If you have Parkinson’s disease (PD), you need enough sleep to ensure that you have the energy to effectively manage your symptoms and obtain the maximum benefit from your medications. A refreshing sleep may even offer you “sleep benefit,” a period of time when you remain symptom free after waking.

Despite this need, you may find your sleep disturbed by a number of factors. Fatigue and sleepiness are common symptoms of PD, and may be due to the fact that your quality of sleep has decreased. Difficulty turning over in bed or a constant need to go to the bathroom throughout the night can significantly decrease your quality of sleep. You may also find that your PD symptoms, such as rigidity, tremor, dystonia, or pain return at night, increasing your difficulty to sleep or stay asleep.

Sleep disturbances can significantly reduce one’s ability to function. The primary sleep-wake cycle can be deregulated among those with PD, causing individuals to have fragmented sleep patterns. The regulation of sleep and wakefulness is linked to the complex interplay of various brain regions and neurotransmitters. Unfortunately, many of the elements that govern this process are impacted in individuals with Parkinson’s disease (Stefani & Hogl, 2019). A commonly cited study from 1988 found that 98% of people with PD had some issues with sleep, and as many as 30% showed disrupted regulation of wakefulness (Stefani & Hogl, 2019). Another study found that people with PD slept just five hours a night on average and experienced twice as many wakeups as people with a similar age who did not have Parkinson’s (American Parkinson Disease Association, n.d).

As a result, people with Parkinson’s may experience excessive daytime sleepiness and fatigue. It is clear that optimizing sleep is critical. Some benefits of good sleep are:

  • Improved quality of life
  • Improved mood
  • Clearer cognition
  • Reduced severity of daytime parkinsonism
  • Reduced daytime sleepiness

 

Common Sleep Disorders in Parkinson’s

REM Sleep Behaviour Disorder (RBD)

REM sleep behaviour disorder iscommon among people with PD. People with RBD do not have the normal muscle relaxation during sleep that others do. This causes them to act out their dreams during the REM (rapid eye movement) stage of sleep. They may kick, shout or punch because their body is responding to their dreams. People with severe RBD may want to consider sleeping alone to avoid doing any harm to their bed partner.

Effective treatment of RBD may include taking melatonin before bed, or a low dose of a muscle relaxant such as clonazepam. It is extremely important that you do not treat yourself for these disorders and that you discuss them with your doctor or neurologist in order to determine the best form of treatment for you.

Sleep Apnea

Sleep apnea involves irregular breathing patterns during sleep, including pauses in breath, or shallow breathing throughout the night. This may be a result of upper airway dysfunction as a result of the disease (Maggi et al., 2023). However, the good news is that sleep apnea does not appear to be more common in people with PD than those without (Cochen de Cock et al., 2010). In fact, a higher body-mass index, older age, and male sex are most predictive of developing sleep apnea (Maggi et al., 2023).

Restless Leg Syndrome

Restless leg syndrome (also called Willis-Ekbom Disease) typically occurs during the evening and is characterized by an intense urge to move the legs or other limbs, accompanied by uncomfortable tingling or pulling sensations. While this symptom can be caused by PD, it may also be due to unrelated factors (Parkinson’s UK, 2018). When caused by Parkinson’s, restless leg syndrome is a result of dopaminergic cells being damaged in the brain, which results in muscle spasms (Parkinson’s UK, 2018). However, other conditions, such as iron deficiency anemia, pregnancy, and kidney failure can also be behind restless legs, so make sure to speak with your doctor or neurologist (Parkinson’s UK, 2018).

Insomnia

Insomnia is a sleep condition that can make falling asleep, staying asleep, or getting back to sleep after waking difficult. Thirty percent of people with Parkinson’s may experience insomnia (American Parkinson Disease Association, n.d.). One five-year long study found that depression, motor fluctuations, and high doses of dopamine agonists were correlated with worser insomnia in people with PD (Zhu et al., 2016). Other mental health challenges, such as anxiety, can also contribute to insomnia (American Parkinson Disease Association, n.d.).

The best treatments for insomnia include improvement of sleep hygiene (see below), as well as medication when necessary. Before taking any medication or supplements, even if herbal or over the counter, make sure to check with your doctor to rule out any interactions.

Sleep Fragmentation

This is a very common complaint amongst people with PD, resulting in a disturbed sleep pattern marked by frequent night awakenings (American Parkinson Disease Association, n.d.). Studies have compared sleep stages in people with PD to an age-matched control group and have found that those with Parkinson’s spent significantly less time in slow-wave and REM sleep (American Parkinson Disease Association, n.d.). The consequences of this can be serious, as sleep fragmentation has been linked to medication-induced hallucinations, as well as daytime sleepiness (American Parkinson Disease Association, n.d.).

Nighttime Urinary Frequency (Nocturia)

The need to frequently urinate at night is one of the most common non-motor symptoms of Parkinson’s, with detrimental impacts on quality of life for people with PD and their carepartners (Batla et al., 2016). Over half of people with Parkinson’s report some degree of nocturia, which is defined as getting up to urinate two or more times each night (Batla et al., 2016). There are many causes of nocturia for people with Parkinson’s, including reduced bladder capacity at night due to disruptions in dopamine (Batla et al., 2016) and autonomic dysfunction, which is a ubiquitous symptom in people with Parkinson’s disease (American Parkinson Disease Association, n.d.). To rule out other causes of nocturia, such as infections, enlarged prostate, or other kidney issues, please see your doctor.

Anticholinergic medications may help this symptom, and studies have also found that a hormone called ddAVP, which is administered as a nasal spray at bedtime, may also be beneficial (American Parkinson Disease Association, n.d.).

 

Getting a Good Night’s Rest

The following strategies can help you fall asleep, or stay asleep through the night:

  • Switching to a longer lasting or extended-release form of medication, only with the direction of your neurologist or doctor, might help control your symptoms throughout the night.
  • Keeping a regular sleep schedule and bedtime routine. Sleep in bed and keep room cold and dark.
  • Nap if you need to, but avoid doing so after 3:00pm. Limit naps to a maximum of 30 minutes.
  • Sleep on your side. If your back or hips are sore, put a small soft pillow between your knees.
  • If you can roll over without difficulty, spend at least 20 minutes a day on your stomach with your chin resting on your folded arms. This gives the spine an excellent stretch to relieve tension.
  • Avoid strenuous exercise, and hot baths or showers before bedtime.
  • Do not go to bed hungry, but avoid heavy evening meals and stimulants.
  • If you are disturbing your bed partner’s sleep or vice-versa, consider the occasional night in separate rooms. Alternatively, you may consider replacing one large bed with two three-quarter or twin-size beds with separate mattresses and covers.
  • Use the bed only for sleeping or sexual activity, rather than watching late night television. • Upon waking, immediately expose yourself to bright light (natural or otherwise). This helps regulate the sleep-wake cycle (American Parkinson Disease Association, n.d.).

Additionally, to ensure the best possible sleep, your bed should be comfortable and appropriate for your needs. Consider the following:

  • The bed should be high enough to allow you to sit down on it comfortably.
  • The mattress should be firm.
  • Use a soft pillow that you can position for the greatest comfort.
  • Bedcovers should be light but warm.
  • If you sleep with a partner, you may find separate covers more comfortable.
  • You may find it easier to be independent in bed if one side is up against a wall for you to push against.
  • If you have difficulty turning over in bed, try reducing the friction between your pajamas and sheets. Avoid brushed nylon or flannel bottom sheets, which increase friction. You might want to try silky sheets, but be careful they are not too slippery.
  • Get advice from a physiotherapist about turning and getting in and out of bed.
  • If you have difficulty with swallowing and drooling, sleep with several pillows or raise the head of your bed 30 degrees.

If you are very immobile, you may need a hospital bed with rails and a trapeze. These beds are expensive, but may be tax deductible. Always consult an expert, such as an occupational therapist, before buying.

 

Identifying Sleep Problems

Consider the case of a 67-year-old gentleman, who has reported trouble sleeping. In this case, each of the man’s issues pointed to a specific sleep issue, or associated symptoms. If you identify with any of the points in his case, speak to your healthcare team.

  • The gentleman’s legs started bothering him in the late evening, so he had to walk around for 30 minutes.
    • Restless leg syndrome
  • He woke up several times a night and had trouble getting back to sleep.
    • Nighttime urinary frequency (nocturia) and anxiety
  • He awoke unrefreshed and struggled until mid-morning, when he finally ‘got going’.
    • Drug side effect (e.g. taking high dose of mirtazapine at bedtime)
  • He had a nap in the later afternoon because he couldn’t make it until bedtime without sleeping.
    • Behavioural choice affecting sleep later in the night
  • His wife slept in a separate room as his sleep was disrupting hers.
    • REM sleep behaviour disorder
  • He was becoming more irritable and having problems with his short-term memory.
    • Mood and cognitive symptoms caused by poor sleep

 

Sources

American Parkinson Disease Association (n.d.). Sleep Problems. https://www.apdaparkinson.org/what-is-parkinsons/symptoms/sleep-problems/

Batla, A., Phé, V., De Min, L., & Panicker, J. N. (2016). Nocturia in Parkinson’s Disease: Why Does It Occur and How to Manage? Mov Disord Clin Pract, 3(5), 443–451. https://doi.org/10.1002/mdc3.12374

Cochen De Cock, V., Abouda, M., Leu, S., Oudiette, D., Roze, E., Vidailhet, M., Similowski, T., & Arnulf, I. (2010). Is obstructive sleep apnea a problem in Parkinson’s disease? Sleep Medicine, 11(3), 247-252.

Dr. Claire Hinnell, Jim Pattison Outpatient Care and Surgery Centre, Prince George. Presentation 2016.

Maggi, G., Giacobbe, C., Iannotta, F., Santangelo, G., & Vitale, C. (2023). Prevalence and clinical aspects of obstructive sleep apnea in Parkinson disease: A meta-analysis. European Journal of Neurology, Early View. https://doi.org/10.1111/ene.16109

National Parkinson Foundation, www.parkinson.org, USA.

Pacific Parkinson’s Research Centre, University of British Columbia, Vancouver, BC.

Parkinson’s UK. (2018). Restless legs. https://www.parkinsons.org.uk/information-and-support/restless-legs

Stefani, A., & Högl, B. (2019). Sleep in Parkinson’s disease. Neuropsychopharmacology Reviews, 45, 121-128.

Zhu, K., van Hilten, J. J., & Marinus, J. (2016). The course of insomnia in Parkinson’s disease. Parkinsonism & Related Disorders, 33, 51-57. https://doi.org/10.1016/j.parkreldis.2016.09.010


Last updated: January 3, 2024