Levodopa taken at bedtime can help with quality sleep, small study finds
23 adults with mild to moderate Parkinson's seen to sleep longer, awaken less
Taking levodopa before bedtime can reduce the number of times people with Parkinson’s disease wake up during sleep and the amount of time they remain awake at night — although such differences might not be obvious to patients.
The findings, which came from a small study in patients in early or middle disease stages, used an actigraphy device to monitor their sleep-wake patterns. Its findings, the researchers said, underscore the importance of objective tools in measuring sleep quality, especially when considering the effect of medications.
“Clinicians should take these findings into account when deciding whether to administer levodopa to [Parkinson’s] patients before they go to bed at night,” Fábio Barbieri, PhD, a professor of motor control who led the study at São Paulo State University in Brazil, said in a news release from the São Paulo Research Foundation, which supported the study.
“The actigraphic readings pointed to an improvement in sleep quality after the patients took the drug, although they themselves didn’t experience any benefit. This is important from the standpoint of clinical care,” Barbieri added.
Disturbed sleep, trouble falling asleep can be common with Parkinson’s
The study, “Sleep ‘ON’, sleep better! Positive effects of levodopa on sleep behaviour in people with Parkinson’s disease,” was published in the Journal of Sleep Research.
Many Parkinson’s patients spend restless nights troubled by vivid dreams and difficulties falling or staying asleep, sometimes starting years before disease motor symptoms develop. Poor sleep quality, in turn, appears to worsen various Parkinson’s symptoms.
Levodopa, a mainstay Parkinson’s treatment, restores the levels of dopamine in parts of the brain that control movement. Dopamine is a neurotransmitter, or brain signaling chemical, that is gradually lost in the disease. Because dopamine also regulates sleep-wake patterns, levodopa may help reset a person’s sleep schedule and contribute to more restful nights by easing motor symptoms.
To understand how levodopa around bedtime affects sleep, Barbieri’s team asked 23 Parkinson’s patients, ages 50 and older, to wear an actigraph device on the wrist for four consecutive nights to monitor their sleep-wake patterns. Each morning, patients rated how well they had slept.
The patients, 11 men and 12 women, were seen to be in early to middle disease stages, with scores of three or less on the Hoehn & Yahr scale.
Over two-thirds (69.5%) preferred morning activities, while most of the others were neutral about their daily routines. All reported sleep problems, and 10 (43.5%) had rapid eye movement sleep behavior disorder, which often precedes Parkinson’s onset.
On and off levodopa states were monitored using a wrist-worn actigraphic
The study looked at how levodopa affected sleep by comparing nights when the medication was active (an on state) with when it was not (off state). All enrolled were on a stable levodopa dose, and they were monitored for three nights while in on states and one night in an off state.
With taking levodopa, the patients slept better, with researchers noting a 7.8% increase in total sleep time and a 3.7% increase in sleep efficiency, the ratio between the time a person is asleep and the total time spent in bed.
Shorter periods of wakefulness after falling asleep also were noted with levodopa’s use, with a 29.2% reduction in the number of times patients’ woke up during sleep and a 22.3% reduction in the amount of time they remained awake.
Among those who responded well to levodopa, sleep efficiency during the night without a treatment dose decreased by 6.6%, and the time these patients remained awake after falling asleep increased by 25.7%. “Going to bed without the fourth dose was worse,” Barbieri said.
Patients’ waking episodes averaged 10 per night during study
However, patients reported little difference between on and off nights were asked about how well they had slept. Barbieri, who heads the university’s Human Movement Research Laboratory, wasn’t surprised by the difference between actigraphic readings and what patients felt.
“The perceptions of [Parkinson’s] patients are impaired by the disease. The number of waking episodes was ten per night on average, so it’s understandable that they failed to report any improvement,” he said. “That’s why it’s important to take the actigraphic measurements into consideration.”
While limited by its small size and short duration, “from a clinical point of view, our results suggest that sleeping in the ON-night resulted in increased total sleep time and sleep efficiency,” the researchers concluded.
They recommended further studies with a longer duration, and noted their findings might not apply to people in advanced Parkinson’s stages already using levodopa at higher doses, which are known to be “associated with worse sleep quality.”
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