Saturday, June 22, 2024

Insomnia And Parkinson’s Disease

Sleep Problems At Later Stages Of Pd

Parkinson’s Medications – Part 4: Medications for Insomnia

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.

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.

How Are Sleep Problems Diagnosed In People With Parkinsons Disease

If youre having problems sleeping, sit down with your healthcare provider to discuss the issue in detail. Your provider will ask you questions to better understand your symptoms.

Be prepared to explain when sleep disruptions happen and how they affect your life. Keeping a sleep journal for a few weeks can help you remember the details.

If your provider suspects you may have a sleep disorder, they may recommend you have a sleep study. This overnight test uses electrodes attached to your skin to track how your body functions when youre sleeping.

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Eeg/emg Analyses And Sleep Scoring

EEG/EMG analyses and sleep scoring methods followed those reported in the literature.,, In brief, all EEG/EMG recordings were split to consecutive 10 s segments, and each segment was categorized as wakefulness, REM sleep and non-REM sleep. The EEG power spectra were computed for each segment in the frequency range of 1 to 25 Hz by fast Fourier transformation. Wakefulness is defined by desynchronized EEG and absence of tonic EMG. NREM sleep is defined by synchronized EEG with high-amplitude or spindle rhythm activities and consists of low-frequency delta activities. REM sleep is defined by high rhythmic activity at theta band and relatively low EMG activity. A few EMG twitches can be found during REM sleep, which was calibrated by video recordings.

What Did Work For Me


At the same time as implementing the solutions below, I was already undertaking daily Block Therapy, the Safe and Sound Protocol sessions, and many breathing exercises, which have all been helping to lower, and continue lower, my pain and discomfort, my anxiety and my drug burden. I’m sure this has all also allowed me to sleep better in large part too. Also, even now, getting good rest still requires very strict adherence to sleep hygiene. For me this requires strictly no food or drink apart from water after 6 pm, no looking at computers or phone screens after 7:30 pm, being in bed for sleep before 10pm. In fact, according to the work of Dr Panda mentioned above, the time restricted eating in particular may have had a more significant impact on my sleep than I had realized.

What I’ve found really helped me start to resolve my total insomnia was the “Sleep RX” program of the Brain Tap app., which I first heard about in an episode of the Better Health Guy podcast. The app contains listening programs which consist of special combinations of guided meditations, hypnotherapy, tonal therapy and music. I started by listening to one of the half hour sessions mid-morning each day, after the first dose of PD medication has worn off, while I am in the âoffâ state. I quickly notice that the choice of the female voice worked better for me. After about a week, I found I was at least getting a couple of hours sleep a night.

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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.

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.
  • Watching stimulating or exciting content such as a movie or television program can also interfere with sleep. Its a good idea to avoid watching high-energy content in the hour or two before going to bed. This will also reduce your exposure to blue-light sources.
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    Parkinson’s Disease And Sleep

    Approximately two thirds of people with Parkinsons Disease experience one or more sleep-related symptoms, with insomnia being the most common. The neurodegenerative process in the brain, disturbances of the sleep-wake cycle, the effect of symptoms of Parkinson’s Disease on sleep, and having another sleep disorder such as restless legs syndrome, all contribute to sleep disturbances in people with Parkinson’s Disease.

    Sleep disorders often cause major discomfort in Parkinsons Disease. Not only is the persons health and quality of life affected, but so are their family members, especially if they are also carers. And we have little evidence to suggest that current practices work for long-term treatment of sleep-related problems in people with Parkinsons Disease. Despite the recognised impact of sleep disturbance in Parkinsons Disease, there have been few studies in this area.

    Restless Sleep May Be An Early Sign Of Parkinson’s Disease

    Sleep and Parkinson’s disease with Dr. Ron Postuma
    Aarhus University
    Patients with the RBD sleep behavior disorder lack dopamine and have a form of inflammation of the brain, researchers have found. This means that they are at risk of developing Parkinson’s disease or dementia when they grow older.

    Researchers from Aarhus University have discovered that patients with the RBD sleep behaviour disorder lack dopamine and have a form of inflammation of the brain. This means that they are at risk of developing Parkinson’s disease or dementia when they grow older.

    Do you sleep restlessly and hit out and kick in your sleep? This could be a sign of a disorder associated with diseases of the brain. Researchers from Aarhus University have studied the condition of the dopamine producing nerve cells in the brain and cells that participate in the brain’s immune system in people suffering from the sleep disorder Rapid eye movement sleep behaviour disorder, RBD.

    The study shows that patients suffering from RBD have a risk of developing Parkinson’s disease or dementia in the future, because they already suffer from a lack of dopamine in the brain. Parkinson’s disease occurs precisely because the group of nerve cells in the brain that produce dopamine stop working.

    “These patients have an inflammation of the brain in the area where the dopamine-producing nerve cells are found,” says one of the researchers behind the study, Morten Gersel Stokholm from Aarhus University and the PET Centre at Aarhus University Hospital.

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    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.

    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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    Contribution Of Socioeconomic Status To Insomnia And Excessive Daytime Sleepiness In Normal Aging And Parkinsons Disease

    Sleep disturbances are one of the main non-motor control symptoms of Parkinsons disease, and intuitively, it makes sense that they could be worse for people who must work shifts or juggle several jobs to make ends meet.

    No one has thoroughly studied the relationship between socioeconomic status, insomnia or daytime sleepiness, and Parkinsons disease until now.

    Faustin Armel Etindele Sosso, a PhD student at the Université du Québec

    à Montréal, is comparing data contained in the Canadian Longitudinal Study on Aging and the Quebec Parkinson Network to plot any relationship between the educational achievement, income, marital status and postal codes of people with Parkinsons in Canada who have these sleep disturbances.

    Etindele Sosso will also use questionnaires for people with Parkinsons disease to assess the duration and quality of their sleep, daytime sleepiness, anxiety, depression, and cognition.

    Sleep disorders have physiological impacts, says Etindele Sosso. After five or ten years, people who are not sleeping well will develop an issue with immunity and cognitive impairment. You also have a strong association between people who are not sleeping well with an increase in obesity, sleep apnea and diabetes.

    Given the association between sleep disorders and Parkinsons disease, Etindele Sosso wants to see how socioeconomic factors also affect the progression of the


    Conflict Of Interest Statement


    GL received honoraria for participation in clinical trial as sub-investigator from UCB Pharma PC received honoraria for speaking engagements or consulting activities from Allergan Italia, Lundbeck Italy, UCB Pharma S.p.A, Chiesi Farmaceutici, AbbVie srl, Eli Lilly and Company, Zambon FP received honoraria for speaking engagements or consulting activities from Sanofi and Bial. The other authors declare no conflict of interest.

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    Why Is It So Hard To Sleep Now That I Have Parkinsons

    Parkinsons can impact sleep in a number of ways, ranging from trouble falling or staying asleep at night to excessive sleepiness during the day. A good sleep boosts everything from your mood to your ability to think and process to your physical movement. Understanding sleep problems and Parkinsons is often the first step you can take to enhance your sleep.

    In this post, we help you learn more about sleep problems in Parkinsons and how you can improve your quality of sleep.

    Parkinsons can affect sleep in many different ways, including trouble falling or staying asleep, vivid dreams, waking up frequently during the night and excessive sleepiness during the day. Like other non-motor symptoms, sleep problems can appear before the more recognized motor symptoms, like tremor or stiffness.

    People with Parkinsons typically experience some combination of insomnia and sleep fragmentation . Studies have shown people with Parkinsons have different sleep patterns and that their deepest periods of sleep during the night are shorter and interrupted more often than people without Parkinsons. Often this is made worse by medications that may wear off during the night, causing painful stiffness, difficulty moving in bed or other symptoms to return and disrupt sleep.

    Sleep And Parkinsons Disease

    There are many sleep disorders that are associated with PD and that can be problematic throughout the disease course. These include:

    • Rapid eye movement behavior sleep disorder a sleep disorder in which the affected person is not paralyzed during dreaming and can therefore act out his/her dreams
    • Insomnia an inability to fall asleep at the beginning of the night or in the middle of the night upon awakening
    • Restless leg syndrome uncomfortable sensations, usually in the legs, which are temporarily relieved by movement of the legs
    • Sleep apnea a disorder in which breathing stops and starts through the night, leading to periods of low oxygenation in the blood and frequent awakenings
    • Sleep fragmentation brief arousals during sleep cause sleep to be less restful

    PD medications can interfere with sleep by causing:

    • Nightmares and vivid dreams
    • Sleep attacks

    Finally, there are motor and non-motor symptoms of PD that interfere with sleep. These include:

    • Tremor
    • Stiffness

    In addition to all the sleep issues listed above, people with PD often have fatigue, a complicated non-motor symptom of PD, characterized by a general lack of energy, which is sometimes present even in the face of what seems like intact and restful sleep. This can be due to many causes including PD medications, but can also be independent of medication use.

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    Strategies That Improve Wakefulness During The Day

    Non-pharmacologic interventions for EDS

    • Encourage daily exercise and activities a person without an activity planned is much more likely to doze than one who is engaged in an activity. Be realistic about scheduling a person with advanced PD, but aim for at least one scheduled activity a day
    • Light therapy Light therapy, in which a person is exposed to bright light via a light box, is used as a treatment modality for sleep disorders and psychiatric disorders not associated with PD. A small clinical trial testing its efficacy in PD was conducted and demonstrated an improvement in sleep and in excessive daytime sleepiness.

    Pharmacologic interventions for EDS

    There are no FDA approved medications for EDS in the context of PD. However, clinicians sometimes prescribe medication off-label for EDS. These include modafinil, methylphenidate, and caffeine. Istradefylline is a medication approved to treat motor symptoms of PD. A small trial demonstrated its potential improvement of EDS as well. Talk with your physician about the possibility of using a medication to maintain wakefulness during the day.

    Broken Rhythms And Light Therapy

    Parkinsonâs Minute 008 – Insomnia and Sleep Hygiene Tips Part 1

    A major part of the insomnia suffered by people with Parkinson’s Disease is that our body clocks are broken. In a very real sense, we are permanently severely jet-lagged, and our biorhythms are completely out of sync with the timing signals coming from the environment. This is reflected in our eyes and vision, which have a number of peculiar features, including being dark-adapted during the daytime, as if it was night. In his podcast episode, “Timing Your Light, Food, Temperature and Exercise”, Dr Huberman goes into details about these daily rhythms and how the body clock can be reset or the system recalibrated through timing exposure to changing light or temperature levels.

    Indeed, in numerous scientific studies now, strategically timed light therapy has been shown to be able to produce significant reduction in PD symptoms, by resetting the body clock and thereby improving sleep quality. I strongly recommend people with PD to at least worth giving light therapy a good go as a first step, not least because it can have other benefits, such as helping to reduce depression and anxiety. Indeed, before my crisis and subsequent hospitalization a couple of years ago, I had consistently used timed light therapy delivered via a wearable device to keep my sleep under control.

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