Sleep Problems with Parkinson's Disease

What is Parkinson’s disease?

Parkinson’s disease is a movement disorder that causes nerve cells in one part of the brain to slowly degrade (get damaged) or die over time. As this nerve damage gets worse, it causes a cascade of symptoms throughout your body.

Parkinson’s disease most notably causes motor symptoms. “Motor symptoms” is a term healthcare providers use to describe any symptom that makes it harder for you to move (or control your movements).

Parkinson’s motor symptoms include:

• Stiff muscles.
• Tremors (shaking, typically in your hands or legs, that you can’t control).
• Problems with balance or coordination.
• Unusually slow movements (bradykinesia).

Parkinson’s disease can also cause many types of non-motor symptoms. These issues affect your body and mind in different ways. Non-motor symptoms may impact your mood, sense of smell or vision, to name just a few.

What’s the relationship between Parkinson’s and sleep?

Parkinson’s disease and sleep are connected in complex ways that not even scientists completely understand quite yet.

Sometimes, Parkinson’s disease directly causes sleep problems. According to one study, sleep-related symptoms may be one of the earliest signs of Parkinson’s disease. These signs may include things like thrashing while you’re asleep.

Other factors (like Parkinson’s disease treatments and emotional challenges) can also play a role. One thing is clear: For many people with Parkinson’s disease, a restful night’s sleep can be hard to find.

How common are sleep problems for people with Parkinson’s?

Many people with Parkinson’s disease experience sleep problems. Researchers estimate that up to 2 in 3 people with Parkinson’s disease have had trouble sleeping.

How does Parkinson’s disease cause sleep problems?

Researchers have yet to uncover every nuance of the Parkinson’s and sleep connection. So far, medical experts believe several causes may contribute:

• Chemical changes in the brain: Ongoing research shows that Parkinson’s disease may disrupt sleep-wake cycles. Changes to certain brain chemicals may cause people with Parkinson’s to get less (and less restful) sleep.
• Medication: Some drugs that treat Parkinson’s disease may make it harder to fall or stay asleep. A medication may also disrupt your sleep patterns by making you drowsy during the day (and wide awake at night).
• Mental health challenges: People with Parkinson’s commonly deal with mood disorders, such as anxiety or depression. Any mood disorder may keep you up at night or make you sleep less soundly.
• Parkinson’s symptoms: Pain, waking up at night to pee or other Parkinson’s symptoms can make restful sleep harder to come by. Sleep apnea (common in later stages of Parkinson’s) can also disrupt sleep.

What types of sleep problems do people with Parkinson’s disease have?

Parkinson’s disease affects every person differently. It also impacts sleep in different ways. People with Parkinson’s may have:

• Insomnia, finding it hard to fall asleep.
• Fragmented sleep, waking up many times over the night.
• Excessive daytime sleepiness, finding it hard to stay awake during the day.
• Very vivid dreams, which may cause hallucinations or confusion after waking up.
• Emotional dreams or nightmares, which may make you feel emotionally drained after waking up.

What is REM sleep behavior disorder?

Up to half of people with Parkinson’s disease may have this disorder. Your body “acts out” dreams, making strange or possibly dangerous movements while sleeping. Some researchers believe REM sleep behavior disorder could be one of the earliest signs of Parkinson’s.

What other types of sleep disorders do people with Parkinson’s disease have?

Sleep disorders that commonly affect people with Parkinson’s disease include:

• Circadian rhythm sleep disorders.
• Nocturia (waking often at night to pee).
• Restless legs syndrome.
• Sleep apnea.

When do people with Parkinson’s have sleep problems?

Not everyone with Parkinson’s disease experiences sleep issues. If you do, they can occur at any point before or after a Parkinson’s disease diagnosis.

How are sleep problems diagnosed in people with Parkinson’s disease?

If you’re having problems sleeping, sit down with your healthcare provider to discuss the issue in detail. Your provider will ask you questions to better understand your symptoms.

Be prepared to explain when sleep disruptions happen and how they affect your life. Keeping a sleep journal for a few weeks can help you remember the details.

If your provider suspects you may have a sleep disorder, they may recommend you have a sleep study. This overnight test uses electrodes attached to your skin to track how your body functions when you’re sleeping.

How are sleep problems treated in people with Parkinson’s disease?

Your provider will recommend treatments that address what’s causing your sleeping challenges. Your provider may:

• Change your medication: If a medication could be causing your sleep issues, your provider may decide to adjust your treatment plan. Reducing the dose or switching medicines may solve the problem.
• Prescribe a new medication or therapy: If you have a sleep disorder, your provider will discuss your options. In some cases, your provider may recommend a new medication. If you have sleep apnea, wearing a special oral appliance can help. The device enables you to get a steady flow of oxygen, so your body doesn’t gasp for air.
• Suggest lifestyle changes: Your daily habits and sleeping environment can help or hurt your sleep efforts. Setting regular sleep and wake times, keeping the room dark and avoiding electronic screens at bedtime may improve how well you sleep. If you have REM sleep disorder, your provider will discuss options for how best to protect you (and those around you) while you sleep.

What else can I do to sleep better with Parkinson’s disease?

Practicing healthy “sleep hygiene” habits may also promote more restful sleep.

Do:

• Get outside during the day. Bright light tells your body it’s time to be awake.
• Keep your body moving during the day. Even if all you feel up to is a short walk or two, all physical activity offers benefits.
• Try at-home remedies, such as massage or a warm bath. Relaxing your mind may help your body fall asleep.

Don’t:

• Take long naps during the day.
• Use stimulants, such as caffeine, within six hours of bedtime.
• Use your bedroom for activities other than sleeping. Go to another room to read, watch TV or work.

Are over-the-counter sleep aids (medications) safe for people with Parkinson’s disease?

Unfortunately, they’re not. Over-the-counter sleeping medicines may feel like an easy and safe bet to try fixing your sleep issues. But they can pose extra risks for people with Parkinson’s disease.

Some over-the-counter and prescription sleep medicines can make sleep problems worse. Certain sleep medications can have serious drug interactions with Parkinson’s medications. Always talk to your provider before taking any new medication, especially a sleep aid.

When should I call my healthcare provider?

Reach out to your provider if trouble sleeping harms your quality of life. Always call your healthcare provider if you experience symptoms that worry you, especially if they could put you or those around you in danger.

Sometimes, a sleep disturbance could be a sign of depression related to Parkinson's disease. If you’ve lost interest in activities you once loved or feel numb to what’s going on in your life, reach out to a provider you trust. Some people feel better after starting a new medication or talking to someone about what they’re feeling. You don’t have to feel like this.

A note from Cleveland Clinic

Researchers continue to study the sleep-Parkinson’s disease relationship. Understanding more about how Parkinson’s affects sleep (and vice versa) may lead to earlier detection of Parkinson’s disease and more effective treatments. Even now, you have plenty of options to treat sleep problems. Be open with your provider about any sleep issues you’re having. Together, you can find a plan that improves your sleep as well as any other challenges Parkinson’s disease may create in your life.