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Sleep and Parkinson's Disease
Parkinson's Disease Clinic and Research Center
Sleep is characterized by two alternating phases, rapid eye movement (REM) sleep and non-rapid eye movement sleep (NREM). These phases are defined by brain wave activity, muscle activity, and eye movements. As people start to fall asleep they enter into the lightest of the four stages of NREM sleep, Stage 1. As sleep continues, people descend into the deeper states of sleep down through Stages 2 and 3. Then, people move back up through these stages and enter a REM episode. When people are awakened during REM sleep, they often report having been dreaming.
This term refers to things that occur rhythmically roughly every 24 hours. The sleep-wake cycle is one of the most obvious of our body’s circadian rhythms. Other circadian rhythms include body temperature and secretion of many hormones. These rhythms are controlled by a time-keeping mechanism (or clock) in our brains. This clock can be influenced by a variety of internal and external parameters, including aging, time-zone shifts, exercise, melatonin and the light-dark cycle. The light-dark cycle is the strongest external parameter affecting this clock.
Changes in Sleep with Aging
As people age, they experience a number of changes in their circadian rhythms, and among the most noticeable are the changes in the sleep-wake cycle. Older people tend to wake up earlier and go to bed earlier than they did when they were younger. They wake up more often during the night and have more difficulty going back to sleep than younger people. They also tend to sleep more during the daytime hours. Therefore, if one looks at total sleep time over the 24-hour day, the total time spent sleeping changes very little but the distribution of sleep may be quite different. Younger people experience a consolidated nighttime episode with little or no daytime sleep, whereas older individuals experience sleep episodes throughout the 24-hour day. Daytime sleepiness is affected by two major factors: the amount and quality of nighttime sleep, and the strength of the circadian rhythm. In addition, older people tend to have a reduced amount of N3 or deep slow wave sleep.
Sleep Disturbances in Parkinson's Disease
In general, research seems to indicate that people with Parkinson's disease have more sleep disruptions than similarly aged people without the disease. The most commonly reported sleep-related problems are the inability to sleep through the night and difficulty returning to sleep after awakening, generally referred to as maintenance insomnia. Unlike many older adults, patients with Parkinson’s disease often find that they have no trouble initiating sleep, but often wake up within a few hours and find sleeping through the rest of the night to be difficult. People with Parkinson's disease also report daytime sleepiness, nightmares, vivid dreams, nighttime vocalizations, leg movements/jerking while asleep, restless legs syndrome, inability to or difficulty turning over in bed, and awakenings to go to the bathroom.
Although all the reasons for these sleep changes are unknown, potential explanations include reactions to/side effects of medications (e.g. dopamine agonists, levodopa) and awakening due to symptoms such as pain, stiffness, urinary frequency, tremor, dyskinesia, depression and/or disease effects on the internal clock.
Insomnia is the inability to fall asleep or maintain sleep. The first step in treating insomnia is to initiate a “sleep hygiene program” as described below. Not all of these behaviors will be appropriate for everyone. Choose appropriate behaviors that fit your type of sleep problem: getting to sleep, staying asleep, moving in bed, or waking to go to the bathroom. Behaviors should be initiated one at a time, and their effect monitored over a week or more by using a diary (see evaluation, below).
Vivid Dreams and Nightmares
Vivid dreams or nightmares can be the result of a nighttime dose of dopamine medication. If the dreams are bothersome, the dose can be reduced or possibly eliminated. Other medications that can cause vivid dreams are hypnotics, especially triazolam. Some tricyclic antidepressants prescribed for depression or as a sleep aid can also cause nightmares. If acting-out dreams by movement or vocalization is present, REM behavior disorder (RBD) must be considered. RBD is very common in PD patients.. Evaluation may include referral for a nighttime sleep study. Treatment is considered for safety reasons and RBD can usually be controlled with medication.
Periodic Leg Movements of Sleep (PLMS) and Restless Legs Syndrome (RLS)
Leg movements are common in the elderly and even more so in people with Parkinson’s disease. RLS typically occurs while at rest, and typically consists of an uncomfortable sensation in the legs that is relieved with movement. PLMS are jerking movements of the legs during sleep that are not uncomfortable but can result in nighttime awakenings. PLMS often do not bother an individualbut can rarely be associated with sleep disruption. The movements are often reported by a bed partner. Both PLMS and RLS can result from medication side effects or medical conditions other than Parkinson's disease. After medical evaluation, treatment can include continuous release levodopa, dopamine agonists, and clonazepam.
Although not necessarily more common in people with Parkinson's disease, sleep apnea is common in older adults. Obstructive sleep apnea (period of time with no or little breathing) is usually associated with snoring and complaints of excessive daytime sleepiness. Evaluation for apnea is by a nighttime sleep study and treatment is implemented by a sleep specialist.
Excessive Daytime Sleepiness and Unintended Sleep Episodes
For people with Parkinson's disease, daytime sleepiness may be caused by the many problems that interfere with nighttime sleep, resulting in sleep deprivation, or from the sedating effects of antiparkinsonian medications. People with excessive daytime sleepiness tend to fall asleep during the day, and depending on the situation, can pose a safety hazard to themselves and others. Often the sleep episode is very short, and the person is unaware of having fallen asleep. Unintended sleep episodes have been attributed to dopamine agonist medication. However, research has shown that these episodes are not unique to the use of these medications. The unintended sleep episodes can be seen with any of the dopamine medications, including levodopa, and typically are evident with high doses.
Treatment for excessive daytime sleepiness should be discussed the individual's physician. A thorough evaluation of all medications, their side effects, and interactions must be considered. Sleep apnea, PLMS, and RLS need to be treated if present. PD medications can be changed or doses adjusted. For a significant minority of patients with Parkinson's disease, daytime fatigue is related to the disease process itself and even when other causes are excluded and medications are adjusted, they may still feel tired or fatigued during the daytime. Scheduled naps prior to 3pm and/or alerting medications such as modafinil and methylphenidate can be considered and are sometimes helpful. Caffeine may be an appropriate treatment, if not taken too late in the day.
Steps to Better Sleep Hygiene: Behavioral Changes
Getting to sleep
● Regular risetime and bedtime—by doing this every day, you can help your internal clock by providing regular cues, thereby improving your sleep-wake cycle. This should help in getting to sleep faster and reduce the number of nighttime awakenings.
● Get plenty of bright natural light exposure, preferably in the morning along with exercise. This will give your internal clock a strong cue to run on time.
● Avoid stimulants, such as caffeine and nicotine. Avoid caffeine-containing drugs, drinks, and foods for eight hours before bedtime. Avoid tobacco in the evening. This will help with getting to sleep and staying asleep.
● Avoid thoughts or discussions about topics that cause anxiety, anger, and frustration before bedtime. This will help with getting to sleep.
● Institute and maintain a definite bedtime routine that is relaxing to help signal the body that sleep is to occur soon. Examples might include: a bath, brushing teeth, a small glass of warm milk (4-6 oz.), or a light snack. This will help with getting to sleep and will reduce the need to awaken due to hunger.
● Reserve the bedroom and especially the bed for sleeping. Avoid activities like reading and watching television in bed. Your body needs cues to associate the bed with sleeping and not other activities.
● If you nap, try to do so at the same time every day and for no more than 1 hour, and ending by 3pm.
● Don't spend more than 15 minutes trying to sleep—if you cannot sleep after 15 minutes get out of bed and engage in a quiet activity. Ideally, the activity should be in low light and sedentary, for example, listening to soft relaxing music or meditating, not reading with a bright light or watching television. Return to bed only when you are sleepy.
● Minimize light and noise at bedtime and throughout the night. This will reduce stimulation and promote normal function of the body’s melatonin rhythm that helps to promote and maintain sleep. Ear plugs may be helpful if the environment is noisy. Avoid alcohol within 4-6 hours of bedtime. When taken at bedtime, alcohol may help induce sleep but disrupts sleep later in the night.
● Avoid heavy exercise within 6 hours of bedtime. Exercise increases the body temperature. Sleep onset normally occurs as the core body temperature is decreasing. Artificially increasing body temperature can therefore give the wrong cue to the brain and contribute to sleep disruption.
● Avoid heavy late night meals. They can interfere with the ability to fall and stay asleep. A light snack at bedtime, however, may promote sleep. Good bedtime snacks include dairy products and carbohydrates.
● Assure the bedroom environment is right for sleep: comfortable bed, dark, quiet, and a cool temperature for sleeping.
● Avoid looking at the bedroom clock if you awaken. If necessary, face the clock to the wall.
Moving in bed
Use of satin sheets on the bed or pajamas to help with moving in bed can minimize the effects of stiffness or pain. (Also, see antiparkinsonian medications, below)
Waking to go to the bathroom
•Decrease evening fluids (3-4 hours before bedtime) to lessen the chance of waking up to go to the bathroom. Make sure that you drink plenty of fluids in the morning hours. If you often get dizzy when you stand, sit on the side of the bed for a moment or two while flexing your leg muscles before you stand up.
•Go to the bathroom immediately before retiring.
•A commode placed at the bedside will minimize the activity and necessary light needed for nighttime toileting.
Evaluation of Sleep Hygiene Program: Sleep Diary
Monitoring the effectiveness of behavior changes is best done by keeping a diary. The table below depicts a sample diary that could be kept by the bedside and filled out upon arising by the patient or caregiver. If daytime sleepiness and napping are problems, items can be added to record the number, time, and duration of napping episode. The diary can be carried with the patient.
Medications for Sleep
Historically, medications known as benzodiazepines have been widely used for insomnia in all ages. These medications are classified as short-, intermediate-, or long-acting. Short-acting benzodiazepines (e.g., triazolam) are useful when getting to sleep is the primary concern. However, their side effects include confusion, agitation, impaired motor performance, and amnesia. Intermediate-acting benzodiazepines (e.g., temazepam) are useful when sleep maintenance and/or early morning awakening are the primary symptoms. Long-acting benzodiazepines (e.g., flurazepam) are useful for getting to sleep and sleep maintenance, and when insomnia occurs with daytime anxiety. However, these drugs are often associated with daytime sleepiness and confusion. Newer, nonbenzodiazepine drugs, zolpidem (Ambien®), zolpidem CR (Ambien CR®), zaleplon (Sonata®) and ezopiclone (Lunesta®) have recently become available. These newer drugs seem to have a better safety profile, fewer complications with long-term use, and produce fewer daytime symptoms than the older sleeping medications.
Tricyclic antidepressants and trazadone are frequently prescribed for sleep disturbances. Since depression is a common cause of sleep disturbances in patients with Parkinson's disease, these drugs can help treat both problems. The more sedating tricyclics (e.g., amitryptiline) are used to assist in sleep initiation and maintenance. These drugs must be monitored carefully as they have a high incidence of side effects such as constipation and dry mouth.
All of the antiparkinsonian medications can either help or hinder sleep depending on the problem. If symptoms of Parkinson's disease are causing the sleeping problem, the longer acting levodopa formula at bedtime may help. Adding an agonist or COMT inhibitor may also maximize levodopa activity to prevent breakthrough symptoms during the hours of sleep. Levodopa can also have an alerting effect, and may need to be reduced at bedtime. Selegiline is also known to cause insomnia.
To reduce the frequency of urination, medications such as oxybutynin and tolterodine are often used. These prescription medications work by relaxing the bladder.
Other insomnia interventions
In addition to a sleep hygiene program, other interventions may also be useful. These include sleep restriction programs, chronotherapy, bright light therapy, relaxation training, meditation, biofeedback, and cognitive therapy.
---- 2014, The Regents of the University of California
Parkinson Disease Foundation
Most people with Parkinson's find it difficult to sleep through the night. Rigid muscles, tremors or stiffness at night, or not being able to roll over in bed can all interfere with sleep, as can the frequent urge to urinate. In addition, many people with Parkinson's experience vivid dreams or hallucinations and act out their dreams, violent nightmares, a problem called “REM sleep behavior disorder.” Recent research suggests that REM sleep behavior disorder sometimes begins even before motor symptoms are diagnosed in Parkinson's.
Medicine, such as clonazepam, is available for this problem. For some people, an extra dose of anti-Parkinson medications or a sleeping medication can help alleviate sleep disturbances. In other cases, sleep disturbances may be caused by medical conditions not related to PD. For example, a disruption in breathing called sleep apnea can also interfere with sleep, and can be treated separately from PD. Getting a good night's sleep is essential for people with Parkinson's, so if you are having any of these symptoms you should discuss them with your doctor.
Not sleeping well at night often causes people with Parkinson's to feel drowsy during the day. Anti-Parkinson medications and the disease itself can also contribute to excessive daytime sleepiness. A pattern of falling asleep suddenly for short periods of time, similar to narcolepsy, can interfere with daily life. Adjusting antiparkinson medications, or taking a stimulant during the day—under a doctor's supervision, of course—may help alleviate sleepiness during the day.
商品名 : RISPERDAL (1mg or 2mg)
中文名 : 理思必妥錠 (1mg or 2mg)
學名 : Risperidone
藥品許可證 : 衛署藥輸字第022768號
健保局藥理類別 : 281608 抗精神病藥
類別 : PHR 劑量 : TAB
藥理作用 : 本品為benzisoxazole衍生物，具選擇性之單胺拮抗作用，對Serotoninergic 5-HT及Dopaminergic D2接受體具高度親和力。本品亦可與 α-adrenergic接受體結合，對H1-histaminergic及α-adrenergic接受體之親和力較低，而對Cholinergic接受體則無親和力。本品為強效之D2拮抗劑，可改善精神分裂症之活性症狀，並較其他典型之精神阻斷劑不易引起運動功能抑制及強直性昏厥(catalepsy)。
適應症 : 本品適用於急慢性精神分裂症與其他精神病狀態之活性症狀(如幻覺、妄想、思考障礙、敵意、多疑)與負性症狀(如情感遲滯、情結與社交退縮、缺乏言談)。本品亦可減輕伴隨精神分裂症產生之情感症狀(如憂鬱、愧疚感、焦慮)。
1. 病患應於三天內逐漸調整劑量至每天兩次，每次3mg。無論急性或慢性病人，服用本品之劑量為第一天兩次，每次1mg；第二天兩次，每次2mg；第三天兩次，每次增加至3mg。第三天以後，劑量可持續不變或視個別情況而加以調整。一般最適當之劑量為每天兩次，每次2～4mg。投與劑量超過每天兩次5mg時，其療效未必優於較低劑量，且可能導致錐體外徑副作用。由於每天兩次，每次服用8mg以上之安全性未經評估，請勿超過此劑量。如需加強鎮靜作用，可添加benzodiazepine 與本品併用。
5. RISPERDAL CONSTA每兩週使用一次,使用內附之安全針注射深層臀部肌肉。兩臀須交替注射。不能靜脈注射。本藥限由醫師使用。
2. 本品部份代謝成具類似藥理作用之9-hydroxy-risperidone，此代謝物與 risperidone共同形成有效之抗精神病成份。本品另一代謝途徑為N-去羥基化。精神病患者口服本品後，本品之排除半衰期為30小時。9-hydroxy-risperidone與有效抗精神病成份之排除半衰期則為24小時。多數病患血中之risperidone濃度可於一天內達穩定狀態，而9-hydroxy-risperidone約需4～5天方可達穩定狀態。
禁忌 : 已知對RISPERDAL或其任一成份過敏之病人禁用。
184.108.40.206.Second generation antipsychotics (簡稱第二代抗精神病藥品，如clozapine、olanzapine、risperidone、quetiapine、amisulpride、ziprasidone、aripiprazole、paliperidone等)：(91/9/1、92/1/1、92/7/1、94/1/1、95/10/1、97/5/1、99/10/1)
醫療理由或診斷，以及臨床整體評估表 (Clinical Global Impression，簡稱CGI) 之分數。
clozapine 400 mg/day
risperidone 6 mg/day
olanzapine 20 mg/day
quetiapine 600 mg/day
amisulpride 800mg/day (92/1/1)
aripiprazole 15mg/day (94/1/1)
paliperidone 12mg/day (97/5/1）
藥品保存方式 : 藥品應置於攝氏 15 ~ 25 度乾燥處所；如發生變質或過期，不可再食用。
RISPERIDONE 利培酮 ( 理思必妥 )
台灣健保藥品 --- Anxilet 悠寧膜衣錠 , Apa-Risdol 鴻汶理思得膜衣錠, Apo-Risperidone 安保瑞思得內服液劑 , Blue-Up 易憂安膜衣錠, Perisdone 普利思妥膜衣錠, Respor 理斯本內服液, Ripedon 思定妥膜衣錠, Riper 理波膜衣錠, Risdal 利生妥膜衣錠 , Risdine 利思暢 內服液劑 , Risdon 樂思得 膜衣錠, Risdone 雷司動錠, Rispal 勵思膜衣錠, Risperdal 理思必妥膜衣錠, Risperdal Quicklet 理思必妥速溶錠, Riston 理思通膜衣錠 , Seridol 賽力多內服液劑, Serotone 思悅通內服液劑, Spiterin 思特寧膜衣錠.
美國 --- RisperDAL; RisperDAL M-Tab
Risperidone 為第二代『非典型』精神病藥物，主要用於治療精神分裂症之相關症狀，雙極性疾患之躁症發作。治療失智症病人具嚴重攻擊性，或精神分裂症類似症狀。 它也可與鋰鹽(Lithium) 或valproic acid合併使用以控制躁鬱症。除了產品標籤所核准精神分裂適應症外﹑非典型精神病藥物常被醫師廣泛的運用到治療焦慮症﹑強迫症等。
此藥較嚴重的副作用為: 心跳快速或不規則﹑ 皮膚或眼白泛黃﹑肌肉僵硬﹑舌頭不自主伸縮﹑吞咽或呼吸困難﹑身體扭曲呈現怪異姿勢眼球上吊不能向下望﹑眼痛或視覺改變﹑脖子僵硬﹑發燒﹑短暫﹑或不規則心悸﹑視力模糊﹑說話速度變慢或困難﹑嘴巴歪斜﹑ 頸向後仰﹑顛癇或抽搐等等。通常這些副作用發生的機率較低，但是如果發生時，應該盡快通知醫師。
Parkinson's Disease and Sleep
Source: National Sleep Foundation
Parkinson's disease is a disorder of the central nervous system that causes a loss of cells in the part of the brain that controls movement. People with Parkinson’s disease experience a range of symptoms, including tremor (shaking), rigidity (stiffness), slowness of movement, and problems with balance and coordination. They may also have memory problems, depression, and sleep complaints. Parkinson's disease is both chronic and progressive, meaning that once it occurs it does not go away and symptoms generally get worse over time; the rate or speed of progression is different from person to person.
Parkinson’s disease can be idiopathic, meaning that it occurs with no known cause. In this case it probably develops by some interaction between a person's genes and their environment. It can also be secondary, occurring as a result of another disease, exposure to certain drugs, or as a result of repeated head trauma. According to the Parkinson's Disease Foundation, between 15 and 25 percent of people with Parkinson's have a relative with the disease, suggesting that for some people it may be inherited. Age is also a risk factor, with older people being more likely to develop Parkinson’s disease than younger people, according to the National Institute of Neurological Disorders and Stroke at the National Institutes of Health. Exposure to toxins may also play a role but the nature of that role is not well understood.
Sleep problems may be an early sign of Parkinson’s disease, even before motor symptoms have begun. Some of the common sleep problems for Parkinson’s patients include:
● Excessive daytime sleepiness
● Sleep attacks (a sudden involuntary episode of sleep)
● REM sleep behavior disorder (acting out dreams during sleep)
● Periodic leg movement disorder (PLMD)
● Restless legs syndrome (RLS)
● Sleep apnea
● Nocturia (frequent nighttime urination)
A recent study by UCLA researchers found an association between Parkinson's disease and narcolepsy, a disorder caused by the brain's inability to regulate sleep/wake cycles normally. The study revealed that patients with Parkinson's disease and those with narcolepsy both display a loss of orexin/hypocretin (Hcrt) cells in the brain and that loss of Hcrt cells is correlated with severity of PD. However, there is no reason to believe that narcolepsy patients are at increased risk of developing Parkinson's disease. According to study author Jerry Siegel, PhD, professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA, the cause of the hypocretin cell loss in Parkinson's is likely to be quite different from the cause of this cell loss in narcolepsy.
There may also be a connection between REM sleep behavior disorder (dream–enacting behaviors during sleep) and the subsequent development of Parkinson’s disease. In one study, researchers found that up to 75% of patients with REM behavior disorder went on to develop a Parkinsonian disorder, presumably Parkinson’s disease. In addition, people with Parkinson’s disease are at higher risk for restless legs syndrome (RLS) and periodic leg movement disorder, two conditions that may seriously disrupt sleep. However, there is no evidence that RLS or PLMD are risk factors for Parkinson’s disease.
In addition to sleep problems, people with Parkinson's disease often experience sleepiness during the daytime. In fact, one study found daytime sleepiness in 76% of Parkinson’s patients. These sleep-related symptoms can have a major impact on quality of life for Parkinson’s patients and treatment for these problems should be integrated with their therapeutic regimens.
Because of the mystery surrounding the origin of Parkinson’s disease, a great deal of research has been done on this problem. We know that the symptoms of Parkinson’s are primarily the result of the gradual loss of dopaminergic cells (neurons that release dopamine, a neurotransmitter that activates dopamine receptors) in the brain. Some Parkinson’s research has focused on the relationship between Parkinson’s and both the timing and duration of sleep. For example, a 12-year study by researchers at the National Institute of Environmental Health Sciences of the U.S. National Institutes of Health found that among nearly one million nurses, working the night shift was associated with a lower risk of Parkinson’s disease. They also found that long sleep (sleeping 9 hours or more) was associated with a higher risk.
People with Parkinson’s disease have a shortened life expectancy and may find it difficult to maintain their quality of life. Striving to maintain healthy sleep habits can help Parkinson’s patients with both the physical and psychological symptoms of their disease.
The hallmark symptoms of Parkinson's disease are tremor, rigidity, slow movements and problems maintaining balance. Other symptoms may include difficulty walking, talking, eating, or carrying out other simple tasks. Parkinson’s patients also suffer incontinence, constipation, and sexual dysfunction and are at higher risk for developing depression, anxiety, memory, and emotional problems.
Because Parkinson's disease is associated with "sleep attacks," patients may be suddenly overcome with drowsiness and fall asleep – regardless of what they are doing. This is particularly dangerous for those patients who are still driving, operating equipment (even kitchen and lawn equipment or other tools) or caring for dependents.
Not everyone with Parkinson's disease develops all or even most of the symptoms described above. The rate at which the disease progresses is also variable, with some people experiencing a rapid worsening of symptoms shortly after being diagnosed and others spending many years with only mild symptoms.
With Parkinson’s disease, there is a gradual loss of dopaminergic cells in the brain. There is no treatment for slowing or reversing this process, but there are drugs used to treat the symptoms that result. These drug therapies can dramatically improve quality of life for Parkinson's patients. Here are some of the most common types:
● Dopaminergic agents – a class of drugs made from the neurotransmitter dopamine; these are the most effective therapies for Parkinson's patients, improving all of the motor symptoms. Some dopaminergic medications may cause sleepiness.
● COMT inhibitors – block an enzyme that breaks down dopamine; decreases "off time" in Parkinson's patients, which is a period of impaired movement.
● MAO-B inhibitors – prolong the action of dopamine in the brain to improve symptoms; may cause insomnia.
● Anti-cholinergics – restore the balance between acetylcholine and dopamine, thus improving tremor and rigidity.
● Amantadine – an antiviral drug that improves tremor, rigidity, and movement control.
Following diagnosis and the start of treatment, Parkinson's patients may experience a reduction of symptoms. This is called a "honeymoon." After a few years, the honeymoon ends and symptoms intensify, especially the motor symptoms.
People with Parkinson’s disease often have excessive daytime sleepiness. They also fall into REM sleep more quickly than the average person, according to their brain activity. These are both symptoms of narcolepsy and although there is no evidence that narcolepsy is a risk factor for Parkinson’s disease or vice versa, sleep-related symptoms in patients with Parkinson’s may be successfully treated with drugs that are used for narcolepsy, including stimulants for daytime sleepiness and sleeping medication for nighttime sleep. Bothersome dream-enacting behaviors often respond favorably to clonazepam, a sedative medication.
As Parkinson’s disease progresses and symptoms get worse, sleep problems may become more serious. For example, pain and uncontrollable movements may cause severe insomnia. Nighttime symptoms may be improved by taking Parkinson’s medication later in the day or by taking hypnotic sleep aides.
Insomnia may also be caused by certain medications used to treat Parkinson’s symptoms. In that case, taking medication earlier in the day may improve sleep. Keep in mind that any change in medication – including the addition of sleep aides or the timing of administration - should be prescribed by a physician. Sleep aides you can buy without a prescription usually contain diphenhydramine, an anti-histamine, which blocks absorption of dopamine.
Daytime sleepiness may also increase as Parkinson’s disease progresses. Using stimulant or alerting medications during the day may prevent sleep attacks and help patients avoid excessive napping, which may contribute to insomnia. In addition to drug therapies, behavioral techniques should be used for sleep and sleepiness problems in Parkinson’s patients.
Coping with Parkinson’s disease isn’t easy and will depend on the type and severity of the symptoms. However, there are certain things you can do to minimize symptoms, including taking medication as prescribed and getting healthy sleep. Here are some sleep tips for Parkinson’s patients:
● Keep a regular sleep schedule, going to bed and getting up at the same time each day.
● Take sedating medication late enough in the day so that you don’t get an increase in symptoms as you are trying to sleep.
● Use satin sheets and pajamas to help with getting in and out of bed.
● Minimize beverages before bedtime to help avoid nocturia (frequent nighttime urination).
● Get exercise and exposure to light early in the day.
If the Parkinson’s disease is not advanced then behavioral therapies may be useful to try. Behavioral techniques may include changing attitudes about sleep, learning new sleep habits, and sticking to a regular sleep schedule.
Parkinson’s patients are encouraged to spend time outdoors and to exercise each day, preferably in the morning or shortly after waking. Light therapy may also help normalize the sleep/wake cycles of Parkinson’s patients, especially those who may be unable to spend time outdoors.
In general, the quality of life for patients with Parkinson’s disease may be optimized with support and recognizing the opportunities to make lifestyle adjustments. That is why support groups for patients, family members and caregivers can be important. They introduce the participants to caring and supportive individuals and you can learn what decisions others have made and what works best. This can help avoid getting "stuck" at one stage and can help to take advantage of a useful idea. Support groups may be in your local community or you may be able to participate in information exchanges online. Visit the National Parkinson Foundation support group information page to find support resources in your area.
--- (Reviewed by David Rye, MD, PhD, and Mark Mahowald, MD.)