Many people with Parkinson’s disease (PD) have trouble sleeping through the night.
In some cases, PD symptoms like rigidity or tremor keep people awake. The brain changes that are part of PD also can cause sleep difficulties, and some people have problems sleeping even before movement symptoms develop and PD is diagnosed. In addition, some PD medications can disrupt sleep at night, and others make people sleepy during the day.
A good night’s rest is essential to feeling well. Disrupted sleep can affect your health, mood and overall quality of life. Furthermore, when people with PD don’t sleep well, the sleep of their care partners is disrupted too. Care partners also need restful sleep to stay healthy.
Nighttime Sleep Difficulties
- Difficulty going to sleep, because PD symptoms like rigidity make it hard to get comfortable or turn over.
- Difficulty falling asleep due to symptoms of anxiety or depression.
- Difficulty staying asleep, because of a need to use the bathroom during the night, the return of motor symptoms when medications wear off, pain or hot flashes with night sweats.
- Noise produced by tremor against a pillow.
- Vivid dreams or nightmares caused by levodopa medications.
- Early morning awakening, from a too-early bedtime or associated with depressed mood.
- An overwhelming urge to move or an unpleasant sensation in the legs caused by restless legs syndrome.
- Loud snoring, restless sleep and pauses in breathing during the night caused by sleep apnea. Although sleep apnea is usually associated with being overweight, this is not the always the case for people with PD. As many as 40 percent of people with PD have sleep apnea.
- Activity, sometimes violent movements such as kicking, punching, running or getting out of bed due to rapid eye movement (REM) sleep behavior disorder. People with REM sleep behavior disorder do not relax their muscles normally during sleep, and thus act out violent dreams. This affects about a third of men with PD, but is less frequent in women with PD.
- Disruption in the normal sleep-wake cycle caused by excessive sleepiness during the day or taking long naps during the day.
Troublesome Daytime Sleepiness
- Excessive sleepiness during the day may be a symptom of PD and may even start before the characteristic movement symptoms appear.
- Many PD medications can cause sleepiness during the day and may even cause sudden sleepiness with potentially dire consequences, such as falling asleep while driving.
- Too much napping during the day makes it hard to sleep through the night.
Good sleep is a foundation for good health. Not only does it contribute to tiredness and fatigue, it can also worsen any cognitive issues you are experiencing. If you have trouble sleeping, remember that you don’t have to “just live with it.” Medical therapies can help some sleep difficulties:
- A long-acting levodopa medication might prevent PD symptoms from returning during the night. Talk to your doctor about adjusting your PD medications to maximize wakefulness during the day and sleep at night, while controlling your symptoms.
- For REM sleep behavior disorder, doctors may prescribe melatonin or clonazepam (Klonopin®), which is a long-acting sedative.
- For sleep apnea, wearing a CPAP device (Continuous Positive Airway Pressure device) at night can help prevent obstruction of the airways. You need to have an overnight sleep evaluation for a sleep apnea diagnosis to be made.
- Talk to your doctor about over-the-counter sleep aids, such as melatonin, as well as those available with a prescription. It is important to balance the benefits of sleep medications with the risks, especially of daytime sleepiness, cognitive decline and increased falls.
- Antidepressants are sometimes prescribed to help nighttime sleep.
- If urinary frequency keeps you up at night, be sure your doctor rules out causes other than PD. In addition, there are several medications that can be helpful, including oxybutynin (Ditropan®), tolterodine (Detrol®), trospium (Sanctura®), solifenacin succinate (VESIcare®), darifenacin (Enablex®), mirabegron (Myrbetriq®) and fesoterodine fumarate (Toviaz®). If your doctor has difficulty managing bladder symptoms, you may be referred to a bladder specialist (urologist).
- Some physicians prescribe stimulants to help people with PD stay awake during the day.
Tips for Better Sleep
People with PD — and their care partners too — can take these steps to get to sleep faster and stay asleep:
- Keep a regular sleep schedule — go to bed at the same time each night and get up at the same time each morning.
- Choose your bedtime based on when you want to get up and plan to spend seven to eight hours a night in bed.
- Make a bedtime routine — for example, snack, bath, tooth-brushing, toileting — and follow it every evening.
- Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 PM.
- If you can’t get outdoors, consider light therapy — sitting or working near a light therapy box, available at drug stores and department stores.
- If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 pm.
- Avoid stimulants like caffeine, nicotine and alcohol, especially six hours before bedtime. While alcohol can initially cause sleepiness, it actually disrupts sleep.
- Avoid heavy meals in the evening.
- If you take PD medications at night, keep your dose and a glass of water close by so you don’t have to get up in the middle of the night.
- Sleep in a cool dark place and use the bed only for sleeping and sexual activity. Do not read or watch television in bed.
- Avoid “screen time” — television, phones, tablets such as your iPAD — one or two hours before bed.
In addition, people with PD can:
- Use satin sheets and pajamas to make moving in the bed easier.
- Minimize drinking liquids for three hours before bedtime to help prevent frequent nighttime urination.
- Go to the bathroom immediately before retiring.
- Place a commode next to the bed, to minimize the effort, and the light needed, to get up during the night.