How to improve sleep in Parkinson’s disease? This question worries many patients, as insomnia becomes a frequent companion of the disease. Sleep disorders can significantly worsen the physical and psycho-emotional state, but there are ways to improve the quality of rest.
Insomnia in Parkinson’s disease
Insomnia, aka insomnia, characterized by difficulty falling asleep, shallow sleep, sleep fragmentation and early awakening, is seen in a significant number of patients with Parkinsonism. Factors such as restless legs syndrome (discomfort in the legs during sleep, causing them to perform certain movements that disrupt sleep), painful seizures, urinary disturbances, anxiety and depression can also exacerbate sleep problems.
The mechanism for the development of sleep disturbances can be related to a variety of causes, including blood ferritin deficiency, cholinergic dysfunction in brain stem structures, and side effects of dopaminergic medications.
Sleeping pills, sedatives, and low-dose antidepressants are often used to treat insomnia. However, some antidepressants may increase the risk of developing restless legs syndrome and behavioral disorders during the REM phase of sleep (the phase of sleep with the most pronounced brain activity, as seen by rapid eye movement).
Behavioral disorders during sleep in Parkinson’s disease
Behavioral disorders during the rapid eye movement (REM) phase of sleep are considered as potential early signs of Parkinson’s disease development. These disorders, caused by a lack of physiological inhibition of muscle tone during the REM phase, can manifest as complex, non-stereotypical and purposeful movements (talking, singing songs, sudden movements – performing actions consistent with dream content).
Research findings suggest that behavioral disorders in the REM phase may precede the development of parkinsonism syndrome 3-11 years before the onset of characteristic symptoms.
During behavioral disorders, such as sleepwalking, parkinsonian symptoms, such as lack of facial emotion, slowed movements, speech disturbances, tremors, and dystonia, are not noted, which is attributed to the restoration of motor control during sleep. However, clinical observations indicate that a frequent symptom during nocturnal behavioral disorders is dreams of an aggressive nature associated with anxiety and defense against threatening danger.
In addition, some antidepressant medications may provoke or enhance the manifestation of these disorders during sleep.
Daytime sleepiness
Pathologic daytime sleepiness, reaching narcoleptic seizure levels, is also common in patients with Parkinson’s disease, affecting at least one-third of all cases.
One cause of sleepiness in patients with Parkinson’s disease may be disrupted nighttime sleep due to features such as restless legs syndrome, tremors, and seizures. Daytime sleepiness in Parkinson’s disease is associated with impaired function of activating brain systems such as noradrenergic, serotonergic, and orexinergic systems. Accordingly, the use of dopamine receptor agonists used to treat this disease may also increase daytime sleepiness.
Ways to combat insomnia in Parkinson’s disease
1. Cognitive behavioral therapy for the treatment of insomnia
Cognitive-behavioral therapy is an established treatment for chronic insomnia. It helps patients change negative sleep-related attitudes and develop helpful habits that promote sleep. CPT-I may be especially helpful for people with Parkinson’s disease who suffer from anxiety or depression that exacerbates sleep problems.
2. Melatonin use
Melatonin is a hormone that regulates the sleep-wake cycle. Its use can be helpful for behavioral disorders in the REM phase of sleep, as well as circadian rhythm disorders. Melatonin improves sleep quality and reduces night awakenings in patients with Parkinson’s disease, while having a relatively mild side effect profile.
3. Support from a psychotherapist or a neurologist-somnologist
Patients with severe sleep disturbances may require consultation with a specialist such as a somnologist or psychotherapist. Support from a specialist can help identify and correct co-occurring disorders, including anxiety and depression, which often accompany Parkinson’s disease.
4. Use of devices and assistive technology
There are devices that track sleep parameters (e.g., sleep trackers and smart bracelets) that help the patient and physician better understand sleep patterns. Special adjustable beds are also used to facilitate falling asleep and improve comfort at night.
5. Nutrition and evening diet
Heavy meals at bedtime can impair sleep. A light dinner 2-3 hours before bedtime is recommended, avoiding spicy, fatty and hard to digest foods. Certain foods rich in tryptophan (e.g. milk, bananas, turkey) promote the production of serotonin and melatonin, helping you fall asleep naturally.
General recommendations
The first priority in patients with Parkinson’s disease is to reduce the risk of injury by remodeling the bedroom. It is recommended to place the mattress on the floor to reduce the risk of falls, wall lighting to ensure safe movement at night and no furniture near the bed to avoid the risk of injury during nocturnal attacks. Other recommendations are also worth considering to normalize sleep:
- Compliance with the sleep and wakefulness regimen. Regular daily routine, fixed bedtime and wake-up time help to synchronize the circadian rhythms of the body and improve the quality of sleep.
- Creating a sleep-friendly environment. A dark, quiet and cool room, and a comfortable bed are all conducive to restful sleep. Parkinson’s patients are often more sensitive to noise and light.
- Avoiding stimulants before bedtime. Caffeine, nicotine and alcohol can interfere with falling asleep and sleep quality, so they should be avoided several hours before bedtime.
- Regular physical activity. Moderate exercise throughout the day helps normalize sleep, but it is important not to overexert yourself and to plan exercise for the first half of the day. A daily walk in the fresh air gives good results.
This treatment approach not only ensures that symptoms are effectively managed, but also that potential risks to patients during sleep are reduced. It is also important to consider the individual characteristics of each patient when selecting methods and equipment to ensure comfortable and safe sleep.
Conclusion
Sleep plays a key role in maintaining the general well-being and quality of life of patients with Parkinson’s disease. Sleep disorders in this disease are multifactorial in nature and can significantly aggravate the course of the disease, both physically and psycho-emotionally. However, timely detection and a comprehensive approach to the correction of sleep disorders – from medication and behavioral therapy to improving the conditions for rest – can significantly improve the quality of life of patients.
It is important to remember that each case is different, and the choice of tactics should be made together with the doctor, taking into account the symptoms, stage of the disease and general condition of the patient. Regular sleep monitoring, adaptation of the environment and involvement of specialists from related fields – all this helps not only to cope with insomnia and daytime sleepiness, but also to maintain the activity, independence and psycho-emotional well-being of a person living with Parkinson’s disease.
