Parkinson’s Sleep Problems: Symptoms, Causes, Impact, and Treatment Update 04/2024

These two conditions are linked in a significant way. Getting a good night’s rest is an issue for many Parkinson’s patients. REM sleep apnea is a possible side effect of the disease itself. You may also have daytime fatigue or sleep disturbances. A better night’s sleep is just a phone call away.

What is Parkinson’s disease?

When nerve cells in one section of the brain steadily degenerate (become injured) or die, Parkinson’s disease occurs. As the damage to your nerves worsens, you begin to experience symptoms all over your body.

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Parkinson’s disease is mostly characterized by motor dysfunction. Medical professionals refer to any symptoms that make it difficult for you to move as having “motor symptoms” (or control your movements).

Motor symptoms of Parkinson’s disease include:

• The muscles are tense.
• Uncontrollable trembling in your hands or legs, such as tremors.
• Unsteadiness or a lack of cohesion.
• Movements that are unusually slow (bradykinesia).

A wide range of non-motor symptoms can accompany Parkinson’s disease. Your body and mind will be affected in different ways by these problems. Your mood, perception of smell, and vision could all be affected by non-motor symptoms.

What’s the relationship between Parkinson’s and sleep?

Complex connections between Parkinson’s disease and sleep have yet to be fully understood by researchers.

Parkinson’s disease can sometimes induce sleep issues directly. Symptoms of Parkinson’s disease, such as insomnia, maybe one of the earliest warning indicators, according to one study. Thrashing in your sleep is one of these warning symptoms.

Other factors (such as Parkinson’s disease medications and emotional obstacles) may also have a role. One thing is certain: a good night’s sleep can be difficult to come by for many persons with Parkinson’s disease.

How does Parkinson’s disease cause sleep problems?

Parkinson’s disease and sleep have yet to be fully explored by researchers. As of now, medical professionals believe that the following factors may be to blame:

• Chemical changes in the brain: Parkinson’s disease may disturb a person’s sleep-wake pattern, according to a current study. People with Parkinson’s may experience sleep disturbances as a result of changes in brain chemistry.
• Medication: Drugs for Parkinson’s disease may make it more difficult to get or remain asleep. Taking a drug that makes you drowsy throughout the day can also cause sleep disturbances (and wide awake at night).
• Mental health challenges: Anxiety and depression are common symptoms for people with Parkinson’s disease. Mood disorders might keep you awake at night or cause you to sleep less deeply than normal.
• Parkinson’s symptoms: A good night’s sleep may be more difficult to come by if you have Parkinson’s symptoms such as night sweats, restless legs, or restless sleep. As Parkinson’s disease progresses, the condition of sleep apnea (which is common in later stages of the disease) can also interrupt sleep.

What types of sleep problems do people with Parkinson’s disease have?

There is no one-size-fits-all approach to treating Parkinson’s disease. It affects sleep in a variety of ways, as well. Parkinson’s disease sufferers may experience:

• Insomnia, falling asleep is a challenge for me.
• Fragmented sleep, frequently awoke in the middle of the night to use the restroom.
• Excessive daytime sleepiness, difficulty staying awake during the day.
• Very vivid dreams, When you wake up, you may have hallucinations or a lack of clarity.
• Emotional dreams or nightmares, as a result of which, when you wake up, you may feel emotionally depleted.

What is REM sleep behavior disorder?

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People with Parkinson’s disease may have this problem in as many as half of cases. In dreams, your body “acts out,” causing you to move in ways that could be dangerous when you’re asleep. Early indications of Parkinson’s may include REM sleep behavior problems, according to some studies.

What other types of sleep disorders do people with Parkinson’s disease have?

Parkinson’s disease patients are more likely to experience the following types of sleep disorders:

• Circadian rhythm sleep disorders.
• Nocturia (waking often at night to pee).
• Restless legs syndrome.
• Sleep apnea.

When do people with Parkinson’s have sleep problems?

Parkinson’s disease does not affect everyone in the same way when it comes to sleep. Before or after a diagnosis of Parkinson’s disease, they can arise.

What else can I do to sleep better with Parkinson’s disease?

Improved quality of sleep may be facilitated by good “sleep hygiene” behaviors.

Do:

• Get some fresh air during the day. Your body knows it’s time to get up when it sees a bright light.
• Throughout the day, make sure to keep your muscles and joints moving. Even if you only have time for a few minutes of exercise, you can still reap the benefits.
• Make use of at-home therapies, such as a warm bath or a massage. It’s possible that calming your mind will assist you in drifting off to sleep.

Don’t:

• During the day, take extended snoozes.
• Caffeine and other stimulants should be avoided six hours before bedtime.
• Sleeping isn’t the only use for your bedroom. If you want to read, watch TV, or work, move to another room.

Are over-the-counter sleep aids (medications) safe for people with Parkinson’s disease?

They’re not, and that’s a shame. When it comes to getting a good night’s sleep, over-the-counter sleep aids may seem like an easy and safe option. People with Parkinson’s disease, on the other hand, maybe at greater risk.

Even prescription sleep aids might have negative side effects for certain people. Parkinson’s drugs and several sleep aids might have dangerous drug interactions. Even a sleep aid should be discussed with your doctor before being taken.

When should I call my healthcare provider?

If your quality of life is being negatively impacted because of your inability to sleep, speak with your healthcare physician. If you notice any symptoms that alarm you, especially if they put you or others around you in danger, don’t hesitate to call your doctor.

Parkinson’s disease can cause sleep disturbances, which may be a sign of depression. Talk to a provider you trust if you’ve lost interest in activities you used to enjoy or if you’re just not sure what’s going on in your life anymore. After taking an antidepressant or chatting to a friend, some people feel better. You are not obligated to feel this way.

Sleep Disorders Related to Parkinson’s Disease

There are a number of sleep issues that appear to be more prevalent in patients with Parkinson’s disease.

• Circadian rhythm disruptions: The body’s sleep-wake cycle may be dramatically disrupted by a lack of dopamine. Insomnia and drowsiness during the day may result from this interruption of the circadian cycle.
• REM sleep behavior disorder: Up to 50% of patients with Parkinson’s disease have a sleep problem called REM sleep behavior disorder (RSBD). People with this condition act out their dreams without even realizing they are doing so. Violence, such as hitting a bed partner, maybe part of their physical movements. People with REM sleep behavior disorder, as opposed to sleepwalkers, are more likely to recall and characterize their dreams as vivid. Parkinson’s disease frequently begins years before the onset of REM sleep behavior disorder, and it appears to be linked to a more rapid deterioration in cognitive function.
• Obstructive sleep apnea: Snoring and gasping are common symptoms in people with OSA, which is characterized by an inability to breathe for an extended period of time. Upper airway obstruction, restrictive lung disease, and other risk factors for OSA are common in people with Parkinson’s disease.
• Restless legs syndrome: A common symptom of restless legs syndrome is an insatiable desire to move the legs, even while lying down. Parkinson’s disease-related insomnia affects 30 to 80 percent of persons and generally starts early in the course of the disease. A shortage of dopamine in the body may be linked to Parkinson’s disease and restless legs syndrome, according to some studies.
• Nocturia: The great majority of Parkinson’s patients suffer from nighttime urination, or nocturia, at some point. Frequent nightly urination, even if it is not an asleep problem, can disrupt sleep quality and lead to less restorative sleep.

The Relationship Between Parkinson’s Disease and Sleep

It’s not clear if bad sleep causes Parkinson’s symptoms to worsen or if Parkinson’s symptoms worsen due to poor sleep. Most of the time, it’s likely a case of bidirectionality, with each contributing to the other’s aggravation.

Sleep deprivation and fragmented sleep may increase the brain’s vulnerability to oxidative stress, which has been linked to Parkinson’s disease progression. Symptoms of Parkinson’s disease aren’t typically recognized until the disease has progressed to the point where the brain has already been affected. To diagnose Parkinson’s disease earlier, it is important to look for signs of poor sleep quality and sleep abnormalities.

In order to fully understand the complex interaction between Parkinson’s disease and sleep, more investigation will be required. Medical specialists may be able to identify at-risk individuals and possibly prevent the beginning of the disease if they have a better knowledge of this connection.

Parkinson’s Sleep Problems: Diagnosis and Treatment

A chronic and progressive condition, Parkinson’s deteriorates over time. Treatment options exist that can help alleviate symptoms and allow sufferers to obtain a good night’s sleep.

Sleeping better with Parkinson’s disease is as simple as adopting good sleep habits. Parkinson’s disease patients can benefit from the following suggestions for good sleep hygiene:

• Remaining consistent with your bedtimes.
• Following a regular bedtime routine that includes relaxing activities like listening to music or reading a comforting book before retiring for the evening.
• Early in the day exercising is preferable for those who want to stay in shape.
• Getting the right amount of light exposure, whether it’s from the sun or through a light therapy device.
• Stay away from extended snoozes and late-day snoozes
• Establishing an environment conducive to restful sleep, one that is cool, dark, and quiet.
• Only sex and sleep can be done before going to bed.
• One hour before going to bed, turn off all electronic devices.
• Limiting fluid intake in the hours leading up to bedtime.
• Caffeine, alcohol, and smoke should all be avoided.
• Avoid heavy meals at night and eat a balanced diet.

Patients with Parkinson’s disease can benefit from light therapy, exercise, and deep brain stimulation to improve general sleep quality and treat particular diseases, such as REM sleep behavior disorder. However, a greater study is needed to examine the effects of cognitive-behavioral treatment on individuals with Parkinson’s disease (CBT-I) in healthy persons.

When a patient suspects they have a sleep disturbance, they should ask their doctor to conduct a polysomnography sleep study. Multiple sensors track many aspects of sleep, including the stages of sleep, eye movements, and other relevant data, all throughout the course of an overnight examination.

If a sleep issue is found, it can be treated to alleviate any negative effects it may have. To prevent injury to the patient or a sleeping partner from occurring when a patient with REM sleep behavior disorder acts out their dreams, for example, it is critical to make the sleeping environment as safe as possible. A patient with obstructive sleep apnea, on the other hand, may choose to utilize a CPAP machine to ensure undisturbed breathing while they sleep.

A wide range of drugs and sleep aids, including melatonin, is used to treat the sleep-related symptoms of Parkinson’s disease. Consult your doctor before taking any over-the-counter or prescription drugs if you have sleep issues. Your doctor can customize a treatment plan for you based on the specifics of your case. Changing drugs, adjusting dosages, adjusting schedules, or removing medications that interfere with sleep are all options that may be considered.

Tips for Better Sleep

• Maintain a consistent sleep routine by going to bed and waking up at the same time each day.
• Decide on your wake-up time before setting a bedtime. It’s best if you get at least seven to eight hours of sleep per night.
• Establish a nightly routine, such as having a snack, taking a bath, brushing teeth, and using the restroom, and stick to it every night.
• Spend as much time as you can outside and get some exercise every day. Don’t go out and work out after 8:00 p.m.
• Sitting or working near a light treatment box is an option if you can’t go outside.
• Taking a sleep is fine as long as you do it at the same time every day and no later than 3:00 p.m.
• Use the bed solely for sleeping and sex; do not use it for anything else.
• Never read a book or watch TV in bed.
• Make it easy to get out of bed by using silky sheets and pajamas.
• To avoid frequent midnight urination, consume as little fluids as possible for three hours before going to bed.
• Before going to bed, use the restroom immediately.
• Set up a commode next to your bed so that you don’t have to get out of bed in the middle of the night to use the bathroom.
• Avoid:
  • Nicotine, as well as other stimulants like alcohol and caffeine
  • Eating a lot of food late at night (although a light snack at bedtime may be helpful)
  • Intense physical activity within six hours of going to bed
  • Thoughts about things that make you feel agitated, angry, or frustrated before going to sleep
  • “Screen time,” which includes television, phones, and tablets, should be scheduled one or two hours before bedtime.
• Antidepressants like mirtazapine (Remeron) may help with sleep, whereas SSRIs may worsen other sleep-related symptoms of depression.
• PD isn’t the only possible reason for nighttime urination, so be important to have your doctor rule out any other possible causes. Other drugs that may be beneficial include oxybutynin (Ditropan®), tolterodine (Detrol®), trospium (Sanctura®), tofenacin succinate (VESIcare®), darifenacin (Enables®), mirabegron (Moretti®), and phenoperidine fumarate (Toviaz®). Referrals to a bladder specialist may be made (urologist).

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