Parkinson’s disease is a progressive neurodegenerative disorder characterized by the loss of dopamine-producing nerve cells in the brain. Dopamine is a cell-signaling molecule that relays information between nerve cells and between the brain and the muscles. The loss of dopamine leads to symptoms of the motor system such as tremor, bradykinesia (slowness of movement), impaired balance, and rigidity. It can also cause non-motor symptoms, including speech, cognitive, mood, and sleep problems.

Most sleep problems in Parkinson’s patients can be broken down into one of three categories: trouble falling asleep, trouble staying asleep or getting restful sleep, or falling asleep at the wrong times.

Trouble falling asleep

Several Parkinson’s symptoms can lead to difficulty falling asleep and can lead to insomnia. Medications may start to wear off in the night and can lead to worsening rigidity, tremors, or pain, which can make it hard to fall asleep. To help with this, the physician might recommend changing the time at which the patient takes medications or that the patient use a continuous delivery method, such as a patch, for their medication.

Several Parkinson’s medications can also act as stimulants and may keep patients awake. Adjustments to the schedule of when medications are taken may help with this. Alternatively, the doctor may prescribe a sleep aid.

It is important to take steps to reduce insomnia as it has been shown to be correlated with depression in Parkinson’s patients.

Trouble staying asleep or getting restful sleep

Some conditions, including Parkinson’s disease, can interrupt sleep or make it less restful. Sleep fragmentation or interrupted sleep is one of the most common sleep complaints in Parkinson’s patients. Poor sleep can lead to problems with attention and thinking, among other issues.

Several factors can lead to sleep interruptions in Parkinson’s disease. These include the symptoms of the disease returning when medications wear off (off episodes), frequent nighttime urination (nocturia), hallucinations or altered dreams, and sleep apnea.

A large study of almost 3,200 patients (194 with Parkinson’s and 77 with other parkinsonisms) found that sleep apnea was more common in people with Parkinson’s than others.

Another study showed that women with sleep apnea may be at higher risk of getting Parkinson’s disease.

Motor dysfunction of the laryngopharynx, the area where air and food pass through the throat, could also be involved in sleep apnea in Parkinson’s disease patients, according to another study.

Sleep apnea can be treated with oral appliances or airway pressure devices such as a CPAP to keep the airways open. If these are unsuccessful, surgery might be an option.

REM (rapid eye movement) sleep behavioral disorder, restless legs syndrome, and periodic limb movements in sleep (PLMS) are other issues that can lead to less restful or interrupted sleep. These disorders, which involve unwanted movements of the body, have a higher prevalence in Parkinson’s patients and may have similar underlying causes.

Falling asleep during the day

Not getting enough restful sleep at night, some medications, and possibly the disease itself leading to neurodegeneration can lead to daytime sleepiness and even sleep attacks (sudden involuntary episodes of sleep) in people with Parkinson’s disease.

Excessive daytime sleepiness is one of the most frequent sleep disorder symptoms in Parkinson’s disease and can affect a patient’s quality of life.

Trying to get more restful sleep at night and adjusting medications can help with excessive daytime sleepiness.

A new therapy from Theranexus is also currently being investigated in a Phase 2 clinical trial (2017-004475-31) to help with excessive daytime sleepiness.

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