Although insomnia may not be the most debilitating of complaints in patients suffering from Parkinson’s disease, it can nonetheless cause much distress in Parkinson’s patients and the symptoms often aggravate as the disease progresses. Insomnia is the inability to get a good night’s sleep and may be due to :
- Sleep onset problem where the patient has difficulty in going off to sleep even though he/she may be extremely tired. This is most often associated with depression or anxiety states.
- Sleep maintenance difficulty where the patient goes off to sleep easily but wakes up frequently at night. This problem is faced very frequently by Parkinson’s disease patients and they may have abrupt and agitated arousal more than five times at night. This leads to tiredness and excessive daytime sleepiness.
- Excessive daytime sleepiness is caused by inability to sleep properly at night, most often due to waking up several times at night. Dopaminergic medication as part of Parkinson’s drug therapy also contributes to daytime sleepiness in Parkinson’s disease patients.
Causes of Insomnia in Parkinson’s Disease
- Medication – medicines used to treat Parkinson’s disease may cause insomnia due to difficulty in falling asleep or by causing vivid dreams or night terrors.
- Neurodegenerative changes in Parkinson’s disease.
- Periodic limb movements.
- Nocturia – waking frequently to pass urine.
- Inability to turn in bed.
- Sleep-related breathing disorders.
- Pain- generalized aches and pains associated with Parkinson’s disease.
- Pain from agitated pressure point arousal due to less movement in bed.
- Associated with co-existing depression and dementia.
- Increased daytime sleep either due to medications or due to dopamine deficiency in Parkinson’s disease.
- Lack of rapid eye movement or REM sleep, which is associated with deep sleep.
- Nightmares – patients with Parkinson’s disease often suffer from nightmares which prevent them from going back to sleep.
- Age of the patient – Parkinson’s disease occurs in the older age group who, in normal circumstances, often suffer from insomnia.
Management of Insomnia in Parkinson’s Disease
Management of insomnia in patients with Parkinson’s disease should aim at treating the cause of insomnia. Adopting simple measures of sleep hygiene also help.
This entails simple procedures such as :
- Avoiding sleeping in the daytime.
- Keep fixed time for going to bed.
- Restricting water intake in the late evening and before going to bed.
- Avoiding caffeinated drinks and food before within 4 to 5 hours of bed time such as tea, coffee, soft drinks, and chocolate.
- Avoiding alcohol before sleep – it may cause early onset of sleep but the sleep is more likely to be fragmented.
Treatment of Insomnia in Parkinson’s Disease
Identifying and treating the cause of insomnia is most important.
- Dopaminergic medicines used to treat Parkinson’s disease often cause insomnia by increasing daytime sleep. The dose and time of medicine intake may need to be adjusted.
- Treatment of associated depression or dementia needs to be done. Atypical antipsychotics are often more effective, with lesser side effects.
- Sedatives and tranquillizers may be helpful.
Insomnia can be a frustrating condition to content with and is even more difficult to a patient suffering with a debilitating disease such as Parkinson’s. Caregivers should not pass off insomnia lightly and should take every measure to ensure the Parkinson’s patients comfort by taking complaints such as sleeplessness seriously.