evaluated a cohort of 412 patients with PD, 209 of whom had trouble with initiation of sleep or fragmentation during the 5-year study . Motor fluctuations of tremor and rigidity were significantly associated with difficulty falling asleep, obtaining too little sleep and awakening too early in this study. Immobility in bed due to hypokinesia from PD has also been associated with an increased wake after sleep onset . One study evaluated nocturnal mobility in patients with PD by using an accelerometer and number of turnover movements in bed . Turnover movements were negatively correlated with increasing disease duration, levodopa equivalent daily dose, modified Hoehn and Yahr ratings, and UPDRS III scores . This would suggest that sleep dysfunction due to motor symptoms is not as prominent early in or with a less severe disease state.

Completion Of The Pdss

Patients, or caregivers , completed the PDSS, based on their experiences in the past week. Patients were asked to fill in the PDSS either in the consultation room or at home involvement of the caregiver was encouraged. The severity of symptoms was reported by marking a cross along a 10 cm line . Responses were quantified by measuring the distance along each line to the intersection with the cross in centimetres, to the nearest 0.1 cm. Thus scores for each item range from 0 to 10 . The maximum cumulative score for the PDSS is 150 .

Evaluation and calculation of the data were done by SP, AD, RM, and FRP. As the PDSS is employed as part of routine clinical practice and audit in the outpatient clinic assessment of patients with Parkinsons disease, the institutional ethics committee agreed that specific ethical approval was not required for this study.

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Sleeping Easy With Parkinsons Disease

What is Parkinsons Disease ?

Parkinsons Disease is a movement disorder that targets the nervous system of the body. The disease is caused by nerve cell damage in a section of the brain known as the substantia nigra, which subsequently reduces the levels of the chemical dopamine being produced. Dopamine is crucial for smooth control of muscles and movement.

People with this chemical imbalance experience a range of symptoms which can be categorised into motor and non-motor.

Motor symptoms can include:

  • slowing of movements and decreased range of movement
  • stooped posture
  • Fatigue
  • Sexual problems

A 2018 study found between 60-98% of PD patients suffer from sleep disturbances, making it the most common non-motor symptom.

Carers may also be affected by the sleep difficulties of their loved one.

Can PD be cured?

Unfortunately a cure for PD has not been found yet.

At present the main goal of therapy is to slow down progression of the disease so that people can maintain a better overall quality of life for as long as possible.

How can PD symptoms be treated?

There are two broad ways this can be achieved medical and non-medicinal.

Non-medical treatments and management provide a plethora of options, with the underlying aim being to stay active and healthy and promote mobility.

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Studies On The Activity Of Melatonin In Animal Models Of Parkinsons Disease

Sleep and Parkinson’s Disease

Besides the degeneration of DA-containing neurons in the substantia nigra pars compacta , PD is considered a progressive disease that affects various neurotransmitter systems. A major argument in this respect is the demonstration that Lewy bodies are located not only in DA neurons but also in raphe nuclei serotonergic neurons, in brainstem noradrenergic neurons and in specific cholinergic neurons all over the CNS . Non-motor symptoms in PD, like gastrointestinal, genitourinary and cardiorespiratory disorders, neuropsychiatric, visual, and sleep-related disorders and anosmia can thus be explained. In fact, since the preclinical non-motor phase of PD can span more than 20 years, the importance of neuroprotection in this regard is evident.

Microglial activation, astrogliosis, and lymphocytic infiltration are the inflammatory patent of PD . The aggregation of fibrillar -synuclein is typical of PD and other Lewy body diseases . Mitochondrial dysfunction plays a role in this process, as free radicals promote protein folding and aggregation.

TABLE 1. Effects of melatonin in animal models of PD.

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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.

Prepare Your Sleeping Area

Reduce excess light and noise. Consider using a sleep mask to help block out additional light.

A slightly cool environment will help you fall asleep and stay asleep .

It may be helpful to incorporate satin or silk pajamas or sheets if you find it difficult to move in bed. Working with a physical therapist and consulting with your doctor to optimize your medications so that they provide relief throughout the night can also help.

Some people find it beneficial to have a bit of background noise in their bedroom, often called white noise. In addition to using an actual source of white noise like a fan, there are recordings and even smartphone apps available with various meditations and white noise designed to help you fall asleep.

If you do a simple Internet search for white noise, you will find a number of free resources, including recordings on YouTube and apps for all different types of smartphones. You could also buy an MP3 directly on your smartphone, tablet or computer via the Apple App store or or purchase a CD at a local bookstore or other retailer. Your local library may be able to help you locate some free resources as well.

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The Need For An Instrument Such As The Pdss

Work from our own group and others indicates that the aetiology of nocturnal disabilities in Parkinsons disease is multifactorial and that nocturnal motor symptoms are of importance. Traditionally, sleep assessments in Parkinsons disease have taken the form of pure subjective questioning or, in some cases, measurement of sleep architecture. These techniques, however, do not provide a holistic assessment of the night time problems of sufferers from Parkinsons disease. It can be arguedgiven the importance of sleep function in this diseasethat assessment of night time problems requires a specific instrument similar to the UPDRS. The PDSS aims to provide this. Some currently available tools, including the ESS, only address single items such as excessive daytime sleepiness and are thus not comprehensive. In a study of excessive daytime sleepiness and its potential relation to sudden onset sleep in 638 patients with Parkinsons disease, Lang et al recently concluded that the ESS has poor sensitivity for predicting falling asleep while driving, and may not be appropriate for assessing susceptibility to unintended sleep episodes. Other studies have indicated that ESS scores do not correlate significantly with multiple sleep latency test scores, thought to be the gold standard for measuring sleep, and especially REM sleep latency during the daytime. Thus we feel the PDSS may offer a more practical and relevant way of assessing sleep disruption in Parkinsons disease.

Whats Missing In Parkinsons Disease Treatments

Why Do Parkinson

Dr. Abraham Hoffer andDr. Harold Foster believe that there is a second step missing from currentmedical Parkinsons Disease treatments.

They found that this second setof Parkinsons symptoms diminished voluntary movements and increasedinvoluntary movements can indeed be delayed, reduced and even prevented.How?

Dr.Foster explains:

I believe that there are twotypes of symptoms seen in Parkinsons disease patients:

The first set is effectivelytreated with L-Dopa.

This second set of Parkinsons symptoms is different:

  • Even with medication, the situationworsens with the appearance of a second set of symptoms, thataccording to Drs. Foster and Hoffer, seems to result from thederivatives, such as the dangerous toxin dopachrome, that is produced by thebreakdown of dopamine.

As a result, slowly but surely, the L-Dopa increases these secondarysymptoms until the patient becomes demented and often dies.

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Changes In Sleep With Aging

As people age, they experience a number of changes in their circadian rhythms, and among the most noticeable are the changes in the sleep-wake cycle. Older people tend to wake up earlier and go to bed earlier than they did when they were younger. They wake up more often during the night and have more difficulty going back to sleep than younger people. They also tend to sleep more during the daytime hours. Therefore, if one looks at total sleep time over the 24-hour day, the total time spent sleeping changes very little but the distribution of sleep may be quite different. Younger people experience a consolidated nighttime episode with little or no daytime sleep, whereas older individuals experience sleep episodes throughout the 24-hour day. Daytime sleepiness is affected by two major factors: the amount and quality of nighttime sleep, and the strength of the circadian rhythm. In addition, older people tend to have a reduced amount of N3 or deep slow wave sleep.

Bladder Issues And Waking Up To Use The Restroom

Bladder issues are common in people with PD, and some survey respondents shared that they often wake up with the urge to urinate. Studies show that anywhere from 30 to 40 percent of people with PD have urinary problems.5

One respondents experience included:

The 4th Annual Parkinsons Disease In America survey was conducted online from May to August 2020. 1,472 people completed the survey.

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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.

How Are Sleep Problems Treated In People With Parkinsons Disease

Parkinson’s Disease, Sleep and Me

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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How To Take Action And Improve Your Sleep

  • Protect your bedroom. Avoid blue light , preserve your circadian rhythm and dont interfere with natural melatonin production. If you get anxious about not being able to sleep and you find yourself watching the clock, remove any visible clockfaces from view in the bedroom.
  • Prepare your sleeping area. Reduce light and noise, cool the temperature of your room and consider using a white noise machine or app to lull you to sleep.
  • Set a sleep schedule and develop a routine based on whats optimal for you. Make sure to follow a regular bedtime and wake-up time, even on the weekends, because consistent sleep patterns will help you in the long run.
  • Limit your daytime naps. If you do find yourself needing to nap, try to schedule it for 7-9 hours after youve woken up in the morning and limit it to 20-30 minutes so that you dont impede your sleep the next night.
  • Watch when and what you eat. Many people with Parkinsons have constipation and/or acid reflux , so tailoring your diet to avoid exacerbating those problems can also help you sleep. Avoid spicy or acidic foods, avoid too much protein and avoid sugary snacks or caffeine .
  • Limit your liquids. Be extra careful about consuming caffeine and alcohol, especially close to your bedtime. Caffeine competes with adenosine and therefore keeps you awake rather than letting you fall asleep. Alcohol, though it may put you to bed faster initially, actually ends up causing lower sleep quality and can make you wake up more often.
  • Insomnia And Nonmotor Symptoms Of Pd

    Depression and anxiety affect between 30 and 60% of PD patients and appear to result from neurotransmitter changes as the disease progresses . Although early research suggested that decreases in dopamine and norepinephrine were involved in the development of depression in PD, recent literature suggests that serotonin plays a more prominent role . The presence of poor sleep and mood disturbances appears to have a reciprocal relationship, with the presence of one appearing to worsen the other . One study evaluated 98 patients with and without PD using the Insomnia Severity Index and Beck Depression Inventory to measure the impact of insomnia on depression . Total sleep time in patients with PD appeared to have a greater correlation with depression severity than that in controls which could reflect a synergistic effect of depression and PD on sleep duration .

    Fig. 1

    Treatment flow chart for insomnia in Parkinsons disease . Motor symptoms from PD such as tremor, dystonia, and rigidity can contribute to insomnia. The treatment of nocturnal symptoms typically employs long-acting forms of antiparkinsonian medication to last through a night of sleep. Nocturia is a symptom of PD that can significantly disrupt sleep and may be treated with behavioral modification and medications with low side effect profiles. Mood disturbances commonly contribute to insomnia and may be treated with a combination of nonpharmacologic measures and antidepressant medication

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