Monday, July 15, 2024

Parkinson’s Disease And Sleep

Sudden Onset Of Sleep And Eds

Sleep and Parkinson’s Disease

Sudden onset of sleep may warrant other measures, and those with high sleepiness scores should be advised to drive cautiously and not to drive alone or for long distances . Dopamine agonists when started should be titrated up slowly especially in older patients, and patients with excessive day-time sleepiness may respond to an alternative agonist. In patients with severe EDS, concurrent medications that may be sedating should be eliminated or reduced. Formal sleep studies may be required in some patients, and in those with a narcolepsy-like phenotype, modafinil may be useful. Modafinil, a sleepwake cycle activator, is non-stimulating and is the only drug which has shown efficacy in improving EDS without detrimental effect on PD when examined in double-blind placebo-controlled trials . A 7-week double-blind placebo crossover study of 200 mg modafinil followed by a 4-week open-label extension study by Adler et al. showed significant improvement in ESS with modafinil and improvement in clinical global impression scores for wakefulness in the open-label arm. Where EDS is thought to be secondary to the use of dopamine agonists, modafinil may allow the continuation of dopamine agonist therapy.

Video And Electromyography Movement Analysis

We determined the presence or absence of RBD in this group of patients through interviews, video and sleep monitoring using international criteria . Alternatively, if no motor behaviour was observed in the video, we required the presence of REM sleep without atonia lasting > 30% of the REM sleep time and a history of dream enactment . Sleep measures that were recorded included total sleep time, sleep efficiency , per cent of non-REM sleep N1, N2 and N3+4 stages, percentage of REM sleep , percentage of REM sleep without atonia .

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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Clinical Correlates Of Sleep Disorders

Comparisons of the main demographic and clinical characteristics between PD patients with and without a PSG sleep disorder is shown in Table 3. Sleep disorders were more prevalent in males . Regarding sociodemographic and clinical characteristics among men and women with an abnormal PSG, women showed a trend to be treated more frequently with a dopaminergic agonist .

Table 3

Sleep apnea-hypopnea syndrome was more prevalent in males as well as in overweight patients . RBD was also more frequent in males .

In the logistic regression analysis the characteristics associated with SAHS were age and BMI . Regarding RBD, current age , motor onset on the left side and LEDD were the main predictors. No associated factors were identified for PLM.

No statistically significant association were found between the PSG diagnosis and the SCOPA-Sleep diurnal , SCOPA-Sleep nocturnal or SCOPA-Sleep total .

Diagnostic Assessment Of Sleep Disorders In Pd

Solving the Sleep Problems Caused by Parkinson

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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The Neurophysiology Of Sleep In Parkinson’s Disease

Department of Neurology, University of California, San Francisco, San Francisco, California, USA

Correspondence to: Dr. Hengameh Zahed, MD, PhD 505 Parnassus Ave., Box 0114, M-798, San Francisco, CA 94143, USA E-mail:

Department of Neurology, University of California, San Francisco, San Francisco, California, USA

Correspondence to: Dr. Hengameh Zahed, MD, PhD 505 Parnassus Ave., Box 0114, M-798, San Francisco, CA 94143, USA E-mail:

Relevant conflicts of interest/financial disclosures:: Drs. Zahed, Zuzuarregui, and Little have no financial disclosures or conflicts of interest. Dr. Gilron consults for Rune Labs and is funded by NIH grant UH3NS100544 . Dr. Denison is a technical consultant for Synchron, Cortec Neuro and has received speaker fees from Medtronic Inc. and stock in Medtronic and Bioinduction . Dr. Starr has research support from Boston Scientific Inc. and Medtronic Inc.

Funding agencies: : Funding was provided by the Defence Advanced Research Project Agency – grant number HR001118S0041.

Search Strategy And Selection Criteria

The English-language literature was searched with the Medline database to identify articles pertaining to the epidemiology, characteristics, aetiology, diagnosis and treatment of sleep-related problems associated with PD. Bibliographies in articles and books were also used to identify relevant publications.

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Daytime Tips For Better Sleep

  • Wake up at the same time every day, using an alarm if you have to.
  • Get out of bed right after you wake up. Too much time spent in bed can lead to more waking at night.
  • Eat regular, healthy meals, and eat at the same time every day. Three to four small meals are better than 1-2 large meals.
  • Limit daytime napping to a 40-minute NASA nap . Too many or too-long naps can make sleep at night more difficult.
  • Do not drink coffee, tea, sodas, or cocoa after noon. They contain caffeine and can interfere with normal sleep.
  • Do not drink alcohol after dinner. It may help you fall asleep faster, but makes sleep shallower later in the night. Alcohol can also make snoring and sleep apnea worse.
  • Use caution when taking headache and cold medicines. Some contain stimulants that can affect sleep.
  • Stop smoking. Cigarette smoking stimulates the body and makes sleep difficult.
  • Increase or start doing daily exercise. Regular exercise helps to deepen sleep. Avoid heavy exercise 2 hours before bedtime.

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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Rem Sleep Parasomnia In Parkinson’s Disease And Dementia With Lewy Bodies

REM sleep behavior disorder was first described by Schenck et al. and is characterized by a loss of normal muscle atonia during REM sleep associated with coordinated limb movements that mirror dream content. The actions made during REM sleep can be quite vigorous and themes often include defending oneself or others , though not exclusively , and may be associated with injuries. There seems to be far greater male representation in RBD, though it is unclear whether this reflects a referral bias, hormonal effects or a genetic relationship to the underlying pathology. The treatments of choice are clonazepam and more recently, melatonin .

It is important to distinguish RBD from other parasomnias or sleep disorders through polysomnography for proper intervention and to ensure that other sleep conditions are not present that may mimic RBD or that may be exacerbated with the use of clonazepam. For example, severe OSA may include flailing of the limbs and hollering, and nocturnal wandering, confusional arousals and sleep walking , may also be hard to distinguish from RBD without polysomnography. Patients are often unaware of their sleep behavior, and it is crucial to obtain information from a bed partner or somebody who has witnessed the patient’s sleep.

RBD in PD has been associated with orthostatism and non-tremor predominant parkinsonism . Those with PD and RBD are more likely to have cognitive impairment and an earlier onset of dementia than PD patients without RBD .

Parkinsons Disease: The Unusual Early Warning Symptoms Found In The Way You Sleep

Parkinsons disease is a condition that affects the brain. It causes problems like shaking and stiffness that get worse over time. Sleep disorders, however, are one of the most frequent non-motor symptoms of Parkinsons disease , usually increasing in frequency over the course of the disease and disability progression.

According to the Mayo Clinic: Rapid eye movement sleep behaviour disorder is a sleep disorder in which you physically act out vivid, often unpleasant dreams with vocal sounds and sudden, often violent arm and leg movements during REM sleep sometimes called dream-enacting behaviour.

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.

With this study, we have gained new knowledge about the disease processes in the brain in the early initial stages of the disease development.

The idea is for this knowledge to be used to determine which patients with the sleep disorder will later develop Parkinsons disease.

At the same time, this is also knowledge that can help to develop drugs which can stop or slow the development of the diseases, explained Morten Gersel Stokholm about the sleep disorder which most often affects people aged 50-70, and more frequently men than women.

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Classification Of Sleep Disorders In Parkinsons Disease

Sleep disorders in PD may occur during the day or at night. In PD, sleep disorders can be classified into three major categories such as abnormal behaviors and events during or around sleep , inability to sleep , and EDS . These three categories of sleep disorders can be seen separately or together .

NREM parasomnias
Inability to sleep/sleeping difficulty
  • Initial insomnia

  • Maintenance insomnia

  • Terminal insomnia

Treatment Of Excessive Daytime Sleepiness In Pd

More Than Movement: Treating Sleep Problems in Parkinsons

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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Tips For Better Sleep

  • Keep a regular sleep schedule go to bed at the same time and get up at the same time.
  • Choose your bedtime based on when you want to get up. Plan to spend seven to eight hours a night in bed.
  • Make a bedtime routine for example, snack, bath, tooth-brushing, toileting and follow it every evening.
  • Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 p.m.
  • If you cant get outdoors, consider light therapy sitting or working near a light therapy box, available at drug stores and department stores.
  • If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 p.m.
  • Sleep in a cool dark place and use the bed only for sleeping and sexual activity.
  • Do not read or watch television in bed.
  • Use satin sheets and pajamas to make moving in bed easier.
  • Minimize drinking liquids for three hours before bedtime to avoid frequent nighttime urination.
  • Go to the bathroom immediately before retiring.
  • Place a commode next to the bed, to minimize the effort, and light to get up during the night.
  • Avoid:
  • Alcohol, caffeine and other stimulants such as nicotine
  • Heavy late-night meals
  • Heavy exercise within six hours of bedtime
  • Thoughts or discussions before bedtime about topics that cause anxiety, anger or frustration
  • Clock watching
  • Screen time television, phones, tablets one or two hours before bed.

The Related Factors Of Sleep Benefit In Parkinsons Disease: A Systematic Review And Meta

  • Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing original draft, Writing review & editing

    Affiliation Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China

  • Roles Data curation, Investigation, Methodology, Software, Validation

    Affiliation Digestive Department, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China

  • Roles Data curation, Resources, Software, Supervision, Validation

    Affiliation Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China

  • Roles Conceptualization, Data curation, Formal analysis, Software

    Affiliation Department of Neurology, The First Hospital of Jilin University, Chang Chun, Ji Lin Provence, China

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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.

Whats The Relationship Between Parkinsons And Sleep

Sleep Problems and Parkinson’s Disease

Parkinsons disease and sleep are connected in complex ways that not even scientists completely understand quite yet.

Sometimes, Parkinsons disease directly causes sleep problems. According to one study, sleep-related symptoms may be one of the earliest signs of Parkinsons disease. These signs may include things like thrashing while youre asleep.

Other factors can also play a role. One thing is clear: For many people with Parkinsons disease, a restful nights sleep can be hard to find.

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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.

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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.

Pathophysiology Of Rbd In Pd

REM sleep is regulated by the brain stem, hypothalamus, thalamus, substantia nigra, basal forebrain, and frontal cortex . The brain stem structures involved in REM sleep include the pedunculopontine nucleus , retro-rubral nucleus, subcoeruleus/sublateral dorsal nucleus, and medullary magnocellular reticular formation . These brain stem structures provide REM atonia by inhibiting the spinal motor neurons through direct and indirect pathways . Thus, these two inhibitory pathways play a role in skeletal muscle atonia during REM sleep . The PPN and the retro-rubral nucleus also act as a phasic generator circuitry . It is well known that the PPN/laterodorsal tegmental nuclei have both cholinergic activity and non-cholinergic activity. So the PPN/LDN also contains glutamatergic and GABAergic neurons . On the other hand, the cholinergic neurons in the PPN/LDN innervate the pontine reticular formation , MRF, and thalamus . Thus, descending projections of the PPN stimulate the inhibitory interneurons via the reticulospinal neurons and inhibit directly the motor neurons in the spinal cord and modulate the activations of the mesencephalic locomotor region . It has been reported that inhibition of GABA activity in the PPN, an important part of locomotion, results in explosive motor behavior . In addition, the ascending projections to the thalamus from the PPN modulate the sleep

19 ].

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