Sleep Disorders in Parkinson's Disease

Sleep disorders are very common in people with Parkinson’s disease (PD).
More than 3/4 of people diagnosed with Parkinson’s disease have sleep disorders.

Disorders of sleep initiation and maintenance

This refers to both trouble falling asleep and or staying asleep. Some people have insomnia and others have excessive sleepiness.
Causes of sleep disorders in PD:
- With normal aging, people tend to wake earlier and sleep less. This is accelerated in PD.
- PD motor symptoms can occur when medication wears off during the night, with symptoms such as tremors or stiffness of muscles causing wakefulness.
- Restless legs syndrome (RLS), common in PD, can wake a person because of the need to move in order to relieve restlessness.
- Medications used to treat PD can interfere with sleep.
- Other medical conditions may contribute to poor sleep.

Excessive daytime sleepiness

Sudden onset sleep (SOS)

Sleep attacks occur when a person who does not feel sleepy suddenly falls asleep.
It can be very dangerous if this occurs when the person is driving.
It is caused by some dopamine agonist medications, but not levodopa, which is the drug used most often to treat PD.

Parasomnia/REM sleep behavior disorder (RBD)

Active nightmares occur during the rapid eye movement (REM) phase of sleep. During this phase, the body is normally paralyzed when dreams are occurring. In PD, this circuit is disrupted, the body is not paralyzed, and the dreams are physically acted out.
Symptoms of RBD include thrashing, punching, kicking, shouting out, and possibly injuring themselves or their bed partners.
RBD is disruptive to the person and anyone with whom they sleep.
RBD may precede the diagnosis of PD by 20 years and is associated with three times the risk of developing PD.
It also increases the risk of Alzheimer’s disease.
Treatment is a mild muscle relaxant.