Many people with Parkinson’s struggle to get enough sleep, and because sleep is imperative to our quality of life, it’s important we understand the causes and potential treatments of common sleep disorders in Parkinson’s disease.
We asked Dr. Pravin Khemani, Movement Disorder Specialist, to weigh in on the topic. Here is what he had to say:
“Sleep disorders in Parkinson’s disease are almost ubiquitous and may precede the development of motor symptoms by several years.
Four very common and treatable sleep disorders in PD include:
1. Insomnia: This is an inability to fall asleep or maintain sleep (early awakening); the latter aspect is particularly notorious for impairing quality of life (QOL). Insomnia is one of the most common sleep disorders in the world; therefore, it is not surprising it is so prevalent in PD.
The causes of insomnia are myriad, but persistent insomnia which does not respond to short-duration and short courses of sleep aids AND, most importantly, optimization of PD treatment, must be evaluated by a sleep specialist. Levodopa may disrupt or improve sleep, therefore, its effect later in the evening should be carefully assessed by the treating doctor.
Persistent mood disorder, pain, restless legs (RLS), recurrent PD symptoms, and poor sleep hygiene are common culprits causing insomnia. These causes may coexist, therefore, the treating doc should evaluate for each of these conditions by a simple Q/A session with the patient and caregiver. More often than not, a conversation with the patient gives enough clues to identify the underlying cause of insomnia.
2. Restless Leg Syndrome (RLS): Some studies estimate RLS to be prevalent in 90 percent of PD patients! RLS is easily diagnosed by talking to the patient, and in a majority of patients, it is quite treatable.
3. REM Behavior Disorder (RBD): This is acting dreams out–talking, thrashing about, hitting your bed partner, resulting in potentially serious injuries to patient and spouse. RBD disrupts the bed partner’s sleep as much as it interferes with the patient’s sleep. It is highly treatable and closely linked to the emperor or all sleep disorders.
4. Obstructive Sleep Apnea (OSA): This is the potential fountain-head of so many sleep disorders: Insomnia, RLS, RBD, Periodic limb movements (PLMD, constant kicking of legs when asleep)! OSA is best diagnosed by a sleep study and treated by a sleep specialist. Untreated OSA plays havoc not only with PD symptoms but sets us up for heart, lung, and brain dysfunction. Who needs that? Therefore, kindly get evaluated for OSA and get treated for it. Chances are the other sleep-related issues may also mitigate, and overall quality of sleep and QOL will improve.”
Pravin Khemani, MD
Swedish Neuroscientist Specialists
Movement Disorders
Medical Disclaimer: Dr. Khemani’s comments are not prescriptive advice and do not supplant the directions of your treating physician. His views are his alone, based on years of practice and experience in treating Parkinson’s disease, and do not represent the views of his employer or any other organization. Always make medical decisions only under the guidance of your treating doctor.