Sleep disorders are one of the most common problems experienced by people with Parkinson’s Disease. A major study concluded that more than 60% of people with PD experience sleep-related difficulties, with this percentage rising based on the length of time living with the disease.
Insufficient sleep can severely impact quality of life, and exacerbate other PD symptoms.
Like many other aspects of PD, while many people have sleep problems, they do not all have the same type of sleep disturbances.
If you want to improve your sleep, it is important to understand the type(s) of sleep disturbance that you experience. This will allow you to focus on tips and solutions that are most relevant for you, and to better communicate your problems with your doctor(s).
I’ve found this presentation by Dr. Jason Valerio and published by the Parkinson’s Society of British Columbia to be extremely helpful.
It’s a rather long video, but it’s worth watching, and then rewatching.
The first time you watch the video, concentrate on learning a broad overview of the different sleep disorders that are commonly associated with PD. That will help you understand what sleep problems you experience. It is then worthwhile to rewatch the video to concentrate on the tips and suggestions that are applicable to your sleep problems.
Broadly speaking, sleep issues are categorized into one or more of the following categories:
- Difficulty Falling Asleep (Insomnia)
- Difficult Staying Asleep (Sleep Maintenance)
- Excessive Daytime Sleepiness (Hypersomnolence)
In some cases, there are any obvious causes for the sleep problem. For example, if you have trouble falling or staying asleep, the most common contributors to the problem are:
- anxiety/racing thoughts
- tremor
- rigidity and pain/discomfort
- dyskenesia
- poor mobility/difficulty turning over in bed
Many of the above can be associated with “off periods”. If you are taking levodopa medication 3 or 4 times a day, then your medication is optimized to be effective during your waking hours, and all or part of the overnight is an “off period”, where PD symptoms are untreated. Your doctor may suggest medication changes to address this.
In addition to the previous list, there are other more complex factors that can contribute to sleep disturbances:
Circadian sleep-wake dysfunction – Circadian rhythm refers to your body’s internal clock, where cortisol levels peak during day, while melatonin peaks at night. Low levels of melatonin can make it difficult to fall asleep at night. Ironically, this can also contribute to daytime sleepiness because if you don’t sleep well at night, eventually you are going to sleep regardless of melatonin levels.
REM Behavior Disorder (RBD) – This is a disorder where you act out and vocalize dreams, which are extremely vivid and in most cases, frightful, involving being chased or attacked. Shouting, screaming, swearing, punching and kicking are extremely frequent. (People who experience RBD often begin to experience it 5 years before other PD symptoms become noticeable.)
Restless Leg Syndrome (RLS) or variations such as “Motor leg restlessness” – This is a disorder where there is an overwhelming and often unpleasant urge to move the legs while at rest. It is less common but possible to have RLS symptoms in the arms or torso. RLS symptoms are temporarily relieved by movement or pressure.
Periodic Leg Movement Disorder (PLMD) – This is a disorder where there is repetitive cramping or jerking of the legs during sleep, which can cause you to wake.
Obstructive Sleep Apnea – This is a sleep disorder in which breathing is briefly and repeatedly interrupted during sleep. The “apnea” in sleep apnea refers to a breathing pause that lasts at least ten seconds. Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Chronic snoring is a strong indicator of sleep apnea and should be evaluated by a health professional.
Nocturia (frequent nighttime urination) – If you have this sleep disorder, you know you have it.
In addition to Dr. Valerio’s video, the following resources may be helpful:
Parkinson Canada
American Parkinson’s Disease Association
National Sleep Foundation
Michael J. Fox Foundation
Parkinson’s Foundation
Frontiers in Neurology
Parkinson’s UK
US Veterans Health Administration