Insomnia Doesn’t Make a Good Bedfellow for People with Parkinson’s Disease

April is Parkinson’s Disease (PD) Awareness Month. It’s a great time to think about insomnia as a troubling aspect of this condition and how you might prevent it.

Insomnia—trouble falling asleep or staying asleep—is the most common sleep disorder among those with PD.¹ Most commonly, people with PD experience frequent awakenings and disrupted sleep. Sleep-onset insomnia is also a legitimate concern.

Insomnia in PD: causes

Why is insomnia such a problem for those with PD?

Muscle discomfort

Stiff, cramping muscles and tremors can make it difficult to fall asleep; so can the challenging act of turning in bed.¹

Unpleasant sensations

Cold or heat sensations while in bed may lead to periods of wakefulness for those with PD.¹

Vivid dreams and nightmares

These can certainly disrupt sleep for anybody. They can be more common in people with PD, especially if they’re dealing with sudden mood changes.¹

Anxiety and/or depression

Both are linked to PD, causing problems with falling asleep or maintaining sleep throughout the night.¹ Depression is considered the most common non-motor problems in people with PD. In general, depression is both a leading cause of insomnia and a core symptom of depression.² Anxiety and insomnia share similar links. Anxiety leads to insomnia, and lack of sleep heightens anxious behavior.³ Also, anxiety alone can occur in as many as half of all people with PD. This makes it a significant concern.⁴

Restless legs syndrome

Also common in the general population, RLS frequently accompanies and complicates PD and can make it very difficult to fall asleep.⁵

PD medications

Dopamine agonists (such as pramipexole, ropinirole, rotigotine, and apomorphine) and other PD drugs like entacapone, selegiline, amantadine, and rasagiline are thought to cause insomnia by some researchers.¹

Medication withdrawal

Some medications, when discontinued, must be carefully tapered under the observation of a doctor to prevent withdrawal responses that can lead to insomnia.¹

Lengthy daytime naps

People with PD can nap, but too many hours slept during the day can disrupt the “sleep drive.” The circadian process known as the “sleep drive” makes it possible for us to fall asleep at night. It relies on us experiencing consecutive hours of wakefulness in order to generate our nighttime rest periods.⁶

Nocturia

Frequent nighttime trips to the bathroom are common in people with PD, disrupting sleep.⁷

Insomnia in PD: solutions

Here are some different courses to discuss with your physician, should insomnia be a constant in PD for you or your loved one:

Treat your pain and discomfort

Even if it doesn’t go away completely, reducing its severity can help you sleep better.

Cognitive behavioral therapy for insomnia

Also known as CBTi, it’s considered the gold standard for treating insomnia generally. It can help those with PD if anxiety or depression, in particular, are at the root of sleeplessness.

Address other sleep disorders

RLS, obstructive sleep apnea (OSA), and rapid eye movement sleep disorder (RBD) are common sleep disorders experienced by people with PD. Nocturia (frequent nighttime urination) is also linked to OSA. Diagnosing and treating these will help improve both quality and quantity of sleep.

Medication scheduling

Ask your doctor for the best times for taking certain PD medications in order to prevent insomnia.

Withdrawal prevention

If discontinuing a drug, do so only under the observation of a PD specialist.

Medication delivery changes

Some medications can be switched from oral doses to continuous delivery patches which may help reduce the risk for insomnia.

Keep daytime naps short and sweet

Daytime sleepiness caused by nighttime insomnia leads to a relentless loop of circadian rhythm disruption. A short nap (under 30 minutes) may help, but multiple naps or long naps can create havoc with one’s circadian system, leading to even more insomnia at night.

If daytime sleepiness becomes unmanageable without extensive napping, consider asking your doctor for an alertness medication like modafinil to maintain wakefulness during the day.

Sleep hygiene

Good sleep hygiene habits include:

• Practicing consistent bedtimes and wake times
• Using relaxation techniques to encourage sleep
• Follow "no-screen" rules for an hour before going to bed can prepare the body and brain for sleep
• Avoiding caffeine after lunch
• Skipping the evening “nightcap” (alcoholic beverage)
• Exercising during the earlier part of the day, and
• Keeping a sleeping space that promotes sleep (it’s dark, cool, and quiet)

Use of sleep aids

This option exists if all other non-drug approaches to treating insomnia fail. However, consider this: prescription sleep aids pose risks for people dealing with dementia. Use of over-the-counter melatonin may also work, but please talk to your pharmacist and doctor about correct dosages and scheduling for best results.