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Sleep Disorders in Parkinson's

Sleep disturbance is in fact, a very common symptom for those with Parkinson’s Disease with close to 80% suffering from this difficulty. There is not one but many different types of sleep issues.

Disorders of Initiating and Maintaining Sleep

This may not be as significant early in the disease but as Parkinson’s advances, frequent awakenings are common. These arousals can worsen with increased dopamine agonist doses and sometimes with levodopa treatment.

Nocturnal Akinesia

This is essentially being unable to move during the night resulting in problems turning over in bed or getting out of bed for any reason such as using the bathroom. It is associated with recurrent tremor, periodic limb movements and feelings of rigidity.

Periodic Leg Movements in Sleep (PLMS)

Characterized by an uncontrollable urge and movement of the legs, this disorder can affect sleep onset and result in frequent arousals. It can also be experienced as pain and discomfort in the legs when lying down.

REM Sleep Behavior Disorder (RBD)

This serious disorder can occur in up to 60% of individuals with Parkinson’s. Likewise up to 2/3 of people that have RBD for no know reason, may develop parkinsonism within 10 years. RBD occurs during REM sleep (rapid eye movement phase) and is characterized by movements (e.g. the limbs) and dream-related vocalizations (e.g. screaming, laughing or singing) and dream-enacting behaviors. This can be serious as there is a risk to the patient themselves and/or their bed partners.

Nocturnal Respiratory Disorders

These include things like sleep apnea from either upper airway obstruction (loose muscles) or central (brain) reasons. Patients with Parkinson’s may also hypoventilate (breathe less frequently).

Excessive Daytime Sleepiness

After about 20 years of disease duration, approximately 70% of patients will suffer from excessive daytime sleepiness. This may be a manifestation of the Parkinson’s itself or secondary to nocturnal breathing disorders, nocturnal leg movements, fragmented sleep or the often mentioned sleep attacks have been attributed to the use of dopamine agonists.

So what can be done? There are lifestyle modifications that can help. This is known as sleep hygiene and the suggestions include:

  • Be consistent in your wakeup and sleep times.

  • Try to avoid napping during the day.

  • Create a nice sleeping environment with comfortable bedding, pleasant temperature in a well - ventilated room.

  • Use appropriate lighting (dark at night, normal lighting during the day if you take a nap).

  • Use your bed for sleep alone, not catching up on work or watching TV for instance.

  • Avoid exercising within 2 hours of bedtime (the one time I’d recommend not exercising)

  • Avoid caffeine, alcohol or tobacco 4 to 6 hours before bedtime. (Many times people habitually treasure their cup of tea before bed or that cigarette after dinner.)

  • Restrict your liquid intake prior to bedtime (A full bladder is a pretty powerful reason to wake up)

  • Physical aids may be necessary. For example if there is trouble turning over in bed or getting into a comfortable position, satin sheets or a bedside bar can help.

  • Be sure to establish a pre-sleep ritual, practice relaxation techniques and try to not take your worries to bed.

  • And if you aren’t able to fall asleep within 15 to 20 minutes, then don’t stay in bed. Get up, do something relaxing and then try again.

Apart from these guidelines, sometimes it is necessary to make changes in your medication routine as some drugs can cause or worsen sleep issues. In fact dopaminergic drugs can either improve or disrupt sleep depending on the person. And failing these interventions medications may need to be added that specifically promote sleep.

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