Sleep is one of those essential foundations on which everything else depends — without good-quality sleep, nothing else in your life will be as good as it could otherwise be. The motor symptoms of Parkinson's disease makes life difficult enough as it is, but unfortunately, many patients struggle with sleep, too. Folks who live with Parkinson's are less likely to have an undisrupted, restorative, night's sleep than other people their age, and one study even suggests that Parkinson's patients only average five hours of sleep a night.
Sleep problems may be caused by:
- Parkinson's disease itself
- Medications you're taking to help you manage Parkinson's disease
- Depression, also often seen in people with Parkinson's disease
- Unrelated factors
What kinds of sleep trouble do Parkinson's patients encounter?
Insomnia, which is seen in over a third of Parkinson's patients, can mean a few different things:
- Trouble falling asleep
- An inability to stay asleep the whole night (also called maintenance insomnia)
- Consistently waking up earlier than you wanted and needed to
Although medications can help people with insomnia sleep much better, improved "sleep hygiene" — such as maintaining regular schedules, making your bedroom cozy, and winding down mentally before bed — play a very important role in treatment too.
REM behavioral disorder (RBD)
REM behavioral disorder is a kind of sleep disorder that occurs during REM sleep. It can cause those affected to intensely physically active while sleeping, wildly moving their limbs, and even to literally act out their dreams. RBD can be mild or severe, and is thought to occur when the mechanisms that usually keep people fairly immobile during sleep (sleep paralysis) are disrupted. It may affect up to half of all Parkinson's patients, and can pose physical danger to both patients and their partners. Clonazepam is the main treatment of choice.
Vivid dreams and nightmares
Vivid dreams and nightmares can occur as a side effect of Parkinson's medications like levodopa, with research suggesting that as nearly a third of patients using dopaminergic medications experience them. Tricyclic antidepressants and triazolam can be the culprit of this problem as well. The answer lies in reducing your dosage, changing the time at which you take your medication, or possibly switching your medication — always in conjunction with your doctor, of course.
Periodic Leg Movements of Sleep (PLMS) and Restless Legs Syndrome (RLS)
Restless legs syndrome and periodic leg movements of sleep are two actual, medically diagnosable, conditions that sound a bit strange but basically do exactly what they say on the tin. Restless legs syndrome induces uncomfortable sensations that "force" patients to move their legs, while PLMS isn't usually painful but wakes patients up, robbing them of the sleep they need.
Sleep apnea, during which a patient experiences short periods of time in which their breathing stops or becomes limited, is the most frequently seen breathing-related sleep disorder. Already fairly common in older people, it is believed to affect one in five or all Parkinson's patients. Because it interferes with your ability to get a full night's rest, sleep apnea often also goes hand in hand with daytime fatigue. Your partner may suffer too, as snoring is usually part and parcel of sleep apnea too. The condition is evaluated and treated by sleep specialists.
Fatigue and unplanned naps
Fatigue that's so bad you can't stay awake the whole day is often seen in Parkinson's disease patients. This may be due to a combination of poor sleep quality during the night, side effects of medications, and a vicious cycle that keeps your sleep patterns disordered. If you've noticed that you can't get through the day without a nap or multiple naps, medications like benzodiazepines and antidepressants can help you out. These medications are, however, unfortunately quite likely to lead to their very own set of side effects.
1. Commit to a bedtime routine
Your internal clock tends to get used to — and come to expect — the things that are part of your everyday routine. Try "training" your body to sleep at a certain time by going to bed and getting up at the same time every single day. To get in the mood for sleeping, try making repetitive relaxing activities part of that routine, as well; some people like to watch a favorite show, read a chapter or two, or have a nice bath or shower.
2. Say no to things that keep you awake
Caffeine, nicotine, and alcohol can all serve as stimulants (though a lot of alcohol acts as a depressant) — and this means that using products containing these things will keep you awake for longer, especially if you do so shortly before you were planning to go to sleep. Caffeine may actually have some beneficial effects on Parkinson's patients, but try saving it for the morning. While we're at it, drinking copious amounts of water is good for you, but doing so right before bed stimulates a whole other organ; your bladder, of course! Don't do that.
3. Make sure you are exposed to enough sunlight during the day
Sufficient exposure to sunlight helps the body tell the difference between day and night — so try to get outside or at least optimize the amount of natural light that comes into your home by opening curtains and blinds, and perhaps strategically placing your furniture to allow you to see some sunlight. At night, when it's dark, it's best to dim your lights to help your body get ready to sleep.
4. Banish electronics from the bedroom
Many people watch TV or use tablets or other screens within the bedroom these days. Not only are these sources of bright light, they'll also get your mind racing when you need to relax. Try banishing electronics from the bedroom and using it just for sleep and sex. This will help get the message that bed is where you go to sleep to your brain.
5. How comfortable is your bed?
A comfy mattress and pillow are quite literally the foundation of good sleep — but your blanket matters, too. Some people find that a weighted blanket helps them achieve the relaxed state they need to get to sleep. If you don't want to replace your whole mattress, or can't spare the money, mattress toppers are a much more affordable option.
In addition, turn the thermostat down — a slightly cooler temperature is actually more conducive to sleep.
6. Get up if you can't sleep
If you suffer from insomnia and spend prolonged periods of time in bed trying to go to sleep, your body will start associating your bed with sleeplessness. Some people will even recommend that you get up again if you don't fall asleep after 15 minutes, though we think you could first try some relaxing thoughts. If you've been awake long enough that you're tempted to turn on the TV or tablet, though, get up — and do something relaxing instead. Listening to calming music, meditating, or praying (if you are that way inclined) are examples of things you can do that won't get you all riled up.
7. Try to reduce your naps
Naps can play an essential role in your day, and they're even a very normal part of many cultures. Don't overdo it though — napping longer than 40 minutes or so might keep you from sleeping at night. If you do nap, do so at the same time each day so it becomes part of your routine.
8. Keep it quiet
Keeping your bedroom quiet will allow your brain to relax, prepare for sleep, and prevent you from waking up during the night. If your bedroom is noisy, perhaps because you live on a busy street or because your partner snores, noise-canceling headphones may help you out.
9. Adjust the timing of your exercise
Regular exercise is very important to Parkinson's patients as it helps reduce stiffness while increasing your flexibility, strength, and stamina. That doesn't mean you should be working out just before bed, though — exercise raises your temperature slightly, while it should be going down before bed. The morning is a much better time for exercise.
10. Is it time to ask your doctor for help?
Not sleeping well will affect your quality of life negatively, sometimes in a very significant way. Don't continue to suffer alone, as you have a powerful partner in your primary care provider. They will be able to suggest sleep hygiene tips, medications, chronotherapy, bright light therapy, and other therapies that might benefit you. Some patients also find answers in alternative medicine, through things like meditation and biofeedback.