Selected Studies And Characteristics
As shown in Figure 1, we identified 821 records from the PubMed, Cochrane Library, EMBASE, and Web of Science databases. After excluding duplicates and irrelevant studies by reading titles and abstracts, the remaining 53 articles required reading of the full text to identify available data. Forty-six articles were excluded. Finally, we included 7 studies in this systematic review and meta-analysis. The characteristics of the included studies are shown in Table 1.
Figure 1. Study flow diagram.
Table 1. Basic characteristics of included studies.
Attacking Pd From Every Angle
Well be more relentless than your PD, always determined to find the best treatment for your individual symptoms.
Medication will be our first line of treatment, and our pharmacists are always available to answer questions, provide support and help with medication management. If the side effect of any medication is bothersome, well try another.
If medication fails to control your symptoms enough, there are many other advanced therapies, neurosurgery and innovative treatment options, such as Botox or infusions, that we can try. As another layer of targeted care, we may even recommend psychotherapy, such as biweekly cognitive behavioral therapy, which has been proven to improve mobility issues over time.
In addition, our centers active research program offers access to gene therapy and new treatments that may not be available elsewhere.
We also have a Parkinsons disease genetic counseling clinic to help families uncover and understand the potential risk of PD for other family members.
Peripheral Clock Gene Expression
Hair follicles were collected by gripping and tugging the hair shaft with a pair of tweezers and were quickly soaked in Lysis Solution . Hair follicle cells attached to the hair shafts were stored at 20°C until RNA purification. Approximately 210 scalp hair follicles were required to detect clock gene expression at each sampling timepoint. To minimize skin damage, samples were obtained from different regions of the scalp. The RNAqueous-Micro Kit was used with frozen cytolysis solution to purify total RNA. After checking the quality and concentration using a NanoDrop , total RNA was reverse-transcribed using a SuperScript VILO cDNA Synthesis Kit , and real-time PCR was performed using a TaqMan MGB probe and a 1/20 volume of the reverse transcription product. Data were obtained using a PRISM7300 and corrected by 18S ribosomal RNA , the expression of which is constant regardless of cell type and sampling time. The sequences of the primers and probe for the Per3, Nr1d1 , Nr1d2 and 18S-rRNA transcripts are listed in our previous report.
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Deep Brain Stimulation In The Treatment Of Sleep Disorders In Pd
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.
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.
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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 Parkinson’s disease.
Diagnosis Of Rbd In Pd
The diagnosis of RBD can be based on a questionnaire or clinical manifestations without confirmation by polysomnography .Therefore, a detailed history of complex motor behaviors and vocalizations during REM sleep is very important for a clinical diagnosis of RBD. However, for the objective diagnosis of RBD, complex motor behaviors during REM sleep and the presence of REM sleep without atonia should be confirmed by PSG . Additionally, this sleep disturbance should not be better explained by another disorder . PSG can detect increased chin muscle tone by the submental EMG or increased phasic muscle activity by the limb EMG during REM sleep . Thus, PSG is not required for the clinical diagnosis of RBD . It has been reported that a total score of 6 or higher obtained from the RBD screening questionnaire used for the clinical diagnosis of RBD may strongly support the diagnosis .
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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.
Effect Of Melatonin On Daytime Sleepiness
Five studies used the Epworth Sleepiness Scale to assess the daytime sleepiness of patients with PD. The study of Medeiros showed that in the melatonin group, the mean change in ESS score at the end of treatment was 0.3 it was 0.2 in the placebo group. However, the difference was not statistically significant. The trial showed that treatment with 4 weeks of 3 mg melatonin did not affect daytime sleepiness in patients with PD. In a 6-week, randomized, clonazepam-controlled study, Litvinenko et al. reported that melatonin and clonazepam increased ESS scores in patients with PD. The results showed that ESS scores significantly increased after treatment with 6 weeks of 2 mg clonazepam and were slightly increased after treatment with 6 weeks of 3 mg melatonin .
Delgado et al.’s study used 25 mg of melatonin to assess its efficacy on daytime sleepiness in patients with PD. Melatonin was taken at noon and 30 min before bedtime for 3 months. The results showed that the use of high-dose melatonin failed to reduce the presence of excessive daytime sleepiness . Meanwhile, similar results were observed in that ESS scores after treatment with 4 weeks of 2 mg PRM were not different from baseline .
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Inclusion And Exclusion Criteria
The inclusion criteria were as follows: Study type: randomized controlled trials Participants: patients who were clinically diagnosed with PD Interventions: the experimental group was given melatonin or prolonged-release melatonin Control: the control group was given placebo or clonazepam and Outcome: at least one of the following 4 instruments was employed: Pittsburgh Sleep Quality Index , Epworth Sleepiness Scale , RBD questionnaire and polysomnography sleep parameters.
Exclusion criteria were: Non-randomized controlled trial Repeated publication and Studies whose outcomes did not meet our meta-analysis requirements.
What Types Of Sleep Problems Do People With Parkinsons Disease Have
Parkinsons disease affects every person differently. It also impacts sleep in different ways. People with Parkinsons may have:
- Insomnia, finding it hard to fall asleep.
- Fragmented sleep, waking up many times over the night.
- Excessive daytime sleepiness, finding it hard to stay awake during the day.
- Very vivid dreams, which may cause hallucinations or confusion after waking up.
- Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.
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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.
Parkinsons Disease And Sleep: Common Symptoms
Sleep problems can occur at any stage of Parkinsons disease. Some of the most common sleep problems for PD patients include:
- Insomnia: Difficulty falling or staying asleep
- Excessive daytime sleepiness: Feeling drowsy or fatigued during the day. In Parkinsons, sleeping all day is also common
- Nightmares or night terrors: Bad dreams that seem unusual for you
- Sleep attacks: Sudden, involuntary episodes of sleep, also known as narcolepsy
- Periodic leg movement disorder
- Restless leg syndrome
- REM sleep behavior disorder: Acting out dreams while asleep
- Sleep apnea: When breathing becomes obstructed during sleep
- Nocturia: Frequent night-time urination
When prescribing one of the drugs I take, my doctor warned me of a common side effect: exaggerated, intensely vivid dreams. To be honest, I’ve never really noticed the difference. I’ve always dreamt big. Michael J. Fox
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How Are Speech Problems Treated
There are many options to help improve your speech. A speech-language pathologist can help you pick the right approaches for you. SLPs are trained health care professionals who specialize in evaluating and treating people with speech, swallowing, voice and language problems.Ask your doctor for a referral to a speech-language pathologist. It is also important to contact your health insurance company to find out what therapy and procedures are eligible for reimbursement and to find a list of SLPs covered by your plan.Finally, visit a SLP who has experience treating people with PD. Call the Parkinsons Foundation Helpline at 1-800-4PD-INFO for help locating a speech-language pathologist in your area. Lee Silverman Voice Treatment, discussed below, is a specific voice therapy for PD but it is not the only way to obtain high quality speech therapy for PD.
Insomnia And Motor Symptoms Of Pd
Nocturnal motor symptoms of PD frequently contribute to insomnia and can occur in over 60% of patients . This includes symptoms of tremor, dystonia, akinesia, and restlessness. One study evaluated a cohort of 412 patients with PD, 209 of whom had trouble with initiation of sleep or fragmentation during the 5-year study . Motor fluctuations of tremor and rigidity were significantly associated with difficulty falling asleep, obtaining too little sleep and awakening too early in this study. Immobility in bed due to hypokinesia from PD has also been associated with an increased wake after sleep onset . One study evaluated nocturnal mobility in patients with PD by using an accelerometer and number of turnover movements in bed . Turnover movements were negatively correlated with increasing disease duration, levodopa equivalent daily dose, modified Hoehn and Yahr ratings, and UPDRS III scores . This would suggest that sleep dysfunction due to motor symptoms is not as prominent early in or with a less severe disease state.
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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.
Former Parkinsons Caregivers Could Help Those Now In That Role
He is a fall risk. Sure, everyone with Parkinsons disease falls sometimes, right? Well, yes, they do. His unprovoked retropulsions, which contribute to his loss of balance in a backward direction, can surprise us at any moment without any warning. Hell be standing at the refrigerator looking for a snack, standing in place talking to a friend, or in many other situations when BAM! Hes on the floor.
This has prompted frequent emergency room trips to ensure he didnt have a brain bleed or a broken rib and to check out his deep brain stimulator. Fun stuff!
He has trouble communicating. For the past few years, his speech has taken a direct hit from the Parkinsons disease fairy. I think the speech issues started after his deep brain stimulation surgery and have worsened over time.
He recently told me he could communicate with our kids much better when Im not around. I think thats because Ive taken on the role of speaking for him, maybe when he doesnt need me to. He probably requires me to be more patient and understanding, but I always feel I need to help him get the words out.
This may be more of a me issue than a PD issue. Consequently, Ive made it a point to have him place his order at restaurants or use the phone to book his appointments to encourage him not to depend on me.
The endless fury of worry swirls through my mind like a tornado in a trailer park. But again, this sounds like a me problem rather than a PD problem.
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Cost Analysis Of Home Telerehabilitation For Speech Treatment In People With Parkinsons Disease
- Telerehabilitation in Communication Disorders and Mental Health2020
- Telerehabilitation in Communication Disorders and Mental Health2020
- The SAGE Encyclopedia of Human Communication Sciences and Disorders2019
- The SAGE Encyclopedia of Human Communication Sciences and Disorders2019
- SAGE Handbook of Mixed Methods in Social & Behavioral Research2010
- SAGE Research MethodsCase
- James F. Sallis and morePhysical Activity & Behavioral Medicine
- Encyclopedia of Medical Decision Making2009
- The SAGE Encyclopedia of Human Communication Sciences and Disorders2019
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What Is The Cause
PD damages the nerves in the brain. It causes problems with movement and communication, including changes in speech. The exact way that PD causes speech and swallowing problems remains unclear.4,5
The nerve cells in the heavily damaged area of the brain produce dopamine. This is a chemical messenger that transmits signals to parts of the brain that help regulate smooth, purposeful movement.4
The muscles in the face, mouth, and throat also need to move to generate speech and help with swallowing. Doctors think that damage to dopamine-producing nerve cells leads to dysfunction in the movement of muscles involved in speech and swallowing, along with those in the trunk and limbs.4
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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.
What Type Of Healthcare Professional Helps People With Speech Problems From Parkinsons Disease
If you have speech and voice problems, see a speech-language therapist. Your primary healthcare provider can help you find a therapist in your local area. Some speech-language pathologists have specialized training that focuses on training people with Parkinsons disease to amplify their voice. This is called the Lee Silverman Voice Treatment.
Speech-language therapists are specifically trained to diagnose and treat speech, language and swallowing disorders. If you have Parkinsons disease, a speech-language pathologist can help you:
- Maintain as many communication skills as possible. Teach you techniques to conserve energy, including using nonverbal communication skills.
- Introduce you to assistive devices and techniques to help improve your communication.
- Recommend exercises to help you improve muscle strength and movements needed to improve your speech and communication options.
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