Parkinson’s Disease and Sleep

This article explores how Parkinson's disease (PD) symptoms may be causing an inadequate amount or lower quality of sleep, and strategies on how to improve sleep hygiene. An estimated two-thirds of individuals with Parkinson’s are struggling with sleep disorders (Pacheco, 2022). It is important to receive an adequate amount of sleep to ensure a person with Parkinson's has the energy to effectively manage PD symptoms and obtain the maximum benefit from their medications.

Symptoms of Parkinson’s Disease Related to Sleep: REM/RBD and RLS

If you are an individual with Parkinson’s disease you may experience Rapid Eye Movement (REM) or Rapid Eye Movement Sleep Behavior Disorder (RBD) (‘Acting Out Dreams While Asleep’, n.d.). This means that you may be acting out your dreams while you sleep – including, punching, kicking, or yelling. It is important to note that not all people who experience RBD have Parkinson’s disease, however, it is something to be aware of as it can be a symptom of Parkinson’s. Sleep disorders (SD) are a common non-motor symptom of PD that often worsen over time (Loddo et al, 2017).

Rapid Eye Movement Sleep Behaviour Disorder occurs when our brains do not have the ability to prevent our muscles from moving, which normally they do. For people with Parkinson’s, “these brain signals don’t work properly, and a person moves while dreaming” (‘Acting Out Dreams While Asleep’, n.d.). The dreams people experience may be chaotic and volatile (i.e. being chased, or attacked), or active like playing sports.

Additional sleep disorders those with PD may experience are insomnia and excessive daytime sleepiness (EDS) (Loddo et al, 2017). Insomnia, the most common sleeping disorder among people with Parkinson’s, is characterized by having trouble falling asleep, staying asleep, or waking up earlier than desired. It is most prominent in females, and people experiencing depression and anxiety (Loddo et al, 2017). Excessive daytime sleepiness (also known as a ‘sleep attack’) is when a person gets a sudden and overwhelming sleepiness that can’t be ignored. In some cases, it may even cause the person to fall asleep without awareness (Loddo et al, 2017).

Restless Leg Syndrome (RLS) is another symptom of Parkinson’s that may also cause sleep disruptions. RLS “is a neurologic and sleep-related condition characterized by an irresistible urge to move the legs” (‘Restless Leg Syndrome and Parkinson’s Disease’, 2020.). It is a general feeling of restlessness that can be felt in the legs, specifically the calves and thigh areas, and in some cases, a tingly sensation can also be experienced. These sensations and restlessness are exacerbated when the individual is not mobile or moving around, i.e. resting or sleeping in the evening are when it shows up, making it hard to fall asleep. This is why RLS is considered a sleep disorder. It can cause the individual sleep deprivation and feelings of anxiety when going to bed.

Short-term relief for those experiencing RLS can sometimes be found with the individual getting up and moving their legs around or walking – however, this relief only lasts for as long as the movement continues. In many severe cases, some people may have to pace for hours for lasting relief (‘Restless Leg Syndrome and Parkinson’s Disease’, 2020). Massaging or stretching the legs may also help provide comfort.

The Causes of Sleep Disorders in PD

There are many reasons sleep disorders occur with PD, however, the exact causes are difficult to pinpoint because it often is unclear whether it is symptoms causing poor sleep, or poor sleep exacerbating symptoms. Some contributors to poor sleep among people with Parkinson’s may include:

• The neurodegeneration process: Neurodegeneration “can disrupt the networks regulating the sleep–wake cycle and deplete a large number of cerebral amines possibly playing a role in the initiation and maintenance of sleep” (Loddo et al, 2017). This decreased quality of sleep then causes fatigue and sleepiness.
• Symptoms of Parkinson’s: Sleep can be affected by rigidity, tremor, dystonia, or pain at night, which make it difficult to fall or stay asleep.
• Stress: Increased stress levels may contribute to decreased quality of sleep, so it is important to reduce stress levels to get a good night’s rest.
• Medications: Sometimes prescription medications taken to alleviate Parkinson’s symptoms cause sleep issues (Pacheco, 2022) and circadian rhythm disruptions. Talk to your doctor or healthcare provider about issues with sleep to ensure that your medications are optimized.

Identify Sleep Problems and Sleep Hygiene Tips

Fragmented sleep causes the brain to be more susceptible to oxidative stress, which has been known to cause PD. As a result, it’s important to identify issues and make simple lifestyle changes that can help you fall asleep or stay asleep throughout the night. It’s all about incorporating your favourite relaxation activities into a routine you look forward to. Here are a few tips and ideas you may consider:

• Sticking to regular bedtimes
• Following a consistent bedtime routine with soothing activities such as listening to music or reading a calming book
• Getting regular exercise, preferably early in the day
• Getting adequate exposure to light, whether outdoors or through light therapy
• Avoiding long naps and naps late in the day
• Creating a cool, dark, and comfortable sleeping environment
• Restricting bedtime activities to sex and sleep only
• Turning off screens an hour before bedtime
• Reducing liquid intake before bedtime
• Avoiding caffeine, alcohol, and tobacco
• Eating a healthy diet and avoiding large meals at night

Tips courtesy of: https://www.sleepfoundation.org/physical-health/parkinsons-disease-and-sleep

Try out these sleep hygiene tips and see what fits into your lifestyle and unique needs. As always, for more serious sleep issues, be sure to notify your healthcare provider for a more comprehensive treatment plan.

Sources

“Acting Out Dreams While Asleep.” The Michael J. Fox Foundation for Parkinson's Research | Parkinson's Disease, https://www.michaeljfox.org/acting-out-dreams-while-asleep

Loddo, Giuseppe, et al. “The Treatment of Sleep Disorders in Parkinson's Disease: From Research to Clinical Practice.” Frontiers in Neurology, U.S. National Library of Medicine, 16 Feb. 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311042

Pacheco, Danielle. “Parkinson's Disease and Sleep.” Sleep Foundation, 22 Apr. 2022, https://www.sleepfoundation.org/physical-health/parkinsons-disease-and-sleep

“Restless Leg Syndrome and Parkinson's Disease.” American Parkinson Disease Association, 17 June 2020, https://www.apdaparkinson.org/article/restless-leg-syndrome

This content was published in the January 2023 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.