Living with Parkinson’s Disease: Tips for Managing Sleep Disturbances

April is Parkinson’s Disease Awareness Month, a time dedicated to raising awareness about this debilitating condition and its impact on sleep with individuals and their families.

An estimated 10 million people worldwide are living with Parkinson’s disease, making it the second most common neurodegenerative disorder after Alzheimer’s.

What is Parkinson’s Disease?

Parkinson’s disease (PD) is a chronic, progressive neurological disorder that affects movement, balance, and coordination in the nervous system. It is characterized by slow movement, tremors, stiffness, and difficulty with balance. People with Parkinson’s may also experience cognitive changes, such as memory and thinking problems. It is believed to be related to the degeneration of dopamine-producing neurons in the brain, which leads to a shortage of dopamine, a neurotransmitter that helps control movement. It is also believed to be related to a combination of genetic and environmental factors.

While movement problems are the most visible symptoms of Parkinson’s, many people with PD also struggle with sleep issues. In this article, we will explore how Parkinson’s disease affects sleep and what you can do to sleep better.

Facts about Parkinson’s Disease

• Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease, affecting approximately 1 million people in the United States and 7 to 10 million people worldwide
• Men are nearly twice as likely as women to develop Parkinson’s Disease.
• Smoking increases your risk of developing Parkinson’s by up to 60%.
• Approximately 20% of patients with Parkinson’s experience hallucinations or delusions at some point in their lives due to dopamine imbalances in their brains.
• The majority of those diagnosed will not require medications or surgery, while others may need more intensive treatments such as deep brain stimulation (DBS).
• Regular exercise and physical activity have been shown to help reduce symptoms, improve mobility, and enhance the quality of life for those living with Parkinson’s.

How Parkinson’s Disease Affects Sleep

In addition to movement problems, Parkinson’s disease can also cause a wide range of non-motor symptoms, including sleep disorders, cognitive impairment, depression, and anxiety. Sleep disorders are particularly common in people with PD, affecting up to 90% of patients at some point during their illness.

The brain changes that are part of PD can also cause sleep difficulties. Some PD medications can disrupt sleep and others make people sleepy during the day. Not surprisingly, sleep-related symptoms are reported by approximately 75% of people with PD. According to one study, sleep-related symptoms may be one of the earliest signs of Parkinson’s disease. These signs may include things like thrashing while you’re asleep.

While we know sleep is important for health, with PD it is even more crucial for the restoration and rejuvenation of the brain. In addition, when people with PD don’t sleep well, their carer’s sleep is disrupted, too. Caregivers also need restful sleep to stay healthy and be at their best.

• Insomnia: Many people with PD have trouble falling asleep or staying asleep, which can lead to insomnia. This may be due to the motor symptoms of PD, such as tremors, stiffness, or dyskinesia, which can make it difficult to get comfortable in bed or even to turn over during the night.
• Circadian rhythm disruptions: Reduced dopamine may significantly alter the body’s sleep-wake cycle.
• REM sleep behaviour disorder (RBD): RBD is a sleep disorder that causes people to act out their dreams during REM sleep. In people with PD, RBD is particularly common, affecting up to 50% of patients. They do not have the normal relaxation of the muscles during their dreams which is why they may act out their dreams. This can lead to injuries and sleep disruption for both the patient and their bed partner.
• Excessive daytime sleepiness (EDS): Some people with PD experience EDS, which can make it difficult to stay awake during the day. This can be caused by disrupted sleep at night or by changes in the brain chemistry that control sleep-wake cycles or medication.
• Restless legs syndrome (RLS): RLS is a condition that causes uncomfortable sensations in the legs, especially at night. It is more common in people with PD, and can make it difficult to fall asleep or stay asleep.
• Sleep apneoa: Sleep apneoa can be seen in up to 40% of people with PD even if they are not overweight. 
• Nocturia: Frequent nighttime urination, or nocturia, affects the vast majority of Parkinson’s patients to some degree.

Tips for Better Sleep with Parkinson’s Disease

If you have Parkinson’s disease and are struggling with sleep issues, there are several things you can do to improve your sleep:

• Maintain a regular sleep schedule: Try to go to bed and wake up at the same time every day, even on weekends.
• Get sunshine early in the morning: Get sunshine or daylight first thing in the morning to help with your circadian rhythm. If you can’t get outdoors, consider using a light therapy box.
• Create a relaxing bedtime routine: This could include taking a warm bath, meditation, reading a book, or listening to calming music.
• Create a sleep-conducive environment: Make sure your bedroom is cool, dark, and quiet, and invest in a comfortable mattress and pillows.
• Exercise regularly: Exercise can help improve sleep quality, as well as reduce symptoms of Parkinson’s disease.
• Manage medications: Work with your doctor to adjust your medications if they are affecting your sleep, and avoid taking medications that are known to disrupt sleep.
• Treat co-existing sleep disorders: If you have RBD or RLS, talk to your doctor about treatment options, such as medication or behavioral therapy.
• Cognitive behavioral therapy (CBT): CBT is a technique that helps people change patterns of negative thinking and behavior. It is commonly used to treat mood disorders such as depression and anxiety, but it can also target thoughts and actions that are disruptive to sleep. CBT has been studied in people with PD and found to be effective in treating insomnia. CBT can include many strategies, such as stimulus control, relaxation, sleep hygiene and sleep restriction.

Conclusion

Sleep problems are a common issue for people with Parkinson’s disease, and can have a significant impact on quality of life. By understanding how PD affects sleep and taking steps to improve sleep hygiene, people with Parkinson’s can improve their overall well-being and quality of life. If you or a loved one has Parkinson’s disease and is struggling with sleep issues, it is important to talk to your doctor or a sleep specialist. Keeping a sleep journal for a few weeks can help you discuss the details of your sleep problems with your healthcare provider. They can help identify the underlying cause of the sleep disturbance and provide appropriate treatment to improve sleep quality. By working together with healthcare professionals and adopting healthy sleep habits, people with Parkinson’s disease can get the restful, restorative sleep they need to manage their symptoms and improve their overall quality of life.

Through increased awareness and education, we can promote better understanding and support for those living with Parkinson’s disease.

Disclaimer

Please note that this information is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Resources

American Parkinson Disease Association. Sleep Problems. (https://www.apdaparkinson.org/what-is-parkinsons/symptoms/sleep-problems/)

Parkinson’s Foundation. Sleep Disorders (https://www.parkinson.org/understanding-parkinsons/non-movement-symptoms/sleep-disorders)

Loddo G, Calandra-Buonaura G, Sambati L, et al. The Treatment of Sleep Disorders in Parkinson’s Disease: From Research to Clinical Practice. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311042/) Front Neurol. 2017;8:42.

Mantovani S, Smith SS, Gordon R, & O’Sullivan, JD. An overview of sleep and circadian dysfunction in Parkinson’s disease. (https://pubmed.ncbi.nlm.nih.gov/29493044/) J Sleep Res. 2018;27:e12673.

Parkinson’s Foundation. Sleep Disorders. (https://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Sleep-Disorders)

Parkinson’s UK. Sleep and Parkinson’s. (https://www.parkinsons.org.uk/information-and-support/sleep-and-parkinsons) 

Sleepfoundation.org. Parkinson’s Disease and Sleep. (https://www.sleepfoundation.org/physical-health/parkinsons-disease-and-sleep)