Sleep is a vital physiological function. A good night’s sleep is necessary for our bodies and minds to function properly, regenerate, and even fight disease. Sleep disturbances, of any kind, can be debilitating even for otherwise healthy people. It is therefore easy to see why sleep quality is doubly important for people living with Parkinson’s Disease (PD).
Yet many PD patients struggle to get a good night’s sleep. With the most visible PD symptoms taking center stage – tremor, rigidity, and slow movement are often those first noticed by patients and addressed by their doctors – sleep quality, as well as other less-known issues in PD, are sometimes pushed to the sidelines.
Given the importance of good-quality sleep to your overall physical and mental health, we will review below the different ways PD may be affecting your sleep and how to address them. It is important to recognize sleep disturbance as a possible symptom of PD and to discussing with your health care team potential strategies to address it.
Pain, stiffness, involuntary movement
Pain and stiffness are common PD symptoms. Dystonia, or the painful contraction of muscles especially in your hands, feet, ankles, and wrists, can be particularly bothersome when you are trying to fall asleep or stay asleep throughout the night. Some PD patients are kept awake by restless legs syndrome, an irresistible urge to move the legs. Muscle stiffness, on the other hand, may make it difficult to turn over in bed, further contributing to discomfort.
These symptoms can be improved with the help of medication or nutritional supplements such as iron. Managing these symptoms at night might prove challenging because your medication may wear off at the wrong time – causing you to wake up at night. Your doctor may be able to offer strategies to improve this, for example by changing the timing or dosage of your medication, or by trying a different type of medication.
Other strategies, such as a leg massage, relaxation exercises, or a bath before bedtime may also prove helpful. Changes to your bedding or sleep clothing, such as using satin sheets, may help with nighttime movement. A Parkinson’s nurse or an occupational therapist may help with these adjustments. Additionally, some studies suggest that CBD oil, derived from the cannabis plant, can help with pain and sleep.
Two issues may involve your regular PD medication. One is that your medication may wear off at the wrong time, either keeping you from falling asleep or waking you up at night; and two, your medication itself may cause insomnia as a side effect. The latter is common, for example, in high doses of levodopa or dopamine agonists taken in the evening. Other medications often prescribed to people with PD may also affect your sleep quality. Diuretics, a group of drugs aimed at increasing urination, for example, shouldn't be taken before going to sleep. Another example is antidepressants. Your antidepressant medication may be effecting your sleep and the timing of the medication should take this into consideration. If you feel that your antidepressant is making you drowsy, discuss with your physician whether you should be taking it just before going to sleep, and similarly if it is making you feel more alert then ask your doctor if it would be better to try taking it in the morning.
If you suspect that your medication regimen is affecting your sleep, the first thing you should do is consult with your doctor. You may simply need to change when you take your medication or have your dose adjusted for a better night’s sleep. Sleeping pills are a possible short-term solution, they should be used with caution as you may become dependent on them, or they may even worsen some of your Parkinson’s symptoms. Medical cannabis is available in some countries and in some states in the US. It should be noted however that there still isn’t a strong evidence base (i.e., no large randomized controlled studies and no regulatory approval) to recommend medical cannabis, meaning that caution is needed when prescribing cannabis-based therapies. However, some people, including people with Parkinson’s, do report improvement in their sleep with cannabis.
Nightmares, sleepwalking, and other unusual sleep behaviors
Some PD patients suffer from parasomnias, a group of sleep behaviors which include acting out your dreams or thrashing around in bed. The greatest risk involved in parasomnias is the risk of injury – either to yourself or to the person with whom you share your bed. If you or your significant other suspect that you might be suffering from parasomnias, talk to your doctor to see whether this may be exacerbated by your current medications and whether an adjustment is in order.
There are also some simple steps to take that are not related to your medications. To minimize the risk of injury to yourself due to excessive movement at night, consider lowering your bed so that, should you fall off the bed at night, the distance between the top of the mattress and the floor would be shorter. Guard rails or other padding solutions might also be helpful. If you share your bed with another person who might get hurt, discuss sleeping in separate beds or devising another strategy, for example using separate sheets, that works for you so as to minimize the risk to them.
Anxiety and depression
People living with Parkinson’s often experience various mood disorders such as anxiety and depression. These conditions may be caused by changes in your brain due to Parkinson’s Disease, by your medication, or by other causes; yet regardless of the underlying cause, they may result in sleeping difficulties even in people without PD.
Addressing sleep disturbances due to depression or anxiety involves first addressing the depression or anxiety themselves. You may wish to discuss your mood and worries with your neurologist or another member of your health care team who might suggest making medication changes or initiating a trial of a new medication, such as antidepressants, provided that the risk of interactions with your other medications is low; or they may suggest other therapies, such as "talk therapy" or counselling, which can be very effective for some patients.
You should also look for support in your immediate environment. Confiding in a family member, discussing your difficulties and worries with other people living with PD, or turning to counseling with your local Parkinson’s organization may all have a positive impact on your mood and anxiety, with positive effects on your sleep quality.
Frequent trips to the bathroom at night can be disruptive to your sleep. As mentioned above, some medications often prescribed to people with PD, such as diuretics, are actually intended to increase urination, while other medications – such as blood pressure medication – may cause frequent urination as an unintended side effect. Eating salty foods may also contribute to frequent urination.
This may be remedied by some simple adjustments, such as watching your salt intake and tracking your blood pressure, as high blood pressure can often send you running to the bathroom at night. If this doesn’t help, specific medications are available to treat night-time urination, also known as nocturia. Your doctor may also refer you to a continence specialist for further evaluation. In the meantime, make arrangements to make getting up at night easier – if you struggle to walk to the bathroom, consider an appropriate bedside solution, and use a mattress protector just in case.
Another possibility is that night time urination is actually a symptom of your Parkinson’s. Any stiffness, pain or tremor at night time can result in discomfort that actually wakes you up from your sleep. Once awake you may feel like you need to urinate and you may misattribute your awakening to your need to urinate. In such cases simple adjustment of your Parkinson medication may solve the problem, at least partially.
Many people with PD struggle to stay awake during normal waking hours, either because they didn’t get enough sleep the night before or because of their medications. Daytime sleepiness may be especially dangerous while driving or doing any potentially hazardous activity.
Talk to your doctor about adjusting your medications to help improve daytime sleepiness. If you still feel the urge to sleep during the day, try to limit your naps to 20 minutes and before 3pm. It may also be helpful to engage in energizing activities, such as exercising outdoors.
Sleep apnea is a condition where you stop breathing at night. This affects many people with PD, as well as others, and can seriously affect your sleep and overall health. A telltale sign of sleep apnea is when you make loud snoring or choking noises at night, or if you wake up with a headache. If you suspect you are suffering from sleep apnea, your doctor may suggest that you use a special device to make sure you are breathing easily at night.
Your Sleep Is Important
A good night’s sleep can help improve your overall well-being, allowing you to enjoy life to the fullest. It may also support better cognitive functioning during your waking hours. If you feel that the quality, duration, or timing of your sleep aren’t what they should be, talk to your doctor or a Parkinson’s nurse about different strategies – including lifestyle adjustments, home remedies, and medication – to help you get the sleep that you need.
Source: Parkinson's Europe
THIS ARTICLE DOES NOT PROVIDE MEDICAL ADVICE and is not a substitute for professional medical advice, diagnosis or treatment. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment immediately. Never disregard professional medical advice or delay in seeking it because of something that you have read on this website or in any linked article, blog or other materials.