Beating The Lockdown Blues
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.
Sleep Attacks And Medication Side Effects
In the last 10 years, the phenomena of sleep attacks in PD, defined as an event of falling asleep suddenly, unexpectedly and irresistibly while engaged in some activity have received a great deal of attention.
Compared to levodopa, the ergot agonists and non-ergot D2-D3 dopamine agonists show an increased risk of daytime sleepiness and episodes of unintended sleep . With the exception of a dose-related effect, levodopa is generally not sedating in PD or DLB . In a sample of 6,620 PD respondents to a questionnaire, 42.9% reported the sudden onset of sleep that was predicted by exposure to a non-ergot dopamine agonist . Factors contributing to sleepiness with dopamine agonists include older age, male gender, history of sleep problems, cognitive impairment, dysautonomia and an overall higher dopaminergic load . Unlike levodopa, the ergot and non-ergot dopamine agonists are more likely to aggravate cognitive impairment and may elicit or intensify hallucinations .
Polysomnography data reveal that sleep attacks are objectively characterized as intrusions of non-REM stage 1 and 2 sleep, and a subset are represented by microsleep episodes, which last 15-120 s . Whether sleep attacks are truly abrupt and occur in the absence of a history of sleep disturbance is a point of contention, particularly since patients often have reduced awareness of daytime sleepiness and microsleep episodes are often not perceived by patients .
Deep Brain Stimulation Of The Subthalmic Nucleus
Long-term STN-DBS may improve sleep quality through decreased nocturnal mobility and reduction of sleep fragmentation . Therefore, STN-DBS seems to be an effective therapeutic option for the treatment of advanced PD because it improves the cardinal symptoms and also seems to improve sleep architecture.
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Talk To Your Doctor About Sleep
Here are some questions to ask yourself:
If so, this might be a good time to approach a neurologist with your concerns. You might have a medication side effect to address, a hidden sleep disorder, or other health condition that needs treatment.
Evaluation Of Sleep Hygiene Program: Sleep Diary
Monitoring the effectiveness of behavior changes is best done by keeping a diary. The table below depicts a sample diary that could be kept by the bedside and filled out upon arising by the patient or caregiver. If daytime sleepiness and napping are problems, items can be added to record the number, time, and duration of napping episode. The diary can be carried with the patient.
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Mechanism Of Arousal In Parkinson’s Disease And Dementia With Lewy Bodies
Lewy body disease affects the brainstem and hypothalamic sleep-wake centers, and the pathology affects multiple neurotransmitter systems . Saper et al. have provided data and a theoretical framework for a neuroanatomic flip-flop switch that regulates the transition from sleep to wakefulness. It includes mutually inhibitory elements responsible for sleep initiation, and brainstem nuclei that promote arousal. One hypothesis for the daytime somnolence in PD and DLB may be associated with the disruption of the wakefulness centers, but perhaps also to damage to the mechanism that switches and maintains wakefulness, presumed to reside in the hypothalamic hypocretin neurons. Involvement of the latter may lead to difficulty keeping the arousal switch in place, which may result in trouble maintaining wakefulness and/or frequent brief transitions of sleep into wakefulness, or microsleeps.
Restless Legs Periodic Limb Movements And Sleep
Both drug-naïve and drug-treated PD patients may develop a syndrome of nocturnal restlessness resembling RLS and periodic leg movements during sleep, whereas RLS has been reported to occur in PD at a rate twice the normal prevalence of RLS in general population .
Sleepy PD patients may also have day-time somnolence because of sleep-disordered breathing, and formal polysomnography will identify sleep apnoea in a considerable number of such patients . Obstructive sleep apnoea may occur in up to 50% of patients with PD with resultant daytime sleepiness and tiredness. Sleep apnoea may co-exist with RLS or PLM or RBD . This is important to diagnose as these patients need specific and targeted treatment.
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Things That Can Cause Seniors With Parkinsons To Sleep A Lot
By Annette Campbell 9 am on April 29, 2020
Sleeping throughout the night is difficult for many seniors with Parkinsons, often due to symptoms like restless legs syndrome and depression. Because seniors with Parkinsons may have difficulty resting at night, its common for them to experience daytime sleepiness, which also affects their bedtime routines. Take a look at some of the reasons seniors with Parkinsons rest so much and what you can do to help your elderly loved one develop better sleeping habits.
Long Naps And Parkinson’s Risk Factor
Research published in Innovation in Aging in 2017 looked at unplanned naps among people aged 65 or older and found that almost 60 percent of those surveyed took unplanned naps. Almost 20 percent of the same baseline population took long naps of more than 1 hour. Both groups napping behaviors were associated with poorer self-reported health and a higher number of chronic conditions.2
Some research also points to naps as being associated with a higher risk for developing PD among older men.3 The International Journal of Epidemiology published a study that found that men who napped at least an hour every day were more likely to develop PD. Fortunately, it appears that napping for 30 minutes or less did not result in the same risk factors for PD.
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The Critical Difference Between Sleepiness And Fatigue
Fatigue is a physical or psychological feeling where people feel weary and exhausted and lacking energy. EDS is about needing and having the urge to sleep.
Fatigue is something that people can experience along with EDS however, people who experience fatigue on its ownthe feeling of being tired and out of energy do not also necessarily fall asleep when sedentary, as people who experience EDS often do.
It is estimated that EDS affects up to 50% to 75% of people living with Parkinsons and fatigue is estimated to affect 40% to 60%. Fatigue, however, is more likely to go undiagnosed.
Because the terms fatigue and sleepiness are so heavily linked, and sometimes used interchangeably, research has concluded that fatigue and EDS should be assessed separately in people with Parkinsons so that we can improve our understanding of their overlapping physiology.
With that knowledge, researchers from the University Hospital of Zurich, Switzerland designed a study to determine the overlap between fatigue and EDS and then associate them with other motor and non-motor symptoms as well as dopaminergic medication.
In their study of 88 outpatients, the researchers found that 72% experienced fatigue or EDS and just under half experienced both. Some of the key findings of the study include:
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.
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Parkinsons Sleep Problems: Diagnosis And Treatment
Parkinsons disease is chronic and progressive, meaning it tends to get worse over time. However, there are treatment options that can help manage symptoms and allow patients to get more restful sleep.
The simplest way to start sleeping better with Parkinsons disease is by adopting healthy sleep habits. Sleep hygiene tips for Parkinsons disease sufferers include:
- Sticking to regular bedtimes
- Following a consistent bedtime routine with soothing activities such as listening to music or reading a calming book
- Getting regular exercise, preferably early in the day
- Getting adequate exposure to light, whether outdoors or through light therapy
- Avoiding long naps and naps late in the day
- Creating a cool, dark, and comfortable sleeping environment
- Restricting bedtime activities to sex and sleep only
- Turning off screens an hour before bedtime
- Reducing liquid intake before bedtime
- Avoiding caffeine, alcohol, and tobacco
- Eating a healthy diet and avoiding large meals at night
Light therapy, exercise, and deep brain stimulation have been successfully used to improve overall sleep quality and to treat specific conditions, such as REM sleep behavior disorder, in patients with Parkinsons disease. Cognitive behavioral therapy for insomnia has proven effective at reducing insomnia in healthy adults, although further research is needed on the effects of CBT in patients with Parkinsons disease.
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Potentials Ways To Reduce Fatigue
- Exercise. It may seem counterintuitive get moving if youre feeling fatigued however, the right kind and the right amount of exercise can significantly reduce fatigue. Experiment. Sometimes just getting out the door for a walk in the fresh air can reduce fatigue.
- Talk to your doctor if you think you may be depressed. Its possible that an anti-depressant could reduce fatigue.
- Plan your time. Identify when you tend to have the most energy throughout the day and plan to get your most important jobs done then.
- Be realistic, but still do something. If youre feeling extra exhausted on a certain day, dont put pressure on yourself to accomplish everything you planned. Do somethingbecause accomplishing something will give you an energy boost but be realistic about what youre capable of doing.
- Delegate. Its not easy. You may have concerns about being a burden to others. Most people will be thrilled to help. Let them.
- Organize and declutter. Opening up spacephysically, emotionally, mentally and logisticallycan help you reduce stress and as a result reduce feelings of fatigue.
- Connect with others. We know that when you feel wiped out that the last thing you want to do is attend a support group meeting or event, but connecting with others in a positive way has the potential to not only make you feel supported and encouraged and loved, but it may very well give you the exact bump in energy that you need.
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Why Do Parkinsons Patients Sleep So Much
Parkinson’s patients experience difficulties with their sleep due to the disease itself and the medications that treat it. This can lead to increased sleepiness during the day.
Parkinsons disease can cause problems with sleep, and the medications used to treat it can cause even more. Difficulties sleeping during the night can cause daytime sleepiness, and the medications can also cause drowsiness. This disruption to the circadian rhythms can lead to more frequent, lower quality 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.
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Sleep: A Mind Guide To Parkinsons Disease
This 36-page booklet explains normal sleep patterns, the body clock, how much sleep we should get, challenges to sleeping well, tips for good sleep hygiene, and sleep in normal aging before discussing symptoms, diagnosis and treatment of sleep disorders, including insomnia, REM sleep behavior disorder, sleep apnea, restless leg syndrome, and daytime sleepiness.
Hallucinations And Rem Sleep Disorders In Parkinson’s Disease
At timestamp 1:58 in this recording of Thrive: HAPS 2020 Caregiver Conference, you will find a one hour talk by neurologist Joohi Jimenez-Shahed, MD. In it she delves into what REM sleep behavior disorder is and is not, and the distinctions between hallucinations, delusions, and delirium. Managment options for RBD and hallucinations are included.
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Planned And Unplanned Napping
Planned napping is an important concept to consider here. Unplanned, or unintended, napping is not the same thing and may be a cause for concern. Unintended sleep episodes can be a dangerous side effect of not getting quality nighttime sleep or could be related to medication side effects. When one suddenly falls asleep, this is a sign that the body and brain are dealing with something out of balance.
These sudden sleep episodes can occur during driving or while performing other tasks where safety may be of concern. Sudden sleepiness, as a regular feature of living with PD, can also disconnect people from activities they love and interfere with time spent with family. Unplanned naps may not be a solution for EDS if they are long-lasting, inconsistent, and do not result in waking up refreshed and energized.
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
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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.
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.
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Medication Not Working The Way It Used To
In the early stages, taking medicine works well to get rid of symptoms. But as Parkinsons progresses, your medication works for shorter periods of time, and symptoms return more easily. Your doctor will need to change your prescription.
Dr. Valerie Rundle-Gonzalez, a Texas-based neurologist, says to pay attention to how long your medicine takes to kick in and when it stops working. She says you should feel like symptoms significantly improve or are almost gone while on medication.
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.
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