How is sleep affected in PD?

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Dr. FernandezJoined: 20 Jan 2007Posts: 90
Posted: Mon May 18, 2009 8:34 am Post subject: How is sleep affected in PD?

Parkinson’s patients frequently complain of insomnia and other sleep disturbances. Sleep disorders affect up to 98% of patients at some point during their disease (Thorpy and Adler 2005). Sleep disorders are perhaps the most common non-motor problem in Parkinson’s disease, and one of the few non-motor symptoms that was initially described by James Parkinson in his original essay on The Shaking Palsy. The causes of sleep disturbances in Parkinson’s disease are often varied. They may arise as a primary manifestation of Parkinson’s disease or may be a result of medications, motor disturbances (such as difficulty turning in bed), pain, nocturia (meaning, frequent urination at night), cognitive problems, hallucinations, depression and/or anxiety. Parkinson’s disease patients may also be at higher risk for other common causes of sleep disturbances including restless legs syndrome, sleep apnea, periodic leg movements of sleep, and rapid eye movement (REM) behavior disorder. How do you bring up these sleep problems with your doctor? Given the number of conditions which can interfere with sleep, a complete history is essential to managing your sleep problems. It is important to determine if you are having difficulty with sleep initiation or sleep maintenance as these may have different causes. Other important points to address include changes of your Parkinson’s disease symptoms during sleeping and waking hours, and history of thinking problems (including hallucinations), motor disturbances (such as motor fluctuations and dyskinesias), abnormal behaviors (vocalizations during sleep, nightmares, dream enactment, leg movements) and urinary problems at night (Kluger and Fernandez 2008). Your spouse or caregiver can also help describe your sleep, particularly if you snore or have lots of movements during your sleep that you may not recall during an appointment. Sometimes, when your doctor discusses appropriate sleep hygiene with you, this issue may also lead to a discussion of a bad sleep habit related that could be associated with your sleep difficulties. A sleep diary, reflecting the hours of sleep and timing of medication dosages is helpful. When the specific cause of your sleep problem cannot be determined, an overnight sleep study (called polysomnography) may be particularly useful in determining a diagnosis and directing treatment. Yours,_________________Hubert H. Fernandez
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