Friday, March 1, 2024

Parkinson’s Disease And Sleep Disorders

Treatment For Parkinsons Disease

Sleep Disorders in Parkinson’s Disease: Dr. Andrew Berkowski

Theres no cure for Parkinsons Disease, but carers and loved ones can help manage symptoms of the patient. When it comes to treating the disease, different measures are used.


Medications can be used to manage the disease. People with Parkinsons Disease in Australia usually avail of prescriptions for dopamine levels to reach the brain and stimulate it. Some of these are levodopa, dopamine agonists, glutamate antagonist, and anticholinergics.


Physiotherapy helps improve muscle tone, range of motion, coordination, balance, and mobility. It boosts muscle strength that helps curb tremors. The general purpose is to enhance patient independence, health, and safety, thus, improving the quality of life and sleep.


In certain cases, brain surgery might need to be performed such as in the case of severe tremors or restlessness. If medication is not effective in controlling involuntary movements, it might be best for surgery. Deep brain stimulation has become popular recently. It generates electrical currents to disrupt signals that cause tremors. However, it doesnt cure Parkinsons Disease.

Self-help measures

There are self-help measures that can be practiced to improve the quality of life of someone who has Parkinsons Disease such as eating a nutritionally-balanced diet, exercising, and sleeping soundly at night.

What Is Rem Sleep Behavior Disorder

It may seem like sleepwalking, but RBD is, by definition, not a sleepwalking disorder. RBD involves dream enactment behavior.

The difference between sleepwalking and RBD is subtle, but important: sleepwalking typically takes place in non-REM and transitional stages of sleep, whereas RBD takes place during REM sleep.

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.

Read Also: Parkinson’s And Muscle Cramps

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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Solving the Sleep Problems Caused by Parkinson

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Also Check: Non Shaking Parkinson’s Disease

Possible Causes Of Excessive Daytime Sleepiness:

  • Poor nighttime sleep all the sleep disorders and PD symptoms that interfere with sleep that were mentioned above can lead to non-restorative sleep at night. This can in turn lead to an overwhelming urge to sleep during the day
  • Medication side effect
  • Neurodegeneration in the areas of the brainstem that are responsible for maintaining wakefulness
  • Neurodegeneration may also occur in the area of the brain that controls circadian rhythms a system of regulation of the sleep-wake cycle and any other process, including hormonal release and body temperature fluctuations, that varies according to the 24-hour clock. If the circadian rhythm mechanism is impaired, the sleep-wake cycle may be interrupted. In its most extreme form, people with advanced PD may have a complete reversal of their day and night.

Treatment for EDS: a two-pronged approach:

  • Improving nighttime sleep as much as possible
  • Trying strategies that improve wakefulness during the day

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.

Recommended Reading: Do All Parkinson’s Patients Get Dementia

Can Melatonin Treat Other Symptoms Of Parkinsons Disease

People with Parkinsons disease who take melatonin tend to have fewer symptoms of less severity than those who do not take it. For a long time, this was attributed to the restorative nature of adequate sleep. However, we now know that melatonin is not only a sleep-inducing hormone but a neuroprotective one as well. Although it is still being researched, melatonins neuroprotective qualities are believed to actually slow the progression of PD, delaying the neurological damage that causes the progressive loss of neuromuscular function.

The circadian rhythm, or the bodys roughly 24-hour cycle, is also an important factor to consider in the timing of administration of other medications taken by people with PD. COMT inhibitors, for example, are a common drug class used to treat Parkinsons disease. These absorb in far higher levels when taken in the morning, thus offering more therapeutic effect. Because the treatment of PD is complicated, it is important to take drugs at times when they will be most effective.

Studies in the field of chronobiology are offering new treatments for some of mankinds most difficult diseases. People with Parkinsons disease may soon get the sleep they need to function as well as more effective treatments due to a better understanding of this diseases effects on the circadian rhythm.

Meds That Improve Some Symptoms Can Exacerbate Others

Sleep Problems and Parkinson’s Disease

SAN ANTONIO — Roughly three out of four people living with Parkinson’s disease also have sleep disorders, and there is growing recognition that sleep problems are greatly complicated by the disease, its symptoms, and the many medications used to treat it.

“Sleep disorders are among the most common non-motor symptoms in PD, and sleep is something clinicians have to continually monitor when considering medication dosing,” Scott Kutscher, MD, of Stanford School of Medicine in California, told MedPage Today.

“Sleep issues can appear years before the classic motor symptoms of Parkinson’s, but it has only been relatively recently that sleep has become part of the diagnostic workup of the disorder,” he added.

Insomnia, excessive daytime sleepiness, sleep fragmentation, circadian rhythm disorders, restless leg syndrome, and rapid eye movement behavior disorder are all common in patients with Parkinson’s disease.

Although there is some debate about whether having PD increases the risk for obstructive sleep apnea , a recent review of the literature found an increased frequency of OSA and other sleep-disordered breathing conditions associated with the neurodegenerative disorder.

One mechanism suggested for this association is that upper airway musculature may be affected by involuntary movements characteristic of the disease, resulting in abnormal spirometry and upper airway obstruction.

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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 .

Maintain And Invest In Quality Bed Products

Your bed might be the culprit on how to sleep better at night! Is the mattress soggy? Is the frame creaky? Are your pillows making your head itchy? Invest in quality products at Solace Sleep for a good nights sleep. We have a collection of mattresses, bed frames, and adjustable beds that will improve sleep quality by reducing lower back pain, lumbar, and spine stiffness.

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Avoid Caffeinated Drinks And Stimulants

Caffeine keeps you awake, so avoid caffeinated drinks for four to six hours before going to sleep. Likewise, alcohol can increase awakenings and decrease sleep quality at nighttime. Similarly, one should refrain from smoking too close to sleeping time because it inhibits how to sleep better at night.

Deep Brain Stimulation In The Treatment Of Sleep Disorders In Pd

Sleep Issues in Parkinsons Disease

Studies investigating the effect of DBS in the treatment of sleep disorders in PD patients showed that DBS improved the sleep scales and quality . Baumann-Vogel et al. found that subthalamic nucleus DBS-enhanced subjective sleep quality, reduced sleepiness measured by the Epworth sleepiness scale, and reduced sleep fragmentation shown by actigraphy recordings. However, the authors observed that subthalamic DBS was not improved REM sleep features . Similarly, Cicolin et al. reported that RBD symptoms did not benefit from STN DBS. On the other hand, Chahine et al. reported that STN DBS improved significantly symptoms of RLS in PD patients. The effect of PPN DBS on sleep disorders in PD has been investigated in several studies . One study showed that PPN DBS improved sleep quality and reduced EDS however, it caused a reduction in REM latency and a relevant increase in REM sleep . In another study, it has been reported that PPN DBS improved the total duration and rate of REM sleep . As a result, DBS seems to be beneficial in the treatment of sleep disorders in PD because it seems to be useful in improving sleep quality. However, large-scale prospective studies are needed to understand the benefits of DBS in the treatment of sleep disorders in PD.

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Symptoms Of Parkinsons Disease

The disease shows various symptoms at different severeness. The ones mentioned below are the more common ones:

  • Tremors or shaking of the head, arms, or legs
  • Stiffness of trunk, legs, and arms
  • Slowed movement or difficulty in mobility
  • Difficulty in coordination and balance
  • Trouble speaking or eating
  • Sleep-related symptoms are shown below:

  • Insomnia
  • Body pain or low mobility when sleeping
  • Do You Or Did You Suffer From A Sleep Disorder How Has Having Parksinons Impacted Your Ability To Get Quality Rest Ask Questions And Share Your Knowledge Of Pd In Our Forums

    More serious sleeping disorders may also occur such as sleep apnea or REM sleep behavioral disorder. Around 40 percent of people living with Parkinsons disease will experience sleep apnea when breathing becomes obstructed while asleep. The common symptoms of this are loud snoring, pauses in breathing, restless sleep, and feeling very tired during the day. Sleep apnea can be controlled using breathing equipment continuous positive airway pressure throughout the night.

    REM sleep behavioral disorder is where the muscles dont fully relax while dreaming, therefore the person is likely to act out their dreams. This can include hitting, kicking, grinding teeth, and shouting. Around half of those living with Parkinsons experience this but in most cases it can be improved with medication.

    MORE: How Parkinsons disease affects your body.

    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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    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 .

    What To Do If Rbd Is Suspected

    Sleep and Parkinson’s Disease

    While REM sleep behavior disorder may occur in conjunction with, or as a predecessor to, certain neurological disorders such as Parkinsons disease, it can also result from medication usage.

    If you or a loved one is concerned about RBD, contact a movement disorder neurologist or sleep disorders specialist, such as the experts available at Michigan Medicine, for an evaluation.

    Recommended Reading: Difference Between Tremors And Parkinson’s

    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.

    New Pd Subtypes In Development

    New classifications of patients with PD may improve both diagnostics and the accuracy of predicted outcomes.

    A newly developed system of three subtypes focuses on the severity of key motor and non-motor symptoms and highlights RBD as a relevant non-motor marker.

    Thomas Warner MD told Medscape Medical News recently that We have found that it is possible to accurately predict prognosis, disability, and survival of patients with Parkinson’s disease by classifying them into different clinical subtypes at the time of diagnosis.

    Warner, senior author of a new study published in January 2019 at JAMA Neurology, defines these subtypes as:

  • Mild-motor predominant . These patients experience motor problems their prognosis and survival rates are considered the best.
  • Diffuse malignant . These patients experience a combination of motor and non-motor problems theyre more likely to follow a more aggressive disease progression.
  • Intermediate . These patients dont fit inside criteria 1 or 2 with expected outcomes fall somewhere in between.
  • People with PD who also have RBD will likely fall into subtype 2. However, this distinct symptom can help chart a clearer treatment path and prepare you for a more aggressive clinical approach.

    Recommended Reading: Neurostimulator For Parkinson’s Disease

    Sleep Related Breathing Disorders

    There was no significant difference in the AHI between PD patients and controls . The mean central apnea index was extremely low and clinically insignificant in both groups . 49.1% of PD patients had OSA compared to 65.7% of controls. 15.1% of the PD patients had mild OSA, 18.9% had moderate OSA, and 15.1% had severe OSA. In controls 37.3% had mild OSA, 19.4% had moderate OSA and 9.0% had severe OSA. 96.2% and 38.4% of PD patients with OSA reported snoring and feeling unrefreshed on waking from sleep respectively, and 40% had abnormal ESS scores. On MSLT 26.9% of PD patients with OSA had abnormal daytime sleepiness. Snoring was the only significant predictor of OSA in the multivariate analysis .

    Diagnosis Of Individual Sleep Problems And Their Management

    Sleep Issues in Parkinsons Disease

    RLS and / or PLMD

    RLS is diagnosed by specific criteria laid down by the international RLS study group:

    Essential Criteria:

    • Urge to move legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs.

    • Symptoms begin or worsen during periods of rest or inactivity such as lying or sitting.

    • Symptoms are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.

    • Symptoms are worse in the evening or at night than during the day or only occur in the evening or night.

    The diagnosis of PLMD can be suspected clinically, typically with the bed partner complaining of jerky limb movements occurring periodically every few seconds or minutes. This does, however, need to be confirmed through an overnight polysomnography.


    Although treatment strategies essentially remain the same for RLS and PLMD in PD as in other patients, with dopamine agonists and Levodopa, the main challenge often is to control symptoms, when patients are already on high doses of these agents for PD. Improvement of RLS symptoms following bilateral subthalamic nucleus stimulation in patients with PD, has been reported.


  • The patient has a complaint of violent or injurious behavior during sleep.

  • Limb or body movement is associated with dream mentation.

  • At least one of the following occurs:

  • Harmful or potentially harmful sleep behaviors

  • Dreams appear to be acted out

  • Sleep behaviors disrupt sleep continuity

  • Treatment:

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    Get Your Daily Dose Of Vitamin D

    Getting some sunshine can balance your circadian rhythm. Lighting can play a huge role in your sleep. Sunlight can promote alertness and suppresses the melatonin hormone, thus, making you awake during the daytime. If youre feeling sleepy, take a walk or move your desk a little bit closer to the window.

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