A range of sleeping problems are associated with Parkinson’s disease (PD) and unless they are recognized and tackled effectively, they can give rise to serious consequences. Sleep disorders can manifest as restless sleep, nightmares, vivid dreams, acting out dreams during sleep, and excessive daytime sleepiness. These sleep-related problems can affect the quality of life in PD patients, resulting in fatigue, poor attention, memory deficits, and predisposition to accidents.

Types of Sleeping Problems

Problems with sleep can be of two types :

1. Difficulty in falling asleep – sleep onset problem.
2. Inability to continue sleeping without frequent awakenings – sleep maintenance problem or sleep fragmentation.

A third type of sleeping problem – excessive daytime sleepiness – can develop as a result of inadequate sleep at night. This turns into a vicious cycle, with the person unable to sleep at night because of daytime sleeping. Daytime sleepiness can also occur due to the disease itself or due to the effects of Parkinson’s disease medication.

Sudden sleep onset during the day or “sleep attacks”, with the person suddenly falling asleep while driving or operating machinery, can be extremely dangerous.

Often, two or more problems can co-exist.

What Causes Sleeping Problems in PD?

• Certain PD medication, especially when  initially started and the dose has not been regulated satisfactorily.
• As the disease progresses, muscle rigidity, stiffness, tremors and pain increase, contributing to problems with sleep.
• Insomnia may occur due to akinesia or inability to roll over or turn on sides in bed.
• Lower levels of dopamine during the night can aggravate the symptoms of PD causing more frequent awakenings at night.
• Age related insomnia.
• Dementia, depression, hallucinations.
• Nocturia – frequent urge to pass urine at night can interfere with sleep. In a PD patient, getting out of bed to use the toilet each time can become a task.
• Nightmares, vivid dreams, night terrors, and dream-enacting behavior during sleep are common in PD patients due to a problem known as REM sleep behavior disorder (RBD). It can be one of the earliest symptoms of PD. The patient may kick or punch out if he is dreaming of being attacked and unknowingly harm himself or the person sleeping beside him. A person sleeping alone may not even realize that he is suffering from this condition. On being woken up, he will become absolutely normal. Certain PD drugs are associated with causing nightmares too.
• Sleep apnea – disruption of sleep caused by a medical condition where there is periodic suspension of breathing for a few moments.
• Restless leg syndrome (RLS) and periodic leg movement disorder (PLMD) are two similar but different conditions commonly seen in PD patients, which often contribute to sleep disturbance.
• Excessive daytime sleeping.

Management and Treatment of Sleeping Problems

• Reduction of evening fluid intake.
• Avoiding diuretics or caffeinated drinks or food at bedtime.
• Emptying the bladder before going to bed.
• Use of bedside commode.
• Avoiding daytime sleeping.
• Treatment related to the cause of insomnia.
• Over-the-counter drugs to aid sleep should not be taken without consulting a doctor.
• Sedatives and tranquillizers may be prescribed and the dose and time of taking PD drugs may be altered by the doctor.