Parkinson’s patients experience difficulties with their sleep due to the disease itself and the medications that treat it. This can lead to increased sleepiness during the day.
Parkinson’s disease can cause problems with sleep, and the medications used to treat it can cause even more. Difficulties sleeping during the night can cause daytime sleepiness, and the medications can also cause drowsiness. This disruption to the circadian rhythms can lead to more frequent, lower quality sleep.
The different stages of sleep
There are 2 phases of sleep that alternate throughout the night:
- Rapid eye movement (REM) sleep
- Non-rapid eye movement (NREM) sleep
The lightest stage of sleep is NREM, after which comes deeper sleep states. As people move back through to the lighter stages, they enter the REM state. If awoken during REM sleep, the sleeper will often report a dream.
These are defined by:
- Brain activity
- Muscle movement
- Eye movements
Parkinson’s disease and sleep
If you would like further information about Parkinson’s, the causes, history, symptoms and treatments, see Parkinson’s: A Deeper Dive
30% of Parkinson’s patients experience sleep problems. These problems can include trouble falling asleep, and sleep fragmentation (waking up during the night).
Trouble falling asleep can be caused by:
- Anxiety
- Depression
- Night sweats
- Trouble coordinating movement in bed
Sleep fragmentation can be caused by:
- Medications wearing off during the night, causing symptoms to return
- Side effects to the medication itself
- Increased need to use the bathroom
The effect of medication
Sometimes the medications used to treat Parkinson’s can cause their own problems. The most common offenders are:
- Carbidopa-levodopa (Sinemet®)
- Mirapex
- Requip
These can cause vivid dreams and nightmares that regularly disrupt sleep. While these in themselves are not pleasant, they can also be cause for serious concern. Parkinson’s patients and their bedfellows need to consider the serious effects of Rapid Eye Movement Sleep Behaviour Disorder (RBD). This occurs when the processes that prevent them from physically acting out their dreams, stop working. This can lead to yelling, screaming, kicking, or even getting out of bed to ‘act out’ what’s going on in their dream or nightmare.
If the dreams were more pleasant, it might be that the physical reactions would be cause for less concern, but as the content of the dreams tends to be disturbed, the physical reactions can be violent.
Bedfellows have reported being punched, kicked and/or bitten, all while the sleeping person is unaware of their behaviour.
A further result of RBD is that the dreams are vivid, can affect the patient long-term (akin to trauma) and leave them feeling unrested.
There are possible medications that can help, so if your loved one is experiencing RBD, it’s important to speak to a doctor. However, if the effects are long term the simplest solution might be to sleep in separate beds.
If Parkinson’s disease is taking its toll on you or your loved one you might want to consider hiring a home carer. Home carers can fit around your schedule, so if you only need them to be around during the night, that is perfectly possible.
Restless legs syndrome (RLS)
RLS causes stiffness and pain in the legs, which can usually be relieved by moving. The sudden jerking movement can interrupt sleep, although RLS is often reported by the bedfellow, while the patient remains otherwise undisturbed.
RLS can be a side effect of some Parkinson’s medications. Medical evaluation may show that the patient should change treatment to continuous release levodopa, dopamine agonists, and clonazepam.
Maintenance insomnia
This is the most common sleep problem reported by people with Parkinson’s. Patients often state that they have no trouble falling asleep, but awake after a few hours and find getting back to sleep afterwards very difficult.
Waking after a few hours can be caused by nightmares, physical discomfort, and the need to use the bathroom more frequently.
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Unintended sleep episodes
Often daytime sleep episodes are very short, and the patient may be completely unaware that they have fallen asleep. Depending on where they are, these episodes can be very dangerous for themselves and others, and unintended sleep episodes are one of the reasons why Parkinson’s patients need to be assessed for driving safety.
The Parkinson’s disease process can, in itself, be tiring. Medications can contribute or be a cause of the problem, so it’s worth discussing options with a doctor. Doses can be adjusted and drug interactions must be considered. If your loved one has PLMS and/or RLS, these also need to be treated.
What can be done?
After visiting the doctor and discussing options, you can investigate your loved one’s sleep hygiene. Sleep Hygiene simply refers to the routines you carry out before going to bed at night, and the environment in which you sleep.
You can find out more about good sleep hygiene here.
Find out more about Parkinson’s disease:
- How Parkinson’s progresses
- How does Parkinson’s affect daily life?
- What are Parkinson’s symptoms?
- How are Parkinson’s and dementia related?
- How Parkinson’s affects the body
- The treatment of Parkinson’s disease
- Understanding live-in care
- Understanding dementia
