A good night’s sleep is critical to our health and well-being. However, for people with Parkinson’s disease (PD), sleep becomes even more important as the body needs more time to restore and repair itself. The brain changes that are part of PD can also cause sleep difficulties and some people have problems sleeping even before movement symptoms develop and PD is diagnosed.
Some PD medications can disrupt sleep. Others make people sleepy during the day. Not surprisingly, sleep-related symptoms are reported by more than 75% of people with PD.
Disrupted sleep can affect your health, mood and overall quality of life. Furthermore, when people with PD don’t sleep well, their care partner’s sleep is disrupted, too. Caregivers also need restful sleep to stay healthy and be at their best.
Most Common Sleep Issues
- Difficulty falling and staying asleep
- Excessive daytime sleepiness
- Talking, yelling out or physically acting out while asleep
- Vivid dreaming
- Leg movements, jerking, cramping (restless leg syndrome)
- Difficulty turning over in bed
- Waking up to go to the bathroom
Tips for Better Sleep
- Keep a regular sleep schedule — go to bed at the same time and get up at the same time.
- Choose your bedtime based on when you want to get up. Plan to spend seven to eight hours a night in bed.
- Make a bedtime routine — for example, snack, evening medication, tooth-brushing, using the restroom — and follow it every evening.
- Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 p.m.
- If you can’t get outdoors, consider light therapy — sitting or working near a light therapy box, available at drug stores and department stores.
- If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 p.m.
- Sleep in a cool dark place and use the bed only for sleeping and sexual activity.
- Do not read, watch television, or use electronic devices in bed.
- If turning in bed is difficult: use a satin fitted sheet and pajamas; use a light quilt instead of an easily tangled bedsheet.
- Minimize drinking liquids for three hours before bedtime to avoid frequent nighttime urination.
- Go to the bathroom immediately before retiring.
- Consider a soft, rather than bright, light to illuminate your path to the bathroom.
- Place a portable commode next to the bed to minimize effort, if needed.
If you are experiencing sleep problems, you should avoid:
- Alcohol, caffeine and other stimulants such as nicotine
- Heavy late-night meals (although a light snack at bedtime may be helpful)
- Heavy exercise within six hours of bedtime
- Thoughts or discussions before bedtime about topics that cause anxiety, anger or frustration
- Clock watching
- “Screen time” — television, phones, tablets — one or two hours before bed.
Certain antidepressants, such as mirtazapine (Remeron) may help with sleep while others — the SSRIs — can make other sleep symptoms worse. Also, if you are unsure, check with your doctor or pharmacist to ensure alerting medications are being taken in the morning and sedating medications are being taken at night.
If urinary frequency keeps you up at night, be sure your doctor rules out causes other than PD. In addition, there are several medications that can be helpful, including oxybutynin (Ditropan®), tolterodine (Detrol®), trospium (Sanctura®), tofenacin succinate (VESIcare®), darifenacin (Enablex®), mirabegron (Myrbetriq®) and phenoperidine fumarate (Toviaz®). You may be referred to a bladder specialist (urologist).
Excessive Daytime Sleepiness
Sleepiness during the day is seen in about 30 to 50% of people with PD and it is more prominent as the disease advances. Daytime sleepiness related to PD may arise for many reasons, including getting a poor night’s sleep or the use of dopaminergic medications, especially dopamine agonists like pramipexole (Mirapex), ropinirole (Requip) and rotigotine (Neupro).
NOTE: dopamine agonist medications like pramipexole and ropinirole can cause sudden "sleep attacks" while driving. This is a potential cause of motor vehicle accidents and should be monitored.
Problems with Sleep at Night
There are several problems that people with PD may experience during the night:
Sleep apnea can be seen in up to 40% of people with PD. Common symptoms include:
- Loud snoring
- Pause in breathing during night sleep
- Restless sleep
- Sleepiness during the daytime
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body relaxes during sleep and at the level of the throat the human airway is composed of collapsible walls of soft tissue. These can obstruct breathing during sleep.
Unlike the general population, people with PD who have sleep apnea may not be overweight.
REM Sleep Behavioral Disorder
Rapid eye movement, or REM, sleep is the part of the sleep cycle when dreaming occurs. Usually the only part of the body that moves during REM sleep is the eyes.
- People with rapid eye movement sleep behavior disorder (RBD) do not have the normal relaxation of the muscles during their dreams. Therefore, they act out their dreams during REM sleep.
- People with RBD may shout, hit or kick their bed partner or grind their teeth. Sometimes, in moderate to severe RBD, people may have aggressive, violent behaviors, like getting out of bed and attacking their bed partner.
- About half of people with PD suffer from RBD. It may develop after or along with the motor symptoms, but in most cases, it precedes the PD diagnosis by five to 10 years.
Insomnia is the inability to sleep. It includes difficulty falling asleep and staying asleep, as well as waking up too early. About one-third of the adult population has some symptoms of insomnia, and it is even more common in people with PD. Problems with sleep maintenance — such as frequently waking throughout the night with difficulty falling back to sleep — are the most common type of insomnia in PD. There are many causes of insomnia in general. When it comes to people with Parkinson’s:
- Women and elderly people are more likely to experience insomnia.
- People with more advanced PD have more prominent insomnia compared to those with milder symptoms.
- Other medical and psychiatric conditions contribute to insomnia in people with PD. For example, anxiety and depression can lead to difficulties falling asleep.
- Undiagnosed sleep disorders may cause insomnia.
- Symptoms — including rigidity, pain and tremor that returns when you wake during the night — can impact sleep continuity.
- Certain medications can also negatively influence sleep quality.
Page reviewed by Dr. Addie Patterson, Movement Disorders Neurologist at the Norman Fixel Institute for Neurological Diseases at the University of Florida, a Parkinson’s Foundation Center of Excellence.