Parkinsons Disease And Sleep: Common Symptoms
Sleep problems can occur at any stage of Parkinsons disease. Some of the most common sleep problems for PD patients include:
- Insomnia: Difficulty falling or staying asleep
- Excessive daytime sleepiness: Feeling drowsy or fatigued during the day. In Parkinsons, sleeping all day is also common
- Nightmares or night terrors: Bad dreams that seem unusual for you
- Sleep attacks: Sudden, involuntary episodes of sleep, also known as narcolepsy
- Periodic leg movement disorder
- Restless leg syndrome
- REM sleep behavior disorder: Acting out dreams while asleep
- Sleep apnea: When breathing becomes obstructed during sleep
- Nocturia: Frequent night-time urination
When prescribing one of the drugs I take, my doctor warned me of a common side effect: exaggerated, intensely vivid dreams. To be honest, I’ve never really noticed the difference. I’ve always dreamt big. Michael J. Fox
A Woman With A Sandwich Board
When I first saw her at the Portland Patients Out of Time Conference on medical marijuana last year, Helen wore a sandwich board reading, Ask me about Cannabis & Parkinsons. She handed out flyers filled with evidence and advice and chatted amiably with the many who approached her.
A trustworthy-looking woman from Santa Cruz, California, Helen had that particular glint of activism in her eye. Coming up through the early ranks of Students for a Democratic Society the infamous SDS movement of the 60s New Left she became a filmmaker producing educational films to pay the bills and fund the documentaries she made from passion.
In one coup, Helen convinced a film distributor to green-light an educational film she made on the immune system, a topic about to explode in importance as the AIDS epidemic unfolded. It became a widely shown educational film for junior high school students and she turned it into the book The Immune System: Your Magic Doctor.
When a mishap during her fathers open heart surgery caused Helen to spend a week in the hospital with him, she noticed that everyone on staff looked at the machines but they never looked inside the head of the patient to see what was going on there. This led to years of research about the correlation between emotional reactions and illness. Coping with Illness was the book that followed.
I just get interested in stuff, Helen says. Once I learn about it, I share it with others. Thats the RBD study.
Clinical Features Of Insomnia
Insomnia is defined as difficulties initiating sleep , sleep maintenance problem or early awakening . In studies, it has been reported that the frequency of insomnia in patients with PD varies from 27 to 80% . It has been reported that the most common types of insomnia in PD patients are sleep fragmentation , and early awakenings . It has been reported that insomnia may occur alone or accompany comorbid mental or systemic illnesses, and it is associated with disease duration and female gender . Sleep fragmentation is defined as a deterioration of sleep integrity , and it leads to a lighter sleep or wakefulness . In studies, it has been reported that sleep fragmentation is the most common sleep disorder in patients with PD .
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What Is Rapid Eye Movement Sleep What Parasomnias Happen During This Sleep Stage
Rapid eye movement sleep follows the three non-REM stages of the sleep cycle. During REM sleep, your eyes rapidly move under your eyelids and your heart rate, breathing and blood pressure are all increased. This is a time when vivid dreaming occurs. Your body cycles through and repeats non-REM and REM sleep about every 90 to 110 minutes.
Parasomnias happen during the latter part of the night. If awakened during the event, its likely youd be able to recall part or all of the dream.
Parasomnias that happen during REM sleep include:
Other parasomnias include:
- AllyKeymaster
Has Parkinsons affected your sleep? Do you experience night terrors or wake up to find out from your partner that you were acting out your dreams in bed? Has this ever caused you or your partner harm?
Thats the subject of a recent column by Mary Beth Skylis, which you can listen to as a flash briefing here.
If this is something you have personal experience with, Id love to hear from you.
- January 13, 2022 at 7:31 pm#22947Participant
REM behavior disorder was one of my first clues that I have PD.
Whilst my wife is still game to share a bed with me she does so at some risk as I sometimes lash out . Keeping as far away on the opposite side of the bed helps mitigate the risk but means I am liable to roll over onto the floor!PD has a lot to answer for.
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Treatment Of Excessive Daytime Sleepiness In Pd
The first step in the treatment of EDS should be the correction of underlying conditions . For example, it may be useful to treat the conditions that disturb sleep quality at night or to arrange medications that cause daytime sleep episodes. After that, pharmacological treatment options for EDS should be considered. Nonpharmacological treatment approaches can be performed in the treatment of mild to moderate EDS cases . Modafinil is widely used for the symptomatic treatment of EDS, which appears to stimulate catecholamine production . Common side effects of modafinil are insomnia, headache, dry mouth, dizziness, nausea, nervousness, and depression . A review has reported that sodium oxybate and methylphenidate have inadequate evidence that they are effective in the treatment of EDS in PD . Amantadine and selegiline are reported to have an alerting effect . Thus, amantadine and selegiline may be preferentially used in PD patients with EDS.
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Parasomnias In Parkinsons Disease
In PD, parasomnias are quite common, and REM parasomnias are more common than those in NREM . As REM parasomnia in PD, RBD can be seen in near two-thirds of patients . In PD, non-NREM parasomnias can include sleepwalking, confusional arousals, and sleep terrors. However, NREM parasomnias are not a frequent cause of sleep disorders in PD .
The Importance Of Giving Medication On Time
The drugs available for Parkinsons replace the dopamine the body is not making naturally. The dosage has to be timed precisely.
They can have four lots of medicine during the day, and it has to be taken at the precise time. Twenty minutes makes a big difference. They will freeze and then it takes them a long time to unfreeze. If they are trying to manage their medication themselves, its difficult because they will take more medication to unfreeze themselves and are then unsure what dosage to take the next time, so medication management is very important.
Because the progress of the disease is so unpredictable, families find it hard to deal with.
Sometimes they get impatient they say you could do it yesterday, so why cant you do it today, you are just being lazy.
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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.
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.
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Sleep Disturbances Common In Parkinson’s Disease Can Be Early Indicator Of Disease Onset
- Date:
- IOS Press BV
- Summary:
- Up to 70% of Parkinsons disease patients experience sleep problems that negatively impact their quality of life. Some patients have disturbed sleep/wake patterns such as difficulty falling asleep or staying asleep, while other patients may be subject to sudden and involuntary daytime sleep attacks. A new article discusses the underlying causes of sleep problems in PD, as well as medications, disease pathology, and comorbidities, and describes the most appropriate diagnostic tools and treatment options.
Up to 70% of Parkinsons disease patients experience sleep problems that negatively impact their quality of life. Some patients have disturbed sleep/wake patterns such as difficulty falling asleep or staying asleep, while other patients may be subject to sudden and involuntary daytime sleep attacks. In the extreme, PD patients may exhibit REM-sleep behavior disorder , characterized by vivid, violent dreams or dream re-enactment, even before motor symptoms appear. A review in the Journal of Parkinsons Disease discusses the underlying causes of sleep problems in PD, as well as medications, disease pathology, and comorbidities, and describes the most appropriate diagnostic tools and treatment options.
The presence of other conditions common in PD patients such as depression, dementia, hallucinations, and psychosis may interfere with sleep. Unfortunately, some antidepressants can also impair sleep.
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Diagnostic Assessment Of Sleep Disorders In Pd
The history taken from the patient and its neighbors is very important in assessing sleep disorders in PD. The type of sleep disorder should be identified in the history, and information about possible related factors should be obtained from the history. In PD, general and specific scales can be used to investigate the subtype of sleep disorder and to determine its severity. Objective methods can be used to further investigate the diagnosis of these disorders. Further investigative techniques include sleep recording methods such as actigraphy or PSG. Polysomnographic findings of each sleep disorder have been explained in the relevant section. In addition, information about screening scales used in each sleep disorder has been described in the relevant section.
Actigraphy is an electrophysiological device that measures the movements of the patient during sleep by recording from wrist or ankle for many days. Actigraphy evaluates indirectly the circadian sleepwake patterns . It is especially used in circadian rhythm disorders or insomnia and prolonged daytime sleepiness .
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Symptoms Of Night Terror
As they differ from nightmares, people experiencing night terrors generally cant wake up and tend to stay asleep through the episode.
While nightmares occur during the rapid eye movement sleep, night terrors occur during the first-third of the sleep, aka slow-wave sleep.
Signs that a person is experiencing night terrors may include:
- Thrashing and flailing limbs
- Heavy breathing and sweating
Usually, the more terrifying the dream, the less likely a person is to remember it upon waking up.
At what age do night terrors stop?
Night terrors dont specifically end at a particular age. But they do tend to peak at around 18 months of age. And as the nervous system of a child develops, night terrors generally disappear.
Parkinsons Disease And Sleep Problems: Symptoms Treatments
Parkinsons disease and sleep issues affect around 75% of patients. Despite the importance of sleep when dealing with a long-term illness, most people with PD experience sleep issues at some stage of their condition. Sleep problems often occur long before motor symptoms have begun, making them one of the first signs of Parkinsons disease. Some of the most common sleep problems in PD are insomnia, restless leg syndrome and excessive daytime sleepiness. Parkinsons can also cause night-time disturbances such as sleep apnea, bad dreams and frequent night-time urination. Let’s explore Parkinson’s disease and sleep problems in more detail.
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The Trouble With Levodopa
One of the most common treatments for Parkinsons is Levodopa. Often referred to as L-DOPA, it was the medication featured in the Robert DeNiro-Robin Williams film Awakenings, based on Oliver Sacks account of waking up patients permanently asleep from encephalitis lethargica.
Levodopa can be produced in a lab but it already occurs widely in nature across animals, plants and humans. In our brains, it serves as the precursor for the production of adrenaline, noradrenaline and dopamine. When administering an IV drip to human patients in the early 60s showed dramatic results, levodopa rose to become the prominent treatment of the last 30 years.
One advantage of the drugs delivery is that, unlike dopamine, levodopa crosses the blood-brain to be converted in the midbrain. The drugs ability to reduce early motor symptoms of the disease became one of the key tools in deciding on a diagnosis of Parkinsons.
Robert started his treatments and responded well to the first line of levodopa.
Parkinsons is often broken down into two stages: The first, where levodopa gives anywhere from some relief to almost complete reduction of symptoms, and a second, where the levodopa itself causes motor complications .
More accurately, Helen later observed, the smoked cannabis didnt seem to present any additional relief over the still reasonably effective levodopa in their early experiments.
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.
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What Sleep Issues Do People With Parkinsons Face
Research shows that sleep disorders are a major issue for people living with PD, affecting up to 75 percent of those with the condition.1,2 In our survey, 47 percent of the respondents reported trouble sleeping and/or insomnia as a symptom that they have experienced in the last month.
Experts have found that many people with PD also experience:1-3
- Leg movements, jerking, and cramping, or restless leg syndrome
- Worry or anxiety
Numerous survey respondents said they have a combination of sleep issues, leading to frustration about rest. Here is a look at some of the sleep challenges they frequently experience.
Bizarre Sleep Disorder Linked To Alzheimers And Parkinsons
People with a bizarre sleep disorder that causes them to kick, punch and cry out while dreaming are at dramatically increased risk of developing Alzheimers or Parkinsons diseases, a new study reports.
Little is known about the disorder, called REM Sleep Behavior Disorder, but it is thought to mainly affect men in their 50s, 60s and 70s. It occurs when the brain activates the muscles during the REM, or rapid eye movement, stage of sleep. During REM sleep, the time when dreaming occurs, the eyes move rapidly and breathing continues, but muscles elsewhere in the body become frozen.
People with REM sleep behavior disorder, in contrast, act out and vocalize their dreams. It is different than night terrors, in which people have serious nightmares, or sleepwalking. It also differs from sleep apnea, a fairly common sleep ailment that causes the airways to collapse and people to temporarily stop breathing many times during the night. One recent study found that treating sleep apnea could help to ease the symptoms of Alzheimers disease.
The new research suggests that the REM sleep disorder may be an early symptom of Alzheimers, Parkinsons or other serious brain disease. The findings appeared in the medical journal Neurology.
The researchers calculated that people with the sleep disorder are at more than 40 percent risk of developing a serious brain ailment within 10 years, and more than 50 percent after 12 years. In those without the disorder, the risk is less than 5 percent.
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Parkinsons Disease Sleep Disorders: Treatment And Tips
If youre experiencing sleep problems in Parkinsons disease, your doctor may suggest changing or altering your medication. Some medications act as stimulants and can keep you awake. Others may wear off at night and cause a worsening of PD symptoms. If this happens, your doctor may suggest switching you to a drug thats delivered to your body continuously, such as skin patches or levodopa infusions.
If changing your medication doesnt help, you may be referred to a specialized sleep clinic. You may also need certain breathing equipment during the night if your sleep apnea is severe.
There is plenty you can do to improve your sleep health. Here are some tips to overcoming sleep disturbances in Parkinsons disease:
- Dont drink water for a couple of hours before bed
- Create a relaxing night-time routine that doesnt involve talking about heavy topics before sleep, watching TV or eating a heavy meal before you lie down
- Enjoy a warm bath in the evening before you go to bed
- Do something relaxing before sleep, such as reading or listening to an audiobook
- Get plenty of fresh air and exercise throughout the day, though you should avoid activity at least 2 hours before bed
- If possible, make sure your bedroom temperature is between 60-65 degrees Fahrenheit
- Reduce noise and light in the bedroom