Treatment of Sleep Dysfunction in Parkinson’s Disease

Abstract

Impaired sleep and alertness affect the majority of Parkinson's disease (PD) patients, negatively impacting safety and quality of life. The etiology of impaired sleep-wake cycle in PD is multifactorial and encompasses medication side effects, nocturnal PD motor symptoms, and presence of co-existent sleep and neuropsychiatric disorders. The primary neurodegenerative process of PD involves brain regions that regulate the sleep-wake cycle, such as brainstem and hypothalamic nuclei. Sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep disordered breathing (SDB), restless legs syndrome (RLS), and circadian disruption. Despite its high prevalence in the PD population, there is a paucity of clinical studies that have investigated treatment of sleep dysfunction associated with PD. Therefore, we aim to review available evidence and outline treatment strategies for improvement of disorders of sleep and wakefulness in PD patients. Evidence supporting the efficacy of pharmacological and non-pharmacological treatment strategies in PD is limited. There is thus a great need but also opportunity for development of well-designed clinical trials for impaired sleep and alertness in PD. Providing education about sleep hygiene and strategies for its implementation represents the initial step in management. Prompt diagnosis and treatment of co-existent primary sleep and psychiatric disorders are critical, as this may significantly improve sleep and alertness. While the optimal treatment for insomnia in PD has not been established, available strategies include cognitive-behavioral therapy, medications with soporific properties, and light therapy. Safety measures, clonazepam, and melatonin are the mainstay of treatment for RBD. Continuous positive airway pressure is an effective treatment for SDB in PD. The treatment algorithm for RLS associated with PD mirrors that used for idiopathic RLS. Circadian disruption has emerged as an important etiology of impaired sleep-wake cycles in PD, and circadian-based interventions hold promise for novel treatment approaches.

Subthalamic deep brain stimulation improves sleep and excessive sweating in Parkinson’s disease

“…The causes of sleep disturbances thus seem complex and likely multi-factorial. Motor and non-motor PD symptoms, medication, dysregulation of sleep-wake function, and co-morbidities such as sleep-related breathing disorders can probably all play a role [50][51][52] . Therefore, the improvement of sleep quality probably also can be attributed to several mechanisms.…”

Effects of Exercise on Non-motor Symptoms in Parkinson’s Disease

“…Sleep symptoms negatively influence quality of life and EDS has the potential to impair safety and reduce independence(41, 42). Pharmacologic therapies are available for some sleep complaints in PD, but have potential for side effects(3). For example, soporific agents can impair balance and cognition and cause residual grogginess the next morning(43).…”

“…These non-motor symptoms adversely affect quality of life and can be even more disabling than the motor symptoms(2). Medications used to treat these symptoms are often inadequately effective and can cause intolerable side effects(3, 4). Therefore, patients, physicians, and researchers have developed increased interest in the potential of non-pharmacological therapies to treat non-motor symptoms in PD(5).…”

Management Recommendations on Sleep Disturbance of Patients with Parkinson's Disease

“…Sleep disturbance affects 40–98% of PD patients in the world. [123] In China, the prevalence of PD patients with sleep disturbance ranges from 47.66% to 89.10%. [456789] Sleep disturbance usually has adverse impact on the quality of life of PD patients.…”

“…[3] Although three reviews on the sleep disturbances of PD have recently been published, there is no consensus of recommendations on the management of PD patients with sleep disturbance. [1310]…”