Ever wonder why can’t Parkinson’s patients sleep during the night?
The main reason that Parkinson’s patients find it difficult to sleep during the night is because of the changes in brain chemicals linked to the sleep-wake cycle. Trouble sleeping could also be caused by Parkinson’s medication or symptoms of the disease that frequently appear during the night.
Parkinson’s disease (PD) is a neurological condition that has currently affected over 10 million people around the world. The typical symptoms include slowness of movement, tremor, muscle stiffness, and balance issue. These symptoms develop when more than 50% of the dopamine-producing cells in the brain are lost. Dopamine is a neurotransmitter that is responsible for controlled body movements.
For the majority of PD patients, disrupted sleep during the night is a big problem. And yet it is one of the most under-recognized problems. Unfortunately, this sign of the disease is also underestimated by many doctors.
Normally, there are 3 forms of sleep problems seen in PD patients. These include insomnia, nightmares, and excessive daytime sleepiness. These are often associated with problems like nocturia (excessive urination during the night), painful leg cramps, difficulty in turning over in bed, vivid dreams, and leg jerks.
Researchers are trying to find the reasons for the development of sleep problems in PD. They think that the following 3 reasons could be the potential causes of sleep disturbance:
1. Abnormal changes in brain chemicals
Research suggests that changes in certain brain chemicals could be the reason for developing sleep problems in PD. One such chemical is serotonin, which is a well-known neurotransmitter that plays a critical role in the sleep-wake cycle. Parkinson’s patients are reported to carry up to 50% less of this chemical in their brains.
A study published in the Journal of Neuroimage: Clinical showed that loss of serotonin in the brain is directly related to the severity of symptoms in PD patients. In this study, 28 PD patients and 12 healthy individuals were examined for their sleeping behaviors. At the time of enrolment, half of the PD patients were having sleep dysfunction and the other half were not. By using brain imaging techniques, the researchers of the study found up to 49% decrease in the levels of serotonin in the brains of PD patients that were having sleep dysfunction. They suggested that enhancing serotonin levels in the brain could be a promising approach to treat sleep problems in PD.
Other chemicals that could have relevance to the development of sleep problems in PD include norepinephrine, tyrosine hydroxylase, and glutamic acid decarboxylase.
2. Medication
Trouble sleeping could also be triggered by medicines used in PD treatment. While most Parkinson’s drugs are linked to some sort of sleep disturbances, this is especially prominent in patients treated with levodopa, which is often used as first-line therapy in PD.
Another class of drugs that may cause sleep problems is dopamine agonists. Studies have shown that treatment with dopamine agonists contributes to excessive daytime sleepiness in PD patients. These drugs have also been frequently linked to sleep attacks in patients.
Amantadine is another class of drugs that may interfere with sleep quality in patients with PD.
3. Symptoms of PD
The appearance of other PD symptoms can also disrupt the sleeping process during the night. Pain, tremor, dyskinesia, and stiffness can make it difficult for a patient to fall asleep. Similarly, psychiatric signs like anxiety and depression and other issues that increase the need to urinate can also interfere with nighttime sleep.
How to deal with sleep problems in PD?
Medication is the most effective way of dealing with sleep problems in PD. The following 3 drugs are commonly used.
- Melatonin
- Clonazepam
- Lorazepam
Sometimes a combination of PD drugs could also be useful. A study published in the Journal of movement disorders showed that levodopa/carbidopa/entacapone combination at bedtime could be a useful treatment for sleep disturbance in advanced PD patients with motor fluctuations.
Related post: How to deal with sleep problems in Parkinson’s disease?
In addition to medication, practicing the following healthy habits could help to fall asleep during the night.
- Avoid drinking coffee or tea before going to bed.
- Do physical activities during the day.
- Practice yoga and any form of meditation that reduces anxiety and improves sleep quality.
- Avoid late-night gatherings with friends or family.
- Avoid watching TV or using your phone late at night.
Remember: always take the help of your health care provider if sleep problems are affecting your quality of life.
Disclaimer: The information shared here should not be taken as medical advice. The opinions presented here are not intended to treat any health conditions. For your specific medical problem, consult with your health care provider.
