Management of Sleep Disturbances in Parkinson’s Disease

Abstract

Parkinson’s disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.

The rise of Parkinson’s disease is a global challenge, but efforts to tackle this must begin at a national level: a protocol for national digital screening and “eat, move, sleep” lifestyle interventions to prevent or slow the rise of non-communicable diseases in Thailand

“…Sleep problems are common nonmotor PD symptoms and can be observed in both the prodromal and early stages ( 190 ). The most common sleep disorders are insomnia, sleep disordered breathing, excessive daytime sleepiness, RBD, and sleep-related movement disorders, such as restless legs syndrome ( 191 ). We know that RBD is a strong predictor of subsequent PD ( 60 , 62 ), therefore early detection of sleep problems in older people, in particular RBD, may provide an opportunity for early intervention to treat the sleep disorder itself and to prevent the development of PD.…”

Daytime sleepiness in Parkinson's disease: a multifaceted symptom

“…Exercising during the day, including regular physical activity in the morning and scheduled rehabilitation, may improve many non-motor symptoms in PD, including a reduction of fatigue, an increase in sleep quality, and a reduction of EDS. In addition, outdoor activities and avoiding vigorous physical activity 3-4 h before sleeping might also be helpful in this process (van der Kolk and King, 2013;Schütz et al, 2022). When a circadian rhythm dysfunction is detected (e.g., delayed sleep-wake phase disorder), supplementary exposure to bright light using light therapy in the morning might have beneficial effects on EDS by influencing circadian rhythm; however, there is no consensus on a therapeutic protocol in PD patients, and the efficacy must be proved by more studies (Lin , 2021).…”

Chronobiology of Parkinson's disease: Past, present and future

“…RBD is a sleep disorder characterised by a failure of muscle atonia during REM resulting in dream enactment and other sleep behaviours (Schütz et al, 2022). RBD is a common early sleep complaint in neurodegenerative α‐synucleinopathy diseases (Boeve et al, 2001) and is reported in up to 60% of PD patients; its prevalence is associated with age, male sex, disease severity, duration of motor symptoms and dopaminergic therapy (Lee et al, 2010; Zhu et al, 2017).…”