How To Get To Sleep With Parkinsons Disease
Article written and researched by Dr. Albert Stezin a clinician and neuroscientist who has co-published a paper called Overview of Sleep Disturbances and their Management in Parkinson Plus Disorders to ensure uniqueness and maximum factual accuracy.
Almost 64 to 90% of patients with Parkinsons disease have sleep disturbances.
And the associated cumulative sleep debt can have a serious negative impact on the quality of your life if not addressed properly.
So how do you get better sleep if you have Parkinsons disease?
To sleep better with Parkinsons disease: talk to your neurologist about extending the clinical benefit of your treatment, limiting the side effects of levodopa and MAO-B/COMT inhibitors, treating non-motor symptoms, and trying sleep therapy instead of sleep medication. Adjustable beds can help mobility significantly.
The rest of this article expands on these points more fully so that you can get better sleep if you have Parkinsons disease in 5 steps.
However, you should always consult with your neurologist, doctor, or another qualified medical professional to decide on the correct course of action for your unique situation.
Need an adjustable bed? The mobility benefits of an adjustable bed can make it much easier to move around and get in and out of bed pick from the best adjustable beds to buy online here .
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 .
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Understanding The Side Effects Of Sleeping Tablets
Sleeping tablets dont just affect sleep they may also make you feel drowsy or heavy in the morning, or anxious during the day.
They may interfere with your ability to perform some everyday tasks . The effects you may have will depend on the type of medication and dose taken. Older people are often given lower doses of sleeping tablets as they tend to be more sensitive to their effects.
Many people assume sleeping tablets will help them function normally the next day, but there is little scientific evidence for this. Rather than improving your alertness during the day, some sleeping tablets may actually make your memory and concentration worse.
For example, Benzodiazepines can affect your memory, particularly at night. People may wake up several times during the night, but do not remember doing so in the morning.
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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.
What Else Can I Do To Sleep Better With Parkinsons Disease
Practicing healthy sleep hygiene habits may also promote more restful sleep.
- Get outside during the day. Bright light tells your body its time to be awake.
- Keep your body moving during the day. Even if all you feel up to is a short walk or two, all physical activity offers benefits.
- Try at-home remedies, such as massage or a warm bath. Relaxing your mind may help your body fall asleep.
Dont:
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How Can Parkinsons Medication Impact Sleep
You may find that your symptoms get worse as your Parkinsons medication starts to wear off.
This may lead to stiffness, tremor, pain and being unable to move and turn in bed. When you take your next dose of medication, your symptoms may be less noticeable again.
If your medication is often wearing off during the night and is causing you problems, you may need to switch to a form thats delivered to your body continuously. Examples are skin patches, an apomorphine infusion or an intrajejunal levodopa infusion .
The continuous delivery means you get constant treatment throughout the night. Speak to your specialist or Parkinsons nurse for more advice.
If changing your medication doesnt help, your GP, specialist or Parkinsons nurse may suggest referring you to a specialist hospital centre or sleep clinic for a sleep test.
But its important that you dont stop taking your medication before you talk to a health professional, as this could be dangerous.
What Is The Best Walker For Parkinsons Patients
If you are looking for the best Walker for Parkinsons Patients, I recommend you to go for Drive Medical Folding Walker. The best thing about Drive Medical Folding Walker is that its extremely lightweight due to its aluminum frame. Also, it comes with a foldable design, which makes it easier to carry it while traveling.
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Brain Changes Can Disrupt Sleep In Pd Patients
The exact cause of sleep disturbances in PD is not completely understood.
The pathophysiological changes begin in the back of the brain and spread to the front.
Hence, the brainstem gets involved earlier in the disease than other areas.
The brainstem has the reticular activating system which controls the sleep-wake cycle.
The RAS also communicates with other areas of the brain using many different neurotransmitters.
Brainstem involvement can change the neurotransmitter balance and modulate the activity of other areas.
This imbalance may manifest as sleep disturbances.
The use of dopamine agonists can produce sleep disturbances by altering neurotransmitter function.
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Rem Sleep Behavior Disorder With Parkinsons Disease Can Be A Nightmare
Acting out dreams could indicate REM sleep behavior disorder. What you should know about the symptoms, diagnosis and treatment.
Certain sleep disorders are common in people with Parkinsons disease.
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One of them REM sleep behavior disorder is a condition characterized by the acting out of dreams that are vivid, intense and violent. People have been known to yell or talk while asleep, carry on conversations or hit themselves or their bed partner. Even if physical damage does not occur, the condition can be frightening for the bed partner to witness.
REM behavior disorder does not necessarily disrupt the quality or quantity of sleep itself. But it is potentially harmful because of the physical movements involved.
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Good Night: Sleep And Parkinsons Disease
Lack of good sleep can worsen Parkinsons symptoms. In this 45-minute lecture, Dr. Rafael Zuzuárregui addresses causes of sleep loss and the latest treatments for: insomnia, restless leg syndrome, REM sleep behavior disorder, nocturnal urination, hallucinations, wearing off of medication, dystonia and sleep apnea.
Poor Sleep Seems To Worsen Parkinsons Symptoms
Parkinsons disease and DLB are often considered to lie on the same continuum of disorders marked by toxic buildup of the alpha-synuclein protein in the brain. While they share common symptoms, including movement and cognitive impairments, cognitive problems tend to develop more quickly in DLB.
Both conditions are marked by sleep disruptions, including REM sleep behavior disorder .
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Inflammatory Markers Sleep Disorder Linked In Parkinsons
The lower number of cycles among Parkinsons patients relative to the other two groups could be associated with medication use. Again, the differences between groups were lost when medications were accounted for in the analyses.
A greater degree of motor dysfunction in Parkinsons patients might also play a role, although this was not measured in the study, the team noted.
No sleep measurements differed significantly when comparisons were made between patients with or without RBD regardless of disease type, which suggests that disease differences could play a larger role in arousals and sleep cycle duration changes than the presence of RBD, the researchers wrote.
That hypothesis would merit confirmation from larger sample studies and comparison with a non-neurological control group, the team concluded.
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.
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Effect Of Melatonin On Insomnia
Three studies used the PSQI scale to assess the subjective sleep quality of patients with PD. However, only two studies reported the mean and SD of PSQI scores at the end of treatment. One study showed that compared with baseline and the placebo group, the PSQI score significantly improved in patients with PD treated with 4 weeks of 2 mg prolonged-release melatonin . These results showed that in the PRM group, the mean change in the PSQI score at the end of treatment was 1.75 . We also found that in the PRM group, the PSQI subcomponents improved, including subjective sleep quality , sleep latency , and sleep disturbance . However, in the Ahn et al. study, the mean and SD of PSQI scores after treatment could not be extracted. Therefore, we performed a qualitative analysis in our study.
Two studies reported the mean and SD of PSQI scores. Our meta-analysis results showed that compared with the placebo group, the subjective sleep quality of patients with PD had a significant improvement after receiving melatonin treatment . A fixed-effects model was applied.
Figure 3. Forest plot of the efficacy of melatonin on the subjective sleep quality of patients with PD.
The results of TSA on the data of PSQI scores at the end of treatment are shown in Figure 4. The accumulated Z value of the meta-analysis crossed both the TSA boundary value and the traditional boundary value before the required information size of 140 was reached.
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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Sleep Disturbances Are Common In Pd Patients
Sleep problems constitute the second most frequent non-motor symptom of PD.
They occur due to many reasons.
Sleep disturbances most commonly arise due to inadequate treatment, a side-effect of drugs, and/or neurodegeneration.
These sleep disturbances may be either nocturnal or diurnal in occurrence.
The nocturnal disturbances include insomnia, periodic limb movements, obstructive sleep apnea, and parasomnia.
Diurnal sleep disturbances include excessive daytime sleepiness, sleep attacks, and restless leg syndrome.
A patient can have more than one sleep problem at the same time.
The most prevalent sleep disorders seen in PD patients are as follows:
i) Insomnia
Insomnia affects 27 to 80 % of patients with PD.
It can manifest as frequent awakening and fragmentation of sleep , difficulty in falling asleep , or waking up from sleep earlier than desired .
It is more frequent in women, advanced PD stages, PD with anxiety or depression, and in patients on dopamine agonists, COMT inhibitors, or MAO-B inhibitors.
Treatment depends on the type of insomnia and the underlying cause.
Extended-release levodopa and ropinirole, along with behavioral and cognitive measures are useful in most cases.
If there is no response, your doctor may prescribe you a short course of drugs to help you sleep.
These drugs dont prolong the total sleep duration but decrease the awakening episodes.
Some of these drugs can cause dependence and should be used only for the prescribed duration
iv) NREM Parasomnia
What Is The Best Sleep Aid For Parkinsons Patients
It can be difficult to get a good nights sleep when you have Parkinsons disease. Some common sleep problems include insomnia, nighttime restlessness, and daytime sleepiness. Fortunately, there are some things you can do to get better sleep. Here are a few tips:
Set a regular sleep schedule. Your body will adjust better to a set bedtime and wake time. Try to go to bed and get up at the same time every day, even on weekends.
Create a relaxing bedtime routine. Do things that help you relax before bed, such as reading or taking a bath. Avoid watching television or working on the computer in the hours leading up to sleep.
Exercise during the day. Physical activity can help you sleep better at night. Just be sure to avoid exercising too close to bedtime, as this can actually keep you awake.
stick to a routine and relax before going to bed.
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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.
Consider Using An Adjustable Bed
When you have PD, you should invest in beds/mattresses which offer comfort and function.
Use mattresses that work well with a bed with an adjustable base .
Your mattress should provide good edge support, shallow cushioning, and a fast material response.
The mattress should be medium to firm in consistency and made of latex or flat gel with pocket coils or latex as support materials.
This would provide a firm surface against which you can push yourself to change position whilst also providing pressure relief.
These functionalities can help you get in and out of bed.
You should stay away from memory foam and soft, plush mattresses since they provide deep cushioning which is bad if you are trying to turn over.
Also, do not use mattresses with connected coils or water as the support material since they do not work well in beds with adjustable bases.
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How Is Sleep Apnea Treated
A continuous positive airway pressure machine, a machine that blows air into your airway at a pressure that is sufficient to keep the airway open during sleep, is the most consistently effective treatment for obstructive sleep apnea. The CPAP machine is connected by a tube to a face mask worn when sleeping through the night. It controls pressure in ones throat to prevent the walls of the throat from collapsing, creating better sleep quality. CPAP should be worn for the entire night and for naps.
Melatonin Levels In People With Pd
The researchers studied early-morning levels of melatonin found in the plasma of people with PD. They found their levels to be significantly higher than in people without PD. Melatonin levels should increase at the end of the day and into the night, and fall in the morning.
While theyre still puzzling out why this happens, they have theories:
- Melatonin may serve an important neuroprotective role they dont currently understand
- Elevated levels of melatonin in the morning may simply mark the circadian systems effort to compensate for the neurodegeneration related to PD
Another theory? Most people with PD live with chronic circadian disruption. These elevated melatonin levels provide ongoing evidence.
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Rem Sleep Behavior Disorder
REM stands for rapid eye movement. This is the stage of sleep when dreams take place. People with REM sleep behavior disorder act out their dreams, which can be violent. RBD is one of the early warning signs of Parkinsons. Healthy people with RBD have a higher risk of developing Parkinsons. RBD can be treated with the drug clonazepam .