Sleep Disorder in

Patients with
Parkinson Disease
By Ken-Ucheonye Edohan
 Parkinson??
 Parkinson's is a progressive neurological condition.
 People with Parkinson's don't have enough of a chemical
called dopamine because some nerve cells in their brain have
died (basal ganglia and the extra pyramidal area )
 Without dopamine people can find that their movements
become slower so it takes longer to do things.
 The loss of nerve cells in the brain causes the symptoms of
Parkinson's to appear.
 Everyone with Parkinson's has different symptoms.
 The main symptoms of Parkinson's are tremor, rigidity and
slowness of movement.
 As well as affecting movement, people with Parkinson's can
find that other issues, such as tiredness, pain, depression and
constipation, can have an impact on their day-to-day lives.
 The symptoms someone has and how quickly the condition
develops will differ from one person to the next.
Parkinson Disease and Sleep Problems
An early survey found that more than 85 percent
of patients suffering from Parkinson's disease
(PD) also have sleep disorders, which include
abrupt and agitated arousal throughout the night.
These sleep disruptions often occur as many as
five times during the night. PD patients often find
that their sleep disturbances result from a
combination of medication (excessive and sudden
onset of sleep), cognitive function and severe
mood fluctuation associated with the disease.
(Lees et al,1998). It could be depression or
anxiety, and if identified should be the focus of
the treatment
 In addition, sleep disturbances in PD patients
are divided into three different categories:

1. sleep onset insomnia,

2. sleep maintenance problems and
3. daytime sleepiness.

There are, however, other sleep related

disorders associated with PD.
 Sleep Onset Insomnia
Sleep onset problems are often associated with
anxiety or agitated depression. Anticipation of
PD-related symptoms and restless leg
syndrome are also contributing factors.
Patients with sleep onset insomnia cannot
initially fall asleep. Commonly patients
complain of feeling extremely tired, but they
are still unable to fall asleep once they lie
down.
Sleep Maintenance Problems

Sleep maintenance is the most common form

of sleep disturbance associated with PD.
Traditionally, patients suffering from this
disorder are able to fall asleep, but they are
unable to remain asleep for long intervals.
This sleep disorder often leads to daytime
sleepiness.
 Daytime Sleepiness
Daytime sleepiness encompasses the
continued fatigue that follows a restless
night. In addition to general sleepiness,
patients often find themselves falling asleep
suddenly throughout the day. This can be
especially dangerous for patients who drive.
It also reduces the quality of a patient's life
when the disease is otherwise under control.
Rapid Eye Movement Behavioural
Disorder
Health Central, an online health resource,
characterizes rapid eye movement behavioural
disorder (RBD) as the acting out of violent dreams
during REM sleep. The patient may scream, shout
or even strike during an outburst. This disorder can
occur frequently prior to the onset of PD. In people
without PD, when you have violent dreams, nerve
impulses (atonia) going to your brain are blocked so
you cannot act out those dreams but in patients with
PD, this inhibition is gone.
 Restless Leg Syndrome
 This is when you feel this irresistible urge to
move your legs at night. Although restless
leg syndrome (RLS) is not always associated
with sleep disorders, PD patients often have
trouble sleeping due to uncomfortable
sensations in the legs. When PD patients are
able to fall asleep, RLS can awaken them by
causing sever twitching.
 Treatment Options
 Behavioural Therapy

1. Sleep Restriction Therapy: This is trying to

restrict the amount of time spent in Bed by
Patients with PD. (Spielman et al ,1987)
 Stimulus Control Therapy

 This is a Cognitive Behavioural Therapy

where Patients with PD are taught and advised
to keep a fixed time for sleeping, waking up,
avoid activities in bed-except sleep.(Smith &
Neubauer, 2003)
 Sleep Hygiene Education
 PD Patients are advised and trained on how to
keep bedroom comfortable, free from
disturbances, light and noise, avoiding
stimulants such as caffeine, alcohol, heavy
meals, and smoking in the evening before bed
and also getting regular exercise during the
day. Research has shown that this tends to
work with patients with mild to mid stage
Parkinson Disease( Engle-Friedman et al,
1992)
Safety is also a big issue with PD patients who
get Rapid Eye Movement Behavioural
Disorder. They risk injuring themselves and
their sleep partners. The frequency and
intensity of RBD episodes are sometimes too
much for a sleep partner to endure. This is
often hard for those who suffer from RBD to
understand, because they usually don't
remember the episode because they sleep
through it. Sleeping in a big bed can minimize
the chance a sleep partner will be injured, but
sleep partners often end up sleeping in different
beds or even in different rooms.
 Pharmacologic Therapy
 Sedating Antidepressants may be used but
with caution and in Low Dosage.

 Muscle relaxant and also Gabapentin can also

be used with Caution and in Low Dosage.
(Garcia-Borreguero, 2002)
 References Used
 Lees AJ, Blackburn NA, Campbell VL. The nighttime problems of
Parkinson’s disease. Clin Neuropharmacol. 1988; 11: 512–9

 Spielman AJ, Saskin P, Thory MJ(1987) Treatment of Chronic Insomia by

restriction of time in Bed. Sleep. 1987; 10:45-56

 Smith MT, Neubauer DN(2003). Cognitive Behaviour Therapy

fornChronic insomia. Clin Cornerstone. 2003;5(3): 28-40

 Engle-Friedman M, Bootzin RR, Hazelwood L, Tsao C(1992). An

evaluation of behavioural treatment for insomia in the older Adult. J Clin
Psychol. 1992: 48:77-90

 Garcia-Borreguero D, Larrosa O, De La Llave Y, et al.(2002). Treatment

of restless legs syndrome with Gabapentin. A Double-Blind, cross over
study. Neurology. 2002;59:1573-1579