Sleep problems are a common problem for people with Parkinson’s disease (PD). If you find that you are experiencing poor sleep, talk with your doctor about it because untreated sleep problems make coping with PD all the more difficult -- and sleep problems can be effectively treated, so why suffer?
The first step in dealing with your sleep problem is to get help finding out what the root cause is. If you have early or mid-stage PD, chances are that your sleep problems will involve at least one of the following problems: insomnia, excessive daytime sleepiness, restless or shaky leg movements at night, intense dreams associated with REM behavior disorder, and poor sleep due to depression. While you will need professional medical assistance in finding out what's causing your sleep problems, the following will help you understand what may be going on:
Insomnia refers to the inability to get a good night’s sleep. Insomniacs have trouble falling asleep, and may only sleep for a few hours at a time. Laboratory (polysomnographic and electroencephalographic or EEG) studies of sleep in PD patients who are not depressed show decreases in deep sleep, too much light sleep as well as increases in sleep fragmentation and multiple night wakings.
Excessive Daytime Sleepiness (EDS) in PD
Excessive daytime sleepiness is a common complaint of both early and mid-stage PD patients and may be related to the insomnia we just spoke about. If you cannot get a good night’s sleep you are going to feel sleepy during the daytime. Parkinson's disease medications also can contribute to excessive sleepiness. Use of dopamine agonists pramixepole and ropinirole or high doses of any dopaminergic drug to treat PD is associated with sudden and irresistible "sleep attacks" during the day in some PD patients. However, this is rare.
Periodic Limb Movement Disorder and Restless Legs Syndrome (PLMD/RLS)
Do you often feel the irresistible urge to move your legs around during the night in order to get comfortable? If so, have you noticed that it keeps you awake? Naturally, if you are moving your legs you are probably waking up more often and therefore are not getting a good night’s sleep. So called “periodic limb movements”, or PLMD, are quite common in older adults, including PD patients. Restless legs syndrome also frequently affects middle-aged and older adults, as well as PD patients. In PLMD, there are slow rhythmic movements of the legs and feet, whereas restless legs syndrome causes more twitchy unpleasant sensations in the legs. In both disorders, there is a sensation in the legs that causes the person to move his or her extremities and may contribute to insomnia.
REM Sleep Behavior Disorder (RBD)
This disorder (RBD) refers to the acting out of violent dreams. REM sleep, or rapid eye movement sleep, is the form of deep sleep where you have the most intense dreams. Usually when you dream during REM sleep, nerve impulses going to your muscles are blocked so that you cannot act out your dreams. In REM behavior disorders, that blocking of the muscle impulses no longer occurs, so you are then free to act out your dreams. While estimates vary dramatically, it appears that approximately 50% of PD patients have partial or complete loss of muscle atonia during REM sleep. In other words, while we usually are unable to move our limbs while sleeping, for those with RBD disorder, this inhibition is absent.
This loss of the normal motoric inhibition of REM may then lead to physical enactment of REM dreams, many of which appear to be violent. A patient may report that he attacked his wife while asleep, thinking she was an intruder. This, of course, is dangerous both for the patient and his or her sleep partner.
Sleep-Related Breathing Disorders in PD
PD patients with autonomic dysfunction have been reported to have a higher incidence of sleep apnea. However, most types of breathing sleep disorders are not common in PD patients.
See Page Two for more on sleep disorders associated with PD.