It’s very common for people with Parkinson’s disease to experience sleep problems, including sleep apnea. In fact, 40% of people with PD report experiencing obstructive sleep apnea.

While the link between Parkinson’s disease and sleep apnea is still being explored, there is plenty of research to guide you toward feasible solutions and restful sleep.

What is Sleep Apnea?

Sleep apnea is characterized by common pauses in breathing during sleep. During this time, blood pressure increases, stress hormones are released, and shifts occur in insulin-glucose ratios.

Those with sleep apnea often do not reach the deepest, most restorative sleep cycle due to being consistently woken up through the night. This results in daytime fatigue and the worsening of many of the non-motor symptoms of Parkinson’s disease.

Two Types of Sleep Apnea

People are generally afflicted with one of two forms of sleep apnea: obstructive sleep apnea (OSA) and central sleep apnea (CSA).

Difference Between Obstructive Sleep Apnea and Central Sleep Apnea

The main difference is that in OSA, breathing disruptions are caused by narrowing the airway during sleep. In CSA, the brain’s inability to effectively communicate with the muscles necessary for breathing can lead to disruptions in respiration.

OSA is the more common form of sleep apnea, with CSA accounting for less than 1% of sleep apnea cases.

What Are Symptoms of Sleep Apnea?

Here are the most common symptoms of sleep apnea to look out for:

• excessive daytime sleepiness
• loud snoring
• abrupt awakening accompanied by gasping or choking
• dry mouth upon waking
• morning headache
• difficulty concentrating
• mood changes such as depression or irritability

Although people with sleep apnea may awaken periodically at night, they may not fully wake up and remain unaware that they are experiencing abnormal sleep activity.

How is Sleep Apnea Diagnosed?

The most common way to diagnose sleep apnea is to participate in a sleep study, also known as a polysomnogram. This typically involves an overnight stay at a sleep clinic.

During the study, sensors measure breathing, awakenings, oxygen levels, muscle movement, and sleep stages. Results are then analyzed to determine if breathing is abnormal and identify the type of sleep apnea. At-home tests also exist, though your physician will still need to interpret results.

What Are Treatments for Sleep Apnea?

The use of positive airway pressure (PAP) therapy is the most effective treatment against sleep apnea. PAP therapy typically involves using an oral appliance to deliver air to the upper airway while the user sleeps. There are several types of PAP therapy, the most common being the CPAP machine.

CPAP Machine

The CPAP (continuous positive airway pressure) machine is connected by a tube to a face mask worn at night, blowing air into the airway at sufficient pressure to keep it open during sleep. This prevents the walls of the throat from collapsing, the most common cause of OSA.

PAP Therapy

Research has found that PAP therapy effectively improves the overall non-motor symptoms of Parkinson’s disease, especially anxiety and cognitive dysfunction.

Certain lifestyle changes can aid in the reduction of symptoms as well. These include incorporating regular exercise into your routine, limiting alcohol consumption, and altering your sleep position to avoid back sleeping – a common culprit of sleep apnea.

Is Sleep Apnea Related to Parkinson’s Disease?

Although inconclusive, research suggests that there may be a link between sleep apnea and Parkinson’s Disease.

Sleep apnea reduces oxygenation in the brain; over time, this may stimulate a specific protein alpha-synuclein in the blood. At an elevated level, this protein becomes toxic and contributes to the degenerative process of Parkinson’s disease in the brain.

How is Parkinson’s Disease Linked to Sleep Disorders?

Despite the prevalence of sleep issues in those with Parkinson’s disease, researchers still do not have a complete picture of why these occur. Here are the most common theories:

1. Changes to certain brain chemicals may contribute toward less restful sleep.
2. Side effects of medications used to treat Parkinson’s disease, such as levodopa.
3. Mood disorders such as anxiety and depression make it harder to fall asleep and stay asleep.
4. Symptoms of Parkinson’s disease may contribute toward waking – such as pain or stiffness in the limbs and frequent urination.

The good news is that many effective ways to manage these sleep problems exist. Below we summarize the other common sleep disorders for those with Parkinson’s disease.

Other Sleep Disorders Related to Parkinson’s Disease

REM Sleep Behavior Disorder (RBD)

REM Sleep Behavior Disorder is characterized by vivid dreams that often result in physical outbursts or “thrashing around.”

During normal REM (rapid eye movement) sleep, the body experiences atonia, or temporary muscle paralysis, while the brain exhibits activity similar to wakefulness.

But for those who experience RBD, normal muscle paralysis does not occur. This results in the person physically acting out their dreams. Dreams may be as benign as playing a sport or running or more frightening such as being chased or attacked.

Treatment for RBD

The most common treatment for RBD is the drug clonazepam. Clonazepam is typically used to control or prevent seizures and/or treat anxiety and is effective against RBD in 75-90% of the general population. However, it can create unfavorable side effects, such as sleepiness, forgetfulness, or impaired balance.

Melatonin may also help to reduce or eliminate symptoms and is generally well-tolerated with few side effects.

Insomnia

In many cases, it is not hard for those with Parkinson’s disease to fall asleep but to stay asleep. You may wake up throughout the night due to tremors, vivid dreams (sometimes as a side effect of medications such as levodopa-based medications), frequent urination, and/or general pain and discomfort.

Insomnia is seen in up to 30% of people with Parkinson’s Disease and may be a sign of anxiety and/or depression.

Treatment for Insomnia

Initial treatment for insomnia begins with anxiety management and practicing good bedtime hygiene. This includes limiting screen time before bed, avoiding big meals, caffeine, and/or alcohol before bedtime, and keeping a consistent sleep schedule.

Cognitive behavioral therapy (CBT) is a common treatment against mood disorders and has been found to be effective against insomnia in those with Parkinson’s disease. The therapy works by helping people change patterns of negative thinking and behavior through strategies such as stimulus control, relaxation, and sleep restriction.

Once other motor or sleep-breathing disorders are ruled out, medication may be introduced. Options include melatonin (taken 1-2 hours before bed) or short-acting non-benzodiazepine drugs such as Ambien or Xanax. Medications should be cautiously used as they can contribute to daytime sleepiness and cause further confusion in elderly or demented patients.

Next Steps for Addressing Parkinson’s and Sleep Apnea

Research is ongoing into the causes and relation between Parkinson’s disease and sleep problems, including sleep apnea. Meeting with your doctor is the first step toward diagnosis. With the right treatment, you can get a better night’s sleep and improved mental clarity.