“My wife had trouble sleeping due to restless legs and being awakened by vivid and disturbing nightmares. Fortunately, this condition seems to have been fixed with a prescription from the neurologist. The clonazepam pills have all but eliminated that problem.”
—ED C., PARKINSON’S CAREGIVER
It is common to have problems getting enough sleep if you have Parkinson’s. In fact, it has been estimated that up to 96 percent of those living with PD experience sleep difficulties of some kind.40
Problems with sleep include insomnia, disrupted sleep, acting out dreams (also called REM behavior disorder, very common in PD), nightmares, vivid dreaming, sleepwalking (not very common), sleep talking, sleep apnea (when breathing stops for a few seconds), excessive daytime sleepiness (EDS), nocturia (waking up with the urge to urinate), and restless legs syndrome (RLS).
There are many possible reasons for sleep problems in people with Parkinson’s. One of the more common ones is medication. People with PD can often have problems falling asleep or staying asleep when PD meds (e.g., levodopa or dopamine agonists) start to wear off before the next dose is due. This causes symptoms such as tremor, rigidity, pain, and turning over in bed.
The antiparkinsonian medications amantadine and selegiline can also make it hard for people to fall asleep or stay asleep, due to their stimulant effect. My mom had this problem. With advanced PD she would sometimes experience excessive dyskinesia, which she took amantadine to control. Though the amantadine did work to calm her body, unfortunately it also tended to keep her awake, sometimes the entire night.
Other medications can also be responsible for sleep disruptions—for example, diuretics. If they are not taken early enough in the day you may have to get up a lot during the night to go to the bathroom. The drug ephedrine (a stimulant used to treat postural hypotension) can also disrupt sleep. And keep in mind that over-the-counter pills like decongestants and antihistamines may cause sleep problems as well.
Food is another common—and often overlooked—culprit. Stimulants make falling and staying asleep more difficult. Avoid the caffeine rush from consuming tea, coffee, and chocolate. Alcohol is another one to steer clear of; while initially a depressant that makes you sleepy, it can ultimately act as a stimulant and cause you to wake up during the second half of the sleep period.
Anxiety, depression, and other psychological problems (including dementia) are also causes of insomnia and sleep disturbances.
Sleep problems should be discussed with your doctor. Before you go in for your appointment, look for patterns in your sleep disturbance. Did you notice that it became worse after you started a new medication? Taking your medications at different times may help your difficulties with sleep, but it may take some time to figure out when the best times are. Your doctor can help you determine this, and whether you need to change the dosage before bedtime. Do you always have painful cramping at a certain time of night? Do you notice that certain foods or drinks make it worse? The more specific the information you can provide yourdoctor, the better. If you have one or more of these problems, the following tips may help you.
For problems moving or turning in be
• Try side rails, a trapeze, ropes, or a handle to grip
• Use satin sheets or pajamas. (Mom said satin sheets are the best!
• Change to a firmer, lower, or higher mattress
• Consult a physical or occupational therapist
For foot and leg sensitivity in be
• Take the pressure off your feet and legs. You can use a bed hoop or a blanket cradle to do this, or you may find that an electric blanket or light down comforter provide enough relief
For restless legs, painful cramping, or abnormal movement
• Talk to your doctor because he or she may change the times or dosages of your medications, or order other medications for pain, spasm, cramps, or anxiety
• Try relaxation techniques (see chapter 21) or slow, relaxing stretching exercises
• Walk around to help relieve RLS
For frequent urination at nigh
• Talk to your doctor or urologist to correct issues such as prostate problems, urinary retention, or infections
• Put a urinal or commode near the bedside
For fear of falling at nigh
• Make your home safer by getting rid of scatter rugs and using night-lights
• Try using a walker at night if you are able
• To prevent dizziness, don’t get up too quickly
For shortness of breath or heartbur
• Using extra pillows or support blocks to raise the head of your bed may help reduce these symptoms, but both symptoms should be discussed with your doctor
For excessive daytime sleepiness (EDS
• Talk to your doctor if you are taking antidepressants, as he or she may change the times or dosages of your medications
• Be very careful when driving, operating machinery, or doing any other activity that requires you to be alert
• Insufficient or poor-quality sleep at night can cause EDS, so addressing the quality and amount of nighttime sleep can help...).n...t..t...s.d..)
Adapted from the book Complete Guide for People with Parkinson's
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