Tuesday, 14th March 2023
This article was originally published by The Michael J. Fox Foundation for Parkinson’s Research
We all know good sleep is important. And it becomes even more important when living with disease. How unfair then, that Parkinson’s disease (PD) makes sleep more difficult. Many people say they have trouble falling asleep, wake up throughout the night or get only a few hours of shut eye. And these sleep problems — as well as others, like acting out dreams — can disturb bed and care partners’ sleep, too.
Let’s talk about why sleep changes happen in Parkinson’s.
Sleep seems simple, but is a complex activity
But first, let’s talk about sleep itself. Our brain has a central clock that directs the 24-hour sleep-wake cycle, or circadian rhythm. This brain center takes cues from how and how often we move; what and when we eat and drink; what type of light we’re exposed to when; and more. These signals determine whether we feel awake and alert or ready for sleep.
Sleep is divided into four stages, which repeat throughout the night:
Parkinson’s can disturb sleep in many ways
Sleep problems are common in PD because the disease — and medications used to treat it — can impact both brain circuits that play a role in sleep as well as the stages of sleep themselves. That can mean feeling too sleepy during the day, having trouble falling or staying asleep, or experiencing changes in the amount or quality of sleep. (That’s because PD decreases slow wave and REM sleep.) Simply put, Parkinson’s can cause more disrupted and less restorative sleep.
But PD can also cause other symptoms and conditions that affect sleep. Non-motor symptoms, such as anxiety or depression, can disturb sleep. Other sleep conditions can, too. Some people act out their dreams while sleeping. This is called REM sleep behavior disorder, or RBD. Acting out dreams happens when the brain circuits that temporarily paralyze muscles during REM sleep don’t work. People have vivid, sometimes frightening dreams involving fighting, chasing or other high-intensity activities. They could yell, kick, punch or run out of bed — making big, quick movements that contrast with their typically smaller, slower movements. RBD increases risk of injury and decreases sleep quality for both the person acting out dreams and their bed partner.
Others experience Restless Legs Syndrome (RLS), which is just what it sounds like — a feeling of restlessness in the legs that decreases with movement and, because it happens at night, delays falling asleep. Many people with RLS also have Periodic Limb Movements of Sleep — frequent arm, leg or foot twitching or jerking during sleep, which interrupts their and their bed partner’s sleep. For more on these and other sleep symptoms, check out MJFF’s guide on sleep and Parkinson’s.
The challenge, as many of you know, is that significant sleep changes can temporarily worsen motor symptoms. They also may contribute, over the long run, to memory and thinking (cognitive) changes. And research suggests there may be a link between poor sleep and progression of disease.
Research on sleep and Parkinson’s is moving forward
Scientists are working to better understand how sleep brain circuits are affected by PD, who experiences sleep changes and when, and who with RBD goes on to develop Parkinson’s. In tandem, they’re working toward better treatments for these bothersome symptoms as, unfortunately, limited options currently exist. New treatments might include light therapy, novel drugs, or even novel deep brain stimulation (DBS) systems. To be clear, there are treatments to help with RBD, insomnia and some other sleep symptoms. But too often, they don’t fully treat symptoms and they don’t work in everyone. And the benefits and risks of most haven’t been widely researched in people with PD. To learn more about trials on sleep and Parkinson’s, visit foxtrialfinder.org.
Good sleep starts when you wake in the morning
So, what can you do now? Start by talking with your doctor. And, if you haven’t yet, build healthy habits that may invite better sleep:
These tips only scratch the surface of daily routines and nighttime habits that can help or hinder sleep. Talk with your doctor and others in the community for more information and tips. And remember, as much as we’d like to, we can’t control sleep. We can only do our best to prepare for and welcome sleep and then wait for it to arrive.
Thanks to Smita Patel, DO, integrative neurologist and sleep specialist for lending her expertise to this article.
Source: The Michael J. Fox Foundation for Parkinson’s Research