Sleep Disorders in Parkinson’s Disease: Essential Facts & Tips for Patients
What types of sleep disorders can patients with Parkinson’s disease suffer from?
In addition to motor symptoms, which affect movement, patients with Parkinson’s disease often have non-motor symptoms. Sleep problems can be one of those non-motor symptoms. They occur both already earlier and later during the disease. Some sleep disorders can be a problem years before the first motor symptoms appear.
Patients with Parkinson’s disease can develop many different sleep problems. Many patients have trouble falling asleep or staying asleep, which is also called insomnia. Calling and screaming in sleep or acting out dreams, including hitting and kicking can also be a problem – especially for the bedside neighbour who is lying next to the active patient. This is called REM sleep behavior disorder (RBD). Very often patients have frequent nighttime trips to the toilet. Frequently, there is an uncomfortable feeling in the legs after lying down at rest, which is relieved by movement. This is called restless legs syndrome. Jerky leg movements during sleep are also common (periodic leg movements) or breathing stops during sleep (sleep apnea syndrome). Some patients then develop excessive daytime sleepiness and sometimes sudden, involuntary falling asleep (sleep attacks) during the day.
Why do sleep disorders occur? Is there a connection with the medication?
Parkinson’s disease can cause abnormalities in the metabolism of the body’s own chemical substances (so-called neurotransmitters) as well as changes in certain areas of the brain that are responsible for controlling sleep and wake cycles. These changes then cause sleep disorders. Parkinson’s medication can also cause or worsen sleep problems. Those particularly affect daytime sleepiness and/or vivid dreams.
Suboptimal dopaminergic supply during the night can also lead to sleep problems mentioned above. I know many patients who woke up in the middle of the night after just 3 hours of sleep – usually between 1 and 3 a.m. – and had difficulties falling asleep again due to stiffness or painful dystonia, because they did not receive sufficient medication for the night. Usually, infusions should run for waking hours only, unless the patient is experiencing severe night-time problems. After optimizing the therapy for patients with severe night-time problems – many of my patients switched to continuous pump infusions for 24 hours under supervision of their neurologist. Finally, they were able to sleep through the night again with more sleep quality than before.
How are sleep disorders diagnosed?
Parkinson’s patients should talk to their doctor about their sleep problems. The doctor will likely have some questions for the patient and in case to his/her bedside neighbour, to assess the severity of the sleep problem. They may also look at medications to be taken to see if they are affecting sleep. A sleep assessment may also be needed to accurately diagnose the sleep problem. This can be done overnight and is called polysomnography. Or a 24 hours assessment that records body movements is called actigraphy.
How can Parkinson’s patients sleep better?
There are some tips that Parkinson’s patients and their families can follow for better nighttime sleep:
🔘 Develop good sleep habits: Maintain regular bedtimes. For example, go to bed and wake up at the same time every day. Do relaxing activities before bed, such as reading a book. However, make sure that the reading material is less emotionally exciting and stressful, as it will not prevent you from falling asleep. It is better to choose relaxing reading material that makes it easier to fall asleep.
🔘 Avoid going to bed before it’s time. If you go to bed quite early, you will find it difficult to sleep through the night. Adults need a maximum of 7-9 hours of sleep.
🔘 Avoid sleep-disrupting activities before bed, such as sumptuous meal, caffeine, alcohol, and drinking too much fluid (to reduce nighttime trips to the bathroom). But please don’t completely avoid drinking hydrating liquids! Just shift this to the morning and afternoon hours. Basically, I can highly recommend one cup of a herbal tea with ingredients such as hops, lemon balm or valerian before you go to bed, which can certainly help you sleep better.
🔘 Create a comfortable sleeping environment. This includes e.g. a comfortable bed. One of the most common problems with Parkinson’s patients is turning and twisting on a mattress. The patients can hardly get out of bed. Parkinson’s patients also often complain of neck pain, tension, tingling in the extremities and numbness in the arm. In this context, I recently became aware of a special Parkinson’s mattress. There are different companies that produce different models. All manufacturers promise better sleeping comfort and mobility, no sagging, no sinking of the shoulders and a straight spine posture while sleeping. Painful parts of the body are relieved and even when lying on the mattress for longer periods of time there is less pain. Sounds promising when you consider that each of us spends about 1/3 of the day on our mattress.
Also relaxing lighting and adequate room temperatures might have an influence on sleep quality. Studies have shown that the optimal temperature for sleeping is between 15.5 °C and 19.5 °C (60 °F and 67 °F). Depending on your preference, a degree or two higher or lower is fine. However, temperatures above 23.5 °C and below 12.5 °C are not recommended, as they make us either too warm or too cold at night.
If dreaming is a problem, place pillows in and around the bed to prevent injury.
🔘 Therapy blankets can also improve sleep quality in Parkinson’s. They are weighted, which applies gentle, even pressure to the body. This pressure can help reduce the production of stress hormones and promote feelings of relaxation, as well as calming the nervous system and promoting sensory integration. This can alleviate sleep problems and contribute to better sleep quality, which can be particularly beneficial for people with Parkinson’s. Therapy blankets are available in a variety of materials and weight options. This allows users to choose a blanket that suits their personal preferences and needs. Some therapy blankets are designed with breathable materials that can regulate temperature. This is especially important because people with Parkinson’s often struggle with temperature regulation problems. Therapy blankets can also be used during the day to promote periods of relaxation and reduce stress.
🔘 Do regular physical activity and exercise during the day.
🔘 Try to avoid late afternoon or early evening naps. If you take a nap, make sure you don’t sleep for too long. A healthy afternoon nap should not last longer than 20 minutes, otherwise the positive effect will be lost and you will be more tired when you wake up than before. This is because after 20 to 30 minutes you switch from light sleep to deep sleep.
🔘 Try relaxation exercises, music, or light therapy. Also a short walk before bed can help.
🔘 Avoid lying awake in bed for too long. If you can’t sleep for more than half an hour, get out of bed and do something relaxing. Then try to go back to sleep later.
Are there treatment options for sleep disorders?
In addition to the sleep hygiene tips mentioned above, there are various treatment options for Parkinson’s patients with sleep disorders. However, it is important to first discuss any medication changes with the treating neurologist.
🔘 Parkinson’s medications can affect sleep. If motor symptoms are a problem at night, adjusting the medication may help. Please discuss this with your treating specialist.
🔘 Depression, anxiety disorders and pain can worsen sleep problems. Involuntary movements of the limbs and muscle spasms can also contribute to sleep disorders. Treating these conditions or symptoms can help resolve sleep problems.
🔘 If you act out your dreams, there are special medications. Melatonin or clonazepam may be an option. But again: please discuss this with your specialist.
🔘 Cognitive behavioral therapy can sometimes be used for sleep disorders and I know many Parkinson’s patients who find this helpful.
🔘 Sleeping pills can be helpful for Parkinson’s patients with sleep problems, although they are not the first choice of treatment. Different sleeping pills are often preferred for Parkinson’s patients than for people not affected by Parkinson’s. Be sure to discuss taking sleeping medication with your doctor beforehand.
🔘 Sleep apnea should be investigated more closely. CPAP therapy can improve breathing while sleeping and significantly alleviate the symptoms of obstructive sleep apnea. However, wearing a breathing mask at night takes some getting used to and may require support. In many countries such a CPAP mask will be prescribed by your doctor if appropriate.
🔘 In case of daytime sleepiness, it is important to remain active during the day. A doctor can assess whether medication would be useful.
Conclusion
Good and sufficient sleep is essential for our well-being. However, many Parkinson’s patients have problems finding healthy and regular sleep and there are many reasons for poor sleep quality or insufficient sleep. But there are also many tips and tricks on how to improve your own sleep hygiene and thus find a better quality of life in everyday life. Sometimes you have to try out a few things out for yourself, sometimes you have to go to your doctor and sometimes it is just the support of your own family and friends that helps you. Leave no stone unturned and do not give up hope. There will be a way for you to achieve restful nights and well-rested days.
For more information on continuous dopaminergic stimulation, please also refere to the patient information leaflet:
Dacepton/Dopaceptin 5 mg/ml solution for infusion
