Sleep is essential to recharge our body and mind and to promote overall well-being. For people living with Parkinson’s disease (PD), getting proper rest is even more important, as the body requires more time to restore and recover. Below are explanations of how Parkinson’s symptoms, medications, and other factors can affect sleep, along with strategies to optimize rest.
This article is based on the webinar “ZZZ Issues: Sleep Challenges with Parkinson’s,” part of the Parkinson’s Foundation’s Expert Briefings series. It was presented by Dr. Aleksandar Videnovic, Associate Professor of Neurology at Harvard Medical School, who holds a master’s degree in clinical research and is the Director of the Sleep, Circadian Biology, and Neurodegeneration Program at Massachusetts General Hospital.
Aging, PD, and Sleep Problems
As we age, falling asleep becomes more difficult, and nighttime awakenings are more frequent. PD can worsen these sleep disturbances, impacting restorative sleep. It’s estimated that between 80% and 90% of people with Parkinson’s experience sleep problems throughout the course of the disease.
PD disrupts the circadian system—our internal body clock—and affects the natural drive to sleep. In addition, several disease-related factors can interfere with nighttime rest:
- Motor symptoms like tremor, pain, akinesia (difficulty or inability to move), rigidity, and dyskinesias (involuntary movements) may worsen when medication effects wear off at night.
- Anti-Parkinson’s medications, some of which can interrupt sleep or cause daytime sleepiness.
- Depression and anxiety, common PD symptoms, can cause insomnia, as can hallucinations.
- Autonomic nervous system disturbances, such as nocturia (frequent nighttime urination), can affect uninterrupted sleep.
Common Sleep Disorders in PD
- Obstructive sleep apnea and sleep-related breathing disorders: These can lead to frequent awakenings and affect both people with PD and the general population.
- Excessive daytime sleepiness (EDS): This can cause individuals to fall asleep unexpectedly during the day. Brain changes, medications, and other sleep disorders contribute to EDS.
- Restless legs syndrome (RLS): Triggers an irresistible urge to move the legs. It may precede a PD diagnosis, though not everyone with RLS will develop the disease.
- REM sleep behavior disorder (RBD): Affects the REM stage of sleep, causing people to act out their dreams (talking, yelling, or moving). It can precede a Parkinson’s diagnosis and increase the risk of PD or Lewy body dementia.
Strategies for Managing Fragmented Sleep
Discussing sleep issues with a doctor is essential. Medication adjustments can make a significant difference:
- Long-acting levodopa or extra doses before bedtime may help.
- COMT inhibitors prolong the effects of levodopa and are sometimes used at night.
- Adjusting the timing of diuretics and avoiding medications like selegiline and amantadine late in the day can help prevent insomnia.
- Anticholinergics may help with nocturia but should be used cautiously in older adults due to cognitive side effects.
- Caffeine and certain stimulants may improve daytime alertness.
Treating mental health is crucial for improving sleep. PD affects brain areas that regulate mood, energy, and sleep.
Diagnosis and Treatment of Sleep Disorders
If sleep disorders like apnea, RLS, or REM behavior disorder are suspected, a sleep study may be needed:
- Sleep apnea can be treated with devices like CPAP.
- For RLS, treatments include dopamine agonists, benzodiazepines, opioids, or medications like gabapentin. Dopamine blockers, anticholinergics, and antihistamines should be avoided.
- Doctors may recommend melatonin or clonazepam for RBD. Some antidepressants can worsen RLS.
Tips for Improving Sleep
Good sleep hygiene can significantly help:
- Exercise regularly, preferably in the morning.
- Limit naps, especially to under 30 minutes.
- Avoid stimulants like caffeine in the afternoon.
- Reduce screen time before bed.
- Keep a consistent bedtime and wake-up schedule.
- Sleep in a dark environment, use motion-sensor night lights, and consider a low or rail-equipped bed.
- Wear satin pajamas or use satin sheets to ease movement in bed.
- Stay hydrated, but limit fluids before bedtime to avoid nocturia.
Research and New Therapies
Light exposure helps regulate the circadian system, influencing mood, behavior, and sleep. Light therapy is being studied as a non-invasive treatment for non-motor PD symptoms.
In a study published in JAMA Neurology (2017), Videnovic and colleagues showed that exposure to bright light (10,000 lux) or dim red light (<300 lux) twice daily for two weeks improved daytime sleepiness and sleep quality.
The ENLITE-PD trial, conducted across 25 centers, is studying the effects of daily light therapy on Parkinson’s symptoms, including sleep. Its results are expected to lead to a phase III clinical trial.
Sleeping well with Parkinson’s is possible with the right approach, comprehensive medical care, and healthy habits that promote rest.
