Poor sleep quality can decrease a person’s overall quality of life. For those diagnosed with Parkinson’s disease (PD), cognitive decline may contribute to sleep disturbances, which affect alertness in the morning and the ability to fall asleep.

Whether you or your loved one has PD and trouble sleeping, let’s learn about the relationship between the two in this article.

Why Do Parkinson’s Patients Have Trouble Sleeping?

Here are common reasons why people living with PD have trouble sleeping:

• Medications: Many have difficulty sleeping because of their medications to alleviate the disease’s symptoms. Some taking PD prescriptions experience distressing hallucinations when going to sleep. For example, anti-seizure medicines and levodopa can cause hallucinations.
• Cognitive Impairments: Hallucinations may also occur in those who have developed cognitive impairments. One article highlighted a study featuring Parkinson’s Disease people with dementia. It noted that 36% of the participants experienced hallucinations and delusions.
• Mental Health Disorders: Experts suggest that anxiety and depression contribute to sleep problems. Mental health disorders are closely related to insomnia, making the connection between PD and sleep problems more apparent.
• Parkinson’s Itself: PD itself can give you sleep problems and lead to sleeping disorders, including excessive daytime sleepiness (EDS) and insomnia. Plus, motor symptoms may give you trouble getting comfortable as you constantly adjust sleeping positions. The popular belief that parkinsonian tremor vanishes entirely during sleep is inaccurate, as tremors can re-appear, sometimes severely, during sleep arousals.

Sleep Disorders Related to Parkinson’s Disease

Here are common Parkinson’s sleep disorders that people might develop:

Circadian Rhythm Disruptions

Circadian rhythms refer to the 24-hour cycles of people’s body clocks. Your circadian rhythm runs passively in your body to perform essential functions related to regaining lost energy. For example, it is your body’s guide to knowing when to sleep and when to be awake.

Those with Parkinson’s tend to have reduced dopamine levels, significantly altering their sleep-wake cycle. Disruptions to your circadian rhythm may cause you to develop EDS and insomnia.

Nocturia

Many people with Parkinson’s experience nocturia, a condition that causes people to wake up in the night to urinate. Technically, nocturia is not a sleep disorder. However, sleep disorders are among the condition’s leading causes of high fluid intake and bladder obstruction.

In addition, frequent nighttime urination negatively affects a person’s overall sleep quality by leading to impaired sleeping habits and preventing them from enjoying restorative sleep.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) can significantly disrupt sleep quality, causing constant breathing lapses, snoring, and gasping. OSA can result from carrying excess weight and obesity.

However, PD patients tend to have obstructions in their upper airway and develop restrictive lung disease. These factors are only some signs that most likely would lead to OSA.

REM Sleep Behavior Disorder

Over half of people living with PD develop REM sleep behavior disorder. This common sleep disorder is like sleepwalking, where people are unaware that they are acting out their dreams in real life. For instance, those with this sleep condition might hit their sleeping partner or fall down the stairs without knowing it.

People with REM sleep behavior disorder usually describe their dreams as vivid and remember them, unlike those who sleepwalk. Also, it is a risk factor for severe cognitive decline and can occur years before experts can diagnose PD.

Restless Legs Syndrome

People with restless legs syndrome suffer from an irresistible urge to move their legs. It is an early sign of PD, which affects between 30% and 80% of patients with the disease. Researchers suggest that PD and restless legs syndrome go hand-in-hand because of the decreased dopamine levels in a person’s body.

Cause and Effect of Parkinson’s Disease and Sleep

PD and poor sleep have a bidirectional relationship. However, It remains unclear whether PD symptoms cause poor sleep or the other way around. Sleep deprivation increases the chances of developing oxidative stress, which negatively affects the brain and is linked to PD.

Poor sleep quality may serve as an early sign of PD. Understanding how sleep disorders may cause a person to develop Parkinsonian symptoms can help experts diagnose the disease better. Usually, doctors diagnose PD when a patient displays motor symptoms. However, by then, they have already incurred brain cell damage.

As such, longitudinal research into the relationship between Parkinson’s disease and sleep quality remains ongoing. Understanding the connection would help doctors screen patients, for risk of developing the disease, thus allowing them to delay the onset as much as possible.

Issues with PD & Excessive Daytime Sleepiness

Between 30% and 50% of people with PD experience sleepiness during the day. Excessive Daytime Sleepiness (EDS) is more prominent in people who suffer from advanced PD stages. Here are two main causes of EDS:

1. Poor Sleep Quality: Signs include only getting a few hours of sleep, having difficulty falling asleep, waking up during the night more than once, and failing to go back to sleep immediately.
2. Dopaminergic Medications: Taking dopamine agonist medications may contribute to EDS. Such medicine includes pramipexole (Mirapex), ropinirole (Requip), and rotigotine (Neupro). These medicines may also cause “sleep attacks” during the day, potentially leading to motor vehicle accidents.

Tips for Better Sleep

You can improve your sleep quality by adopting lifestyle choices that promote better sleep hygiene. Consider the following practices to help treat EDS and other sleep-related issues:

Set a Sleep Schedule

Having a regular sleep schedule is the best way to promote better sleep. Set a bedtime and wake-up time to train your body. Be sure to strictly follow the times you have set for yourself to see the best results. Wake up as soon as you turn off your alarm and get in bed as quickly as possible. Allot seven or eight hours for your sleep and plan your sleep schedule around those hours.

Try to limit any naps to under an hour. Be sure to take naps at the same time of the day, or at least try to maintain the same nap schedule. Avoid taking naps after 3:00 PM.

Control Your Surroundings

Be sure to get enough sunlight during the day and stay in dark places at night, especially when heading to bed. Excess artificial lights may also affect your circadian rhythm, so try to schedule how much indoor light you expose.

Develop a Bedtime Routine

Your bedtime routine should help you prepare for bed. So be sure to follow it every evening. Essential tasks that every bedtime routine must have include:

• Having a Light Snack: Eat only light snacks if you get hungry before bed. Heavy meals before going to bed are unhealthy and can result in weight gain. Also, avoid snacks that might contain stimulant ingredients like alcohol and caffeine.
• Taking a Warm Bath: Bathing in warm water before bed may improve sleep quality. However, be sure not to spend too much time in the bath as it may wake up your body.
• Go to the Toilet: Be sure to finish your business in the bathroom before bed. Minimize your liquid intake at least three hours before bedtime to help avoid nocturia.
• Brush Your Teeth: Brushing your teeth right before bed helps prevent dental problems, including cavities and decay. Although it is indirectly related to better sleep, having this step in a bedtime routine is helpful.

Avoid Heavy Activities Before Bed

Don’t exercise for about six hours before going to sleep. As much as possible, prepare your body for sleep. Consider light, cool-down stretches if you must get physical exercise before bedtime.

Spend Time Outside During the Day

Take advantage of the sunlight when it’s out in the daytime. Consider spending time outdoors for exercise. Simple walking or running can contribute to your daily exercise quota, but avoid heavy exercises and activities after 8:00 PM.

Your goal for spending time outdoors is to get enough light. You could invest in a light therapy box for artificial light if you have trouble going outdoors. Such tools are available at drug stores.

Limit Lights in Your Room

Minimize your exposure to artificial lights when preparing for bed. Sleep in a cool, dark place. Avoid bright lights when sleeping. You could keep dim night lights if sleeping in complete darkness is uncomfortable.

Avoid watching television and using mobile devices before bed or lying in bed. These devices emit blue lights that could affect your sleeping habits.

Create a Comfortable Environment

Try to make yourself as comfortable as possible to promote better sleep. For example, consider using satin pajamas or silk sheets to help you move much more easily in bed. Also, make sure your bed is appropriately sized to support your sleep comfort and movement.

Being comfortable also involves your mental state. Avoid thinking about thought-provoking topics that keep you up at night when going to sleep. As much as possible, resolve any frustrating issues during the day.

Consult Your Primary Healthcare Physician

Talk to your doctor about your experience with EDS. Depending on your situation, they could decrease your dopamine agonist dosage. They may also reduce your stimulant prescriptions if you take any for PD control.

Conclusion

The key to living happily with Parkinson’s Disease is maintaining a healthy lifestyle. As a vital part of good health, improve your sleep quality by understanding what to look for and tips for better sleep. Remember, proper diet and nutrition are also key to living happily with PD.

If you’d like to speak to someone about developing a sleep regimen or any other questions regarding your health, feel free to reach out to us — we’d be happy to help answer your questions.