Sleep Medication For Parkinson’s

Favor Sleep Therapy Over Sleep Medication

Patients with Parkinsons disease may develop a multitude of sleep problems.

Whilst not all patients need drugs, it is still necessary to identify and treat sleep dysfunction at the earliest.

Treatment of sleep dysfunction begins with the observance of good sleep hygiene practices.

If you still have difficulty falling asleep, try behavioral modification techniques.

These include relaxation techniques such as progressive muscle relaxation, hypnosis, and guided imagery.

If you are having problems getting to sleep due to anxiety, then follow the sleep hygiene practices and other techniques in my guide to getting to sleep with OCD thoughts here.

3.1: Try Sleep Therapy

You can also try other techniques such as sleep restriction therapy and cognitive behavioral therapy.

These are especially useful if your sleep schedule is very erratic.

On day one of sleep restriction therapy, you have to stay out of the bedroom till 3 AM.

On subsequent nights, go to bed 15 minutes earlier until the target bedtime is reached.

In cognitive-behavioral therapy, a psychotherapist will help you replace unwanted thoughts with positive ones.

3.2: Only Use Sleep Medications as a Last Resort

If you are non-responsive to sleep therapy, sleep medicines may be useful.

Over-the-counter medicine such as melatonin taken 1-2 hours before bedtime may useful for some patients.

In severe cases, your doctor may prescribe a short-term course of sleep drugs.

Valerian Root And Other Herbal Supplements

A quick tour in the supplement aisle at a grocery store can give you a dizzying array of herbal supplements advertised to improve sleep. Valerian root is one of the most widely recognized. Although it has the potential for significantly enhancing sleep, people often experience residual sleepiness the next day.

Typically, you will find products combining several different compounds. The ability of these different compounds to induce sleep has not necessarily been studied, particularly in people living with Parkinsons. If youre interested in trying one of these products, consult your doctor with a list of the ingredients before attempting to incorporate them into your sleep routine.

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 Parkinsons 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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Extend The Clinical Benefit Of Your Treatment

Asking your neurologist to extend the clinical benefit of your PD medication can help you to get better sleep because this will reduce the amount of time that the medication is less effective and thus inhibit the reemergence of symptoms that would otherwise prevent you from getting to sleep.

More specifically, replenishing the dopamine deficit in the brain is the treatment of choice in PD.

Treatment involves the use of drugs to restore this balance.

Levodopa is the most common drug used to treat PD .

Over the long term, levodopa causes wearing-off and on-off episodes.

Wearing-off is the loss of clinical benefit before the time for the next dose.

The on-off effect refers to the sudden transition between states of mobility and immobility.

They cause re-emergence of clinical symptoms that can prevent you from falling asleep.

They may also stop you from being able to change your sleep position, awakening you from sleep.

1.1: Ask Your Neurologist to Adjust Your Treatment to Extend its Effect

There are several ways to extend the duration of the clinical benefit of your Parkinsons Disease treatment.

Adjusting drugs by changing the dose and frequency is the most common method.

The use of extended-release drugs and continuous infusion pumps may be other options.

For selective patients, deep brain stimulation surgery may be more beneficial.

Your neurologist will help you choose among these options.

Alternative Therapies May Help With Parkinsons And Sleep

There is limited proof available that acupuncture, qigong, and bright light therapy can help PD patients to sleep better.

Qigong is based on the Chinese philosophy of meditation, coordination, and deep rhythmic breathing.

There are many systems of this exercise.

A modern adaptation of qigong is tai chi.

Few studies have reported that 45 to 60 minutes of qigong exercises done at least 4 times a week improves sleep and other non-motor symptoms of PD.

BLT is believed to restore circadian rhythmicity and is known to be useful in patients with depression and insomnia.

Studies on small groups of patients with PD have also demonstrated this positive effect of BLT on sleep and mood.

However, further research is necessary to establish the role of BLT.

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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.

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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Rem Sleep Behavioral Disorder

Rapid eye movement, or REM, sleep is the part of the sleep cycle when dreaming occurs. Usually the only part of the body that moves during REM sleep is the eyes.

• People with rapid eye movement sleep behavior disorder do not have the normal relaxation of the muscles during their dreams. Therefore, they act out their dreams during REM sleep.
• People with RBD may shout, hit or kick their bed partner or grind their teeth. Sometimes, in moderate to severe RBD, people may have aggressive, violent behaviors, like getting out of bed and attacking their bed partner.
• About half of people with PD suffer from RBD. It may develop after or along with the motor symptoms, but in most cases, it precedes the PD diagnosis by five to 10 years.

What Is Carbidopa And What Is It Used For

Carbidopa is a medication always used in combination with levodopa used to treat Parkinsons disease, a degenerative movement disorder.

Carbidopa is used to increase the bioavailability of levodopa by preventing it from breaking down before it reaches the central nervous system . This helps in enhancing the CNS effects of levodopa with a relatively lower dosage, while reducing its peripheral side effects such as nausea and vomiting.

Carbidopa belongs to a class of medications known as decarboxylase inhibitors. Carbidopa works by inhibiting the aromatic amino-acid decarboxylase enzyme which converts levodopa into dopamine. Carbidopa also inhibits the metabolism of levodopa in the gastrointestinal tract. These two actions prevent the breakdown of levodopa into dopamine peripherally and allow the maximum amount of drug to reach the brain.

Dopamine cannot cross the blood-brain barrier, whereas levodopa can get into the brain tissue where it gets converted into dopamine and exerts its effects. Dopamine is an important chemical with multiple functions including the regulation of movement, memory, and emotions. Carbidopa cannot cross the blood-brain barrier, hence its effects on decarboxylase enzyme is only peripheral and it does not affect dopamine synthesis in the brain.

Carbidopa is used with levodopa or carbidopa-levodopa combination drug for Parkinson’s disease in patients:

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Guide To Parkinsons Disease And Sleep

Parkinsons disease is caused by a complex interaction of environmental and genetic factors.

It is the second most common degenerative disorder and affects 2% of people over the age of 65 years.

It is a progressive disorder that worsens with time.

The cardinal symptoms of PD are due to the loss of dopaminergic neurons in specific areas of the brain.

These include slow movements, tremors, muscle stiffness, and balance problems.

Patients with PD also have non-motor symptoms.

These include smell and taste problems, pain, fatigue, bladder and bowel symptoms, restless leg syndrome, sleep disorders, swallowing difficulty, excessive salivation, double vision, speech problems, mood symptoms, and postural drop of blood pressure.

The diagnosis of PD is clinical and no tests offer absolute diagnostic certainty.

The diagnosis is especially difficult in the initial stage of the disease.

MRI and DAT scans are often used to differentiate PD from other disorders.

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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How Are Sleep Problems Treated In People With Parkinsons Disease

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.

Effect Of Melatonin On Pd

Two studies reported the effect of melatonin on RBD in patients with PD. In a 12-week, randomized, double-blind, placebo-controlled study, the weekly CIRUS-RBD Questionnaire , was used to assess the efficacy of melatonin on RBD in patients with PD the results showed that the number of RBD events after treatment with 8 weeks of 4 mg PRM was not reduced between groups . The results showed that the number of nights in which a dream enactment event occurred during RBD events was not significantly different between groups . In another randomized, double-blind, placebo-controlled, multicenter trial, Ahn et al. used the RBD screening questionnaire to investigate the efficacy of PRM in patients with PD. Coincidentally, the study of Ahn et al. also showed that the RBDSQ scores after treatment with 4 weeks of 2 mg PRM did not differ from baseline in either group . Results of the qualitative analysis are shown in Table 2.

Table 2. Effect of melatonin vs. placebo on sleep disorders in Parkinsons disease.

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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.

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.

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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.

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The Impacts Of Insomnia On Those With Parkinsons Disease

Sleep disorders are one of the most common non-motor symptoms of people living with Parkinsons disease. In fact, research shows that sleep disorders affect approximately 64 percent of people with PD. Of that percentage, up to 80 percent deal with insomnia a far higher percentage than the general population who live with sleep difficulties.

While insomnia refers to the inability to fall asleep or stay asleep, sleep issues can lead to a host of issues, including the following medical conditions:

• Fatigue and excessive daytime sleepiness
• Increased stress

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Diagnosis And Treatment Of Parkinsons Sleep Problems

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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Why Do Parkinsons Patients Have Trouble Sleeping

Despite having daytime tremors, Parkinsons patients do not shake in their sleep. However, both Parkinsons disease itself and the medications used to treat it can give rise to a number of sleep problems that lead to insomnia and excessive daytime sleepiness.

Patients with motor symptoms may have trouble adjusting sleeping positions to get comfortable. Others may experience distressing nocturnal hallucinations when trying to fall asleep. These may be a result of medications or cognitive impairment.

In turn, excessive daytime sleepiness may occur as a consequence of sleeping poorly at night. It may also be triggered by medications. Parkinsons patients who suffer from EDS may be at a higher risk of accidents and unable to safely carry out activities such as operating a motor vehicle.

Since insomnia frequently goes hand-in-hand with anxiety and depression, it may be a contributing factor to sleep problems in people with Parkinsons disease. For that reason, doctors often look for mental health disorders in people with Parkinsons disease who have sleep problems.

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