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Jan. 27, 2016

When you’re living with Parkinson’s, getting a good night’s sleep can be challenging. There are many ways sleep can be disrupted – sometimes they relate to symptoms of the condition, while other times they may be triggered or exacerbated by Parkinson’s treatments.

One of the most common and early sleep difficulties is REM sleep behavior disorder (dream–enacting behaviors during sleep). This problem is characterised by experiencing movements during Rapid Eye Movement Sleep (REM), the stage of sleep when the body would normally be affected by a state of sleep paralysis that stops us from acting out our dreams.

REM sleep disorder is a common symptom in Parkinson's and is often experienced many years before people are diagnosed with Parkinson's. This problem can be disturbing for both the person living with Parkinson's and their bed partner. In addition to this sleep disturbance people with Parkinson’s are at higher risk for restless legs syndrome (RLS) and periodic leg movement disorder, two conditions that may seriously disrupt sleep.

If REM sleep difficulties are causing a problem, you should discuss them with your neurologist who may be able to prescribe medications to assist you. Sleep difficulties can be aggravated by increasingly vivid dreams or nightmares, which are side effects of Parkinson's medication and need to be reported to your treating doctor.

Another sleep problem may be related to difficulties with movement in bed. You may sometimes find it difficult to get comfortable or turn over when you wake up. This may be linked to low levels of Parkinson's medication causing slowness and stiffness and should be discussed with your neurologist. Strategies for assisting with movements during rest times may include introducing medication to increase the level of dopamine in the evening and into the night. Using a satin sheet on your bed and wearing satin pyjamas will help you glide and move in bed.

Needing to frequently get up to pass urine after going to bed is common for people living with Parkinson's. It is associated with reduced mobility and lower blood pressure which causes you to retain fluid and a need to pass urine when you lie down.

The brain sometimes misinterprets signals sent from the bladder, causing people with Parkinson’s to feel they need to go to the toilet more frequently. While there is medication to help with this, it can often be easily managed by having a rest in the afternoon with your feet up. This will help reduce some of the fluid retained during the day - but be careful not to sleep for too long and disrupt sleep at night.

People with Parkinson’s commonly experience sleep attacks - described as experiencing unstable wake - meaning people can find themselves sleeping if they are inactive or sitting quietly. Poor sleep can also be diagnosed as insomnia which involves trouble falling asleep for at least three nights each week for three months or more. To be diagnosed with an insomnia disorder it must cause clinically significant distress or impairment in social, occupational, educational, academic, behavioural, or other important areas of functioning.

Sometimes treatments for insomnia can involve melatonin, a naturally occurring hormone that is secreted at night in response to darkness and increases the propensity for sleepiness. When prescribed the exogenous (tablet form) melatonin, it is critical to pay attention to the timing and dosage to enhance its effectiveness. 

In the short-term, insufficient sleep can affect judgement, mood, ability to learn and retain information, and can also increase the risk of serious accidents and injury. When a person doesn't get a good night's sleep there are a plethora of health and cognitive consequences. It is critical that you alert your treating doctor to your sleep issue. Research shows depression and anxiety can develop as a consequence of a sleep disorder - particularly insomnia. Research has shown that by simultaneously treating insomnia and depression, there is a much better chance of improving sleep quality, mood and overall quality of life.

If you’re concerned about your sleeping habits or your partner's, you could prepare answers to the following 10 questions for your neurologist, General Practitioner or psychologist to conduct an effective assessment and appropriate intervention:
1. What time do you normally go to bed at night?
2. What time do you wake in the morning?
3. Do you have trouble falling asleep at night?
4. Approximately how many times do you wake at night?
5. If you do wake up, do you have trouble falling back to sleep?
6. Do you snore, gasp for air or stop breathing?
7. Do you kick or thrash about while asleep?
8. Are you tired for most of the day?
9. Do you usually take one or more naps during the day?
10. Do you usually doze off without planning to during the day?

Typically, sleep disorders are substantiated through measurements such as a polysomnograph (PSG), also known as an overnight sleep study. Wrist actigraphy – a wrist-watch like monitor - is also used to
continuously record movement and rest and to differentiate sleep from just lying still awake. A sleep diary that records at least two weeks of information is also important for capturing sleep disturbances.

Healthy sleep practices:

  • Curtail time in bed to match sleep time
  • Eliminate the alarm/bedroom clock
  • Ensure regular exercise either in morning or daytime
  • Avoid caffeine 3-5 hours before bed • Alcohol should be curtailed. Although alcohol will make you feel relaxed, it wears off 3-5 hours later and can contribute to fragmented sleep later in the night
  • Keep regular sleep and wake times
  • Explore short naps of 20-30 minutes. Avoid longer naps, especially after 3pm
  • Turn off ’screens‘ at least an hour before bed. The brightness of computer screens, tablets and mobile phones – especially those with blue light sources - suppress people's normal nighttime
  • release of melatonin.
  • Ensure adequate exposure to natural light during waking hours.

When to seek professional help:
People with chronic sleep problems that affect work, school, home life, or your relationships consider seeking assistance. A medical review with a GP or another medical specialist may be suggested to determine whether Parkinson’s could account for the symptoms of insomnia.

A referral to a sleep specialist might also be made. The sleep specialist can do further assessments and might arrange for sleep to be monitored overnight, either at home or in a clinic, to better understand if a physical problem is interfering with sleep or if the natural phases of sleep are disrupted in some way.

Some individuals with insomnia benefit from a combination of medication and psychological interventions. A GP or medical specialist can offer advice and assistance around whether medication may be of benefit.


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