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.
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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.
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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 .
Parkinsons Disease Treatment Involves Drugs Or Surgery
Drugs and surgery can help you manage your symptoms.
The following drugs and surgeries are commonly used in the treatment of Parkinsons disease:
Levodopa is the most effective drug for treating Parkinsons disease.
It crosses into the brain and gets converted into dopamine.
Side effects may include nausea, vomiting, and light-headedness.
Prolonged use also causes abnormal movements that can also affect sleep.
Inhaled forms and infusions of levodopa are also available.
ii) Dopamine Agonists
These are drugs that bind to dopamine receptors and mimic the action of dopamine.
They are not as effective as levodopa but have a prolonged duration of effect.
They also smooth the on-off effect of levodopa.
Drugs under this group are pramipexole, ropinirole, rotigotine, and apomorphine.
These drugs are available in tablet form except for apomorphine and rotigotine .
Important side-effects include hallucinations, sleep attacks, and impulse control disorders.
iii) MAO-B Inhibitors
MAO-B inhibitors prevent the breakdown of dopamine by blocking the monoamine oxidase B enzyme.
This prolongs the availability of dopamine in the brain.
Common MAO-B inhibitors include selegiline, rasagiline, and safinamide.
Common side-effects are dizziness, nausea, and hallucinations.
They also have dangerous side-effects when combined with many drugs.
iv) COMT Inhibitors
COMT inhibitors prevent the breakdown of dopamine by blocking catechol O-methyltransferase enzyme.
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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.
Memory Foam And Natural Latex Mattresses: The Best Mattress Types For Neurological Disorders
While it is almost impossible to categorize one mattress option as being the best option, in a wide variety of cases, I often recommend either a memory foam mattress or a natural latex mattress, because of the cradling and calming nature of these components.
Memory foam, for example, is a kind of polyurethane foam that most people are familiar with, and because it is excellent at relieving pressure and distributing weight away from the body, it often relieves restlessness and can induce deeper sleep.
The secret that lies inside memory foam is that it is an open cell foam. This means that as pressure is applied to a section of cells, air is squeezed slowly from one to another. The signature melting in sensation that memory foam provides is caused by air being moved around through microscopic openings.
Its also excellent for people who are either bed bound or spend the vast majority of their time in bed.
This is due to the ability of memory foam to reduce the incidence of bed sores, since it spreads pressure and weight laterally, rather than down, where pinpoint pressure can cause tissue damage.
Memory foam has multiple advantages in addition to pressure point reduction for patients suffering from neurological conditions.
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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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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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Sleep Matters: A Review Of Sleep Issues In Parkinson’s
Sleep disorders are present in 66-99% of people with Parkinson’s disease . In this 1-hour webinar Okeanis Vaou, MD, describes common sleep disorders in PD and how to treat them. Disorders described include REM sleep behavior disorder, daytime sleepiness, insomnia, nocturnal motor fluctuations, and restless leg syndrome. Dr. Vaou ends the webinar with tips on how to maintain good sleep hygiene.
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:
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
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Clinical Use Of Melatonin In Parkinsons Disease And Rbd
A phase advance in nocturnal melatonin secretion was observed in PD patients treated with l-DOPA . Patients treated with l-DOPA showed increased melatonin secretion during the day, perhaps as an adaptive response to neurodegeneration . PD patients, particularly those showing excessive daytime sleepiness, exhibited a reduced amplitude of the circulating melatonin rhythm . A chronobiologic therapy for non-motor manifestations of PD, comprising the scheduled exposure to bright light in the morning and melatonin administration at sleep time, can thus be recommended.
The postulation of an association between motor fluctuations in PD and the diurnal variation in circulating melatonin levels relies on the existence of melatonin effects on striatal DA and serotonin content . In view that l-DOPA-related motor complications is seen in about 50% of PD patients after 5°years of treatment, the results obtained in experimental parkinsonism warrant the use of melatonin to decrease l-DOPA doses in PD .
TABLE 2. Clinical trials with melatonin in Parkinsons disease.
TABLE 3. Studies including RBD patients with melatonin.
Figure 1 summarizes the different mechanisms by which melatonin can stop the progression of PD. The intersections in the Figure represent the multiple effects of melatonin and the different degrees of overlap discussed in this review article.
Tips For Getting Rest And Sleep With Parkinsons Disease
The physical symptoms of Parkinsons disease can often prevent those who live with the condition from getting a good nights sleep and adequate rest. The restorative effects of sleep can improve health and help those with Parkinsons disease better manage the disease on a daily basis, so ensuring they get enough quality sleep is essential.
The National Parkinsons Foundation has published some tips on how to get a good nights sleep including:
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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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.
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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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.
Sleeping In A Reclining Position
Sleeping in a reclining position is preferable for sleeping with lower back pain and/or sciatica. Specifically, pain that feels worse when standing up straight, and better when bending forward, is a sign that sleeping in a supported reclining position may be beneficial. Options for support while sleeping in a reclining position include:
- Adjustable Bed. With this type of bed, the upper and lower portions of the bed can be raised and lowered in a customized fashion . There are many advantages to an adjustable bed, including the ability to easily raise and lower portions of the bed throughout the night. Adjustable beds are available at a variety of price points and designs.
Elevating the knees by placing a pillow under them, while at the same time lying flat on a bed, can also help relieve back pain caused by many conditions.
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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.
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How We Catch Parkinson’s Disease How Can Bamboo Pillows Help
It is a progressive neurological or nervous disorder. Our body can show movements and our muscles can stay flexible because of Dopamine’. It is a substance in the brain present in the part known as ‘substantia nigra.’ But during Parkinson’s disease, the cells present in this part of the brain begin to fall or die, resulting in lower levels of dopamine. It is hard to believe that its causes are unclear till today and its cure is unclear till today. However, it can grow and become chronic to worsen the issues. There are many symptoms of this disease such as:
- Unable to have a posture
- Motor symptoms of stiffness, slow movements, tremor and shaking, issues in balancing
- No expressions on the face
- Less swallowing and blinking
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