Sleep problems are extremely common in people with Parkinson’s disease (PD), often getting worse as the condition progresses. A good night’s sleep is vital for energy and well-being, and to allow the body time to repair itself.

People with PD also often suffer from fatigue – a feeling of great tiredness – which may or may not result from sleep problems. This fatigue can have a neurological cause, and is also a symptom of depression. You should consult your doctor if you have concerns about tiredness. Exercise often helps.

You may have one or more of the following common PD-related sleep problems:

– Obstructive sleep apnoea (OSA). This is very common, and can have serious health consequences. Symptoms include loud snoring, daytime sleepiness, restlessness and paused breathing. When muscles relax in sleep, the walls of the throat “collapse”, blocking the airway. Diagnosis might require a “sleep study”: overnight monitoring at a sleep clinic. Continuous positive airway pressure (CPAP) is an effective treatment: a machine connected to a facemask controls air pressure in the throat.
– RBD – Rapid-eye movement behaviour disorder. People with PD may not experience normal muscle relaxation during sleep, and during the rapid-eye movement (REM) stage they may “act out” their dreams – shouting, kicking, grinding their teeth, and becoming aggressive. For protection, you may need floor padding or bed rails, and your partner may choose to sleep in a different room! The drug clonazepam is effective against RBD, but has side effects such as night-time confusion, daytime sleepiness, and worsened OSA.
– Daytime sleepiness. This may be due to disturbed night-time sleep, or be an effect of medication. Dopaminergic medications can even cause abrupt “sleep attacks” –particularly dangerous if they occur while driving.
– Difficulty getting to sleep and staying asleep; insomnia
– Early morning waking
– Talking or shouting in your sleep
– Particularly vivid dreams
– Jerking and cramping of the legs; “restless legs”
– Problems with turning over
– Frequent urination

People with PD often take their medication just before bed. When it wears off, symptoms can return during sleep. You may wake up at the same time each night, due to tremor, rigidity, the need to urinate because of a rigid bladder, or an inability to turn over. Certain long-acting PD medications can help, and some people take a small dose during the night to help them go back to sleep.

Tips for getting a good night’s rest include:

– Keep to a regular sleep routine; go to bed and wake up at the same time every day.
– Get plenty of exposure to daylight.
– Don’t spend time in bed during the day, and lie down only when you are sleepy.
– Stay active during the day, and try to get out and about outside the home.
– Maintain a slightly cool bedroom, and keep the lighting and noise levels low.
– If you can’t fall asleep, get out of bed and try some relaxing activity like listening to music or reading until you feel ready to sleep.
– Decrease your fluid intake before bedtime, and make sure to use the toilet just before bed so that you’re not woken by a need to urinate.
– Avoid stimulants like alcohol, caffeine and tobacco.
– Don’t eat a heavy meal before sleeping.
– Don’t exercise strenuously just before bed – but otherwise, get regular physical exercise if possible.
– Take part in stimulating daytime activities outside the home.
– Try taking your meds late in the day to make you more sleepy at bedtime, or take an extra dose. Consult with your doctor about your dose: some PD medications increase daytime sleepiness; sometimes an extra dose can help you fall asleep at night.
– You might need to be prescribed a sleeping pill.
– Just before bedtime, avoid dwelling on things that make you feel upset, angry or anxious.

Sources:

Breslow, D., ‘Parkinson’s Onboard: Traveling with PD’, Northwestern University, National Parkinson Foundation Center of Excellence; Brandabur, M.M., ‘Nutrition and Parkinson’s Disease’, The Parkinson’s Institute; Parkinson’s Disease Foundation: www.pdf.org; National Parkinson Foundation: www.parkinson.org

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