What Types Of Sleep Problems Do People With Parkinsons Disease Have
Parkinsons disease affects every person differently. It also impacts sleep in different ways. People with Parkinsons may have:
- Insomnia, finding it hard to fall asleep.
- Fragmented sleep, waking up many times over the night.
- Excessive daytime sleepiness, finding it hard to stay awake during the day.
- Very vivid dreams, which may cause hallucinations or confusion after waking up.
- Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.
How Are Sleep Problems Diagnosed In People With Parkinsons Disease
If youre having problems sleeping, sit down with your healthcare provider to discuss the issue in detail. Your provider will ask you questions to better understand your symptoms.
Be prepared to explain when sleep disruptions happen and how they affect your life. Keeping a sleep journal for a few weeks can help you remember the details.
If your provider suspects you may have a sleep disorder, they may recommend you have a sleep study. This overnight test uses electrodes attached to your skin to track how your body functions when youre sleeping.
Trouble Staying Asleep Or Getting Restful Sleep
Some conditions, including Parkinsons disease, can interrupt sleep or make it less restful. Sleep fragmentation or interrupted sleep is one of the most common sleep complaints in Parkinsons patients. Poor sleep can lead to problems with attention and thinking, among other issues.
Several factors can lead to sleep interruptions in Parkinsons disease. These include the symptoms of the disease returning when medications wear off , frequent nighttime urination , hallucinations or altered dreams, and sleep apnea.
A large study of almost 3,200 patients found that sleep apnea was more common in people with Parkinsons than others.
Another study showed that women with sleep apnea may be at higher risk of getting Parkinsons disease.
Motor dysfunction of the laryngopharynx, the area where air and food pass through the throat, could also be involved in sleep apnea in Parkinsons disease patients, according to another study.
Sleep apnea can be treated with oral appliances or airway pressure devices such as a CPAP to keep the airways open. If these are unsuccessful, surgery might be an option.
REM sleep behavioral disorder, restless legs syndrome, and periodic limb movements in sleep are other issues that can lead to less restful or interrupted sleep. These disorders, which involve unwanted movements of the body, have a higher prevalence in Parkinsons patients and may have similar underlying causes.
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What Does Osa Look Like
OSA is a sleep breathing disorder with several identifiable risk factors. Sleeping partners may have witnessed their loved ones choking or gasping for air in their sleep. Also, snoringthough not proof alone of OSAis still suspect if its loud and frequent.
OSA is identified as pauses of breathing during sleep which last at least 10 seconds each and which occur five times or more per hour, on average, during a full nights sleep. By comparison, healthy people without OSA experience less than three episodes of breathing pauses per hour per night.
When these pauses occur, a flurry of other processes within the body take flight: higher blood pressure and pulse, the release of stress hormones, and shifts in insulin-glucose ratios.
When experienced repeatedly over the long-term, but left untreated, OSA is a leading cause for many chronic health issues, including cardiovascular disease, hypertension, type 2 diabetes, major depression, and anxiety disorder. Untreated OSA is also a significant cause of motor vehicle accidents and dangerous mistakes and errors that occur during the day as a result of lingering daytime sleepiness.
Other classic symptoms include frequent nocturnal awakenings, and a variety of sensations upon awakening, such as shortness of breath, sore throat, dry mouth, and headache.
The Relationship Between Parkinsons Disease And Sleep
Its unclear whether poor sleep causes parkinsonian symptoms to worsen or whether worsening parkinsonian symptoms cause poor sleep. In many cases its likely a case of bidirectionality, with each one exacerbating the other.
Fragmented sleep and sleep deprivation appear to leave the brain more vulnerable to oxidative stress, which has been tied to the development of Parkinsons disease. Parkinsons disease is not usually diagnosed until individuals have developed sufficient motor symptoms, by which time a significant portion of brain cells have already been damaged. If poor sleep quality or having sleep disorders foreshadows the development of parkinsonian symptoms, these could be useful in early diagnosis of the disease.
More research is needed to clarify the multifaceted relationship between Parkinsons disease and sleep. A better understanding of this connection may offer medical experts the unique opportunity to screen at-risk individuals and perhaps delay the onset of the disease.
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Daytime Tips For Better Sleep
- Wake up at the same time every day, using an alarm if you have to.
- Get out of bed right after you wake up. Too much time spent in bed can lead to more waking at night.
- Eat regular, healthy meals, and eat at the same time every day. Three to four small meals are better than 1-2 large meals.
- Limit daytime napping to a 40-minute NASA nap . Too many or too-long naps can make sleep at night more difficult.
- Do not drink coffee, tea, sodas, or cocoa after noon. They contain caffeine and can interfere with normal sleep.
- Do not drink alcohol after dinner. It may help you fall asleep faster, but makes sleep shallower later in the night. Alcohol can also make snoring and sleep apnea worse.
- Use caution when taking headache and cold medicines. Some contain stimulants that can affect sleep.
- Stop smoking. Cigarette smoking stimulates the body and makes sleep difficult.
- Increase or start doing daily exercise. Regular exercise helps to deepen sleep. Avoid heavy exercise 2 hours before bedtime.
How Are Sleep Problems Treated In People With Parkinsons Disease
Your provider will recommend treatments that address whats causing your sleeping challenges. Your provider may:
- Change your medication: If a medication could be causing your sleep issues, your provider may decide to adjust your treatment plan. Reducing the dose or switching medicines may solve the problem.
- Prescribe a new medication or therapy: If you have a sleep disorder, your provider will discuss your options. In some cases, your provider may recommend a new medication. If you have sleep apnea, wearing a special oral appliance can help. The device enables you to get a steady flow of oxygen, so your body doesnt gasp for air.
- Suggest lifestyle changes: Your daily habits and sleeping environment can help or hurt your sleep efforts. Setting regular sleep and wake times, keeping the room dark and avoiding electronic screens at bedtime may improve how well you sleep. If you have REM sleep disorder, your provider will discuss options for how best to protect you while you sleep.
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Changes In Sleep With Aging
As people age, they experience a number of changes in their circadian rhythms, and among the most noticeable are the changes in the sleep-wake cycle. Older people tend to wake up earlier and go to bed earlier than they did when they were younger. They wake up more often during the night and have more difficulty going back to sleep than younger people. They also tend to sleep more during the daytime hours. Therefore, if one looks at total sleep time over the 24-hour day, the total time spent sleeping changes very little but the distribution of sleep may be quite different. Younger people experience a consolidated nighttime episode with little or no daytime sleep, whereas older individuals experience sleep episodes throughout the 24-hour day. Daytime sleepiness is affected by two major factors: the amount and quality of nighttime sleep, and the strength of the circadian rhythm. In addition, older people tend to have a reduced amount of N3 or deep slow wave sleep.
How Does Parkinsons Disease Cause Sleep Problems
Researchers have yet to uncover every nuance of the Parkinsons and sleep connection. So far, medical experts believe several causes may contribute:
- Chemical changes in the brain: Ongoing research shows that Parkinsons disease may disrupt sleep-wake cycles. Changes to certain brain chemicals may cause people with Parkinsons to get less sleep.
- Medication: Some drugs that treat Parkinsons disease may make it harder to fall or stay asleep. A medication may also disrupt your sleep patterns by making you drowsy during the day .
- Mental health challenges: People with Parkinsons commonly deal with mood disorders, such as anxiety or depression. Any mood disorder may keep you up at night or make you sleep less soundly.
- Parkinsons symptoms: Pain, waking up at night to pee or other Parkinsons symptoms can make restful sleep harder to come by. Sleep apnea can also disrupt sleep.
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Why Treating Osa Matters
Problems with cognition, anxiety, and daytime sleepiness are hallmarks for many disorders, including several different sleep disorders. Its in the best interest of the person with PD to have any suspected sleep problems checked out as soon as possible.
The good news? Treating OSA should bring relief to someone with PD who routinely suffers from daytime sleepiness, brain fog, and mood problems.
Why Do Parkinsons Patients Have Trouble Sleeping
Despite having daytime tremors, Parkinsons patients do not shake in their sleep. However, both Parkinsons disease itself and the medications used to treat it can give rise to a number of sleep problems that lead to insomnia and excessive daytime sleepiness.
Patients with motor symptoms may have trouble adjusting sleeping positions to get comfortable. Others may experience distressing nocturnal hallucinations when trying to fall asleep. These may be a result of medications or cognitive impairment.
In turn, excessive daytime sleepiness may occur as a consequence of sleeping poorly at night. It may also be triggered by medications. Parkinsons patients who suffer from EDS may be at a higher risk of accidents and unable to safely carry out activities such as operating a motor vehicle.
Since insomnia frequently goes hand-in-hand with anxiety and depression, it may be a contributing factor to sleep problems in people with Parkinsons disease. For that reason, doctors often look for mental health disorders in people with Parkinsons disease who have sleep problems.
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Sleep: A Mind Guide To Parkinsons Disease
This 36-page booklet explains normal sleep patterns, the body clock, how much sleep we should get, challenges to sleeping well, tips for good sleep hygiene, and sleep in normal aging before discussing symptoms, diagnosis and treatment of sleep disorders, including insomnia, REM sleep behavior disorder, sleep apnea, restless leg syndrome, and daytime sleepiness.
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More serious sleeping disorders may also occur such as sleep apnea or REM sleep behavioral disorder. Around 40 percent of people living with Parkinsons disease will experience sleep apnea when breathing becomes obstructed while asleep. The common symptoms of this are loud snoring, pauses in breathing, restless sleep, and feeling very tired during the day. Sleep apnea can be controlled using breathing equipment continuous positive airway pressure throughout the night.
REM sleep behavioral disorder is where the muscles dont fully relax while dreaming, therefore the person is likely to act out their dreams. This can include hitting, kicking, grinding teeth, and shouting. Around half of those living with Parkinsons experience this but in most cases it can be improved with medication.
Parkinsons News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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Snoring Treatment For Parkinsons Disease
There are several snoring treatments available on the market. Over the counter, products include nasal cones, nasal strips, nasal sprays, essential oils, and night guards. Prescription based products including snoring mouthpieces and tongue stabilizing devices can also be quite effective. Surgical procedures like the pillar procedure and a tonsillectomy are also other more invasive options. Its important to consult your doctor when deciding on the best snoring solution for you or a loved one with Parkinsons disease.
Study Design And Population
A cross-sectional study was performed on patients with PD from the tertiary outpatient clinic of movement disorders of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto University of São Paulo, São Paulo, Brazil, over a period of 21 months.
In total, 124 consecutive individuals with PD were approached on the day of their usual consultation. Ninety of these individuals provided informed consent, and two of them did not complete the research protocol. Subsequently, the patients who agreed to participate underwent a clinical assessment with neurologists specialized in sleep medicine and movement disorders, and with a psychiatrist. The patients also underwent polysomnography with a maximum interval of two weeks after the initial assessment. During this time, there was no change in drug treatment.
This study was approved by the Ethics Committee of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto University of São Paulo, under protocol number 13410, following the ethical principles of the Declaration of Helsinki.
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Rem Sleep Behavior Disorder
REM stands for rapid eye movement. This is the stage of sleep when dreams take place. People with REM sleep behavior disorder act out their dreams, which can be violent. RBD is one of the early warning signs of Parkinsons. Healthy people with RBD have a higher risk of developing Parkinsons. RBD can be treated with the drug clonazepam .
Inclusion And Exclusion Criteria
The following inclusion criteria were used for study selection: Human studies English language OSA diagnosed by polysomnography use of case-control, cohort, cross-sectional or retrospective study design, sufficient background data for estimating the OR with 95%CI of PD and non-PD patients. Exclusion criteria were duplicate articles data from case report, reviews or letters to the editor subjects with ineligible general population controls criteria studies with patients that had neurodegenerative conditions, Parkinsonian syndromes, or Parkinsonism other than idiopathic PD.
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Rem Sleep Behavioral Disorder
Rapid eye movement, or REM, sleep is a normal part of the sleep cycle when people dream. Usually the only part of the body that moves during REM is the eyes, thus the name.
- People with rapid eye movement sleep behavior disorder do not have the normal relaxation of the muscles during their dreams. Therefore, they act out their dreams during REM sleep.
- People with RBD may shout, kick their bed partner or grind their teeth. Sometimes, in moderate to severe RBD, people may have aggressive, violent behaviors, like getting out of bed and attacking their bed partner.
- About half of people with PD suffer from RBD. It may develop after or along with the disease, but in most cases, it precedes the PD diagnosis by five to 10 years.
- Consider making environmental adjustments to protect the person with RBD and bed partner from injury. This may include padding the floor, using bed rails or sleeping in separate rooms.
- Clonazepam has been shown in large case series to improve RBD in 80 to 90 percent of cases. The dose of clonazepam required is low, usually from 0.5 mg to 1.0 mg. The adverse effects of clonazepam include nocturnal confusion, daytime sedation, and exacerbation of obstructive sleep apnea, if present. It is in generic form and not expensive.
- Talk to your doctor about the over-the-counter sleep aid Melatonin. Doses up to 12 mg at night one hour before can improve RBD.
How Is Daytime Sleepiness Treated
Consider making certain lifestyle modifications, such as:
- Establish good sleep hygiene, including a set bedtime and wake-up time.
- Get exposure to adequate light during the day and darkness at night.
- Remember indoor lighting may not be sufficient to promote a normal circadian rhythm.
- Avoid sedentary activities during the day.
- Participate in activities outside the home. They may help provide stimulation to prevent daytime dozing.
- Get physical exercise appropriate to your level of functioning, which may also promote daytime wakefulness. Strenuous exercise, however, should be avoided six hours before sleep.
- Do NOT drive while sleepy if you experience excessive daytime sleepiness. Motor vehicle accidents increase during periods of drowsiness and may be associated with sudden onset of sleep .
- Talk to your doctor about possibly decreasing the dosage of dopamine agonists if you experience daytime sleepiness or sleep attacks.
- Talk to your doctor about decreasing stimulants like caffeine, modafinil and methylphenidate .
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Strategies That Improve Wakefulness During The Day
Non-pharmacologic interventions for EDS
- Encourage daily exercise and activities a person without an activity planned is much more likely to doze than one who is engaged in an activity. Be realistic about scheduling a person with advanced PD, but aim for at least one scheduled activity a day
- Light therapy Light therapy, in which a person is exposed to bright light via a light box, is used as a treatment modality for sleep disorders and psychiatric disorders not associated with PD. A small clinical trial testing its efficacy in PD was conducted and demonstrated an improvement in sleep and in excessive daytime sleepiness.
Pharmacologic interventions for EDS
There are no FDA approved medications for EDS in the context of PD. However, clinicians sometimes prescribe medication off-label for EDS. These include modafinil, methylphenidate, and caffeine. Istradefylline is a medication approved to treat motor symptoms of PD. A small trial demonstrated its potential improvement of EDS as well. Talk with your physician about the possibility of using a medication to maintain wakefulness during the day.
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