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Insomnia and Parkinson’s Disease

Updated on May 27, 2022
Medically reviewed by
Evelyn O. Berman, M.D.
Article written by
Dawn Ferchak

Parkinson’s disease (PD) comes with its fair share of challenges. Among the most frustrating symptoms of Parkinson’s is insomnia, or difficulty sleeping. Research has found that the majority of people with PD experience trouble sleeping, and more than 3,000 members of MyParkinsonsTeam report difficulty sleeping as a symptom. Lack of regular sleep can have tremendous impacts on a person’s quality of life. In fact, dealing with a sleep deficit can cause anyone to experience problems with memory and thinking.

Good, restful sleep is vital for people with Parkinson’s, but it isn’t always easy to get quality sleep. Luckily, there are some ways you can work toward combating insomnia with Parkinson’s.

The Impacts of Insomnia on Those With Parkinson’s Disease

Sleep disorders are one of the most common non-motor symptoms of people living with Parkinson’s disease. In fact, research shows that sleep disorders affect approximately 64 percent of people with PD. Of that percentage, up to 80 percent deal with insomnia — a far higher percentage than the general population who live with sleep difficulties.

While insomnia refers to the inability to fall asleep or stay asleep, sleep issues can lead to a host of issues, including the following medical conditions:

  • Fatigue and excessive daytime sleepiness
  • Increased stress
  • Difficulty performing tasks or job requirements
  • Irritability
  • Mental health issues
  • Lack of focus
  • Memory issues

Everyday Life and Quality of Life

Insomnia can have serious effects on a person’s quality of life. One MyParkinsonsTeam member shared their experience with insomnia. “I usually sleep for four hours, wake up, toss in bed for an hour, and sleep for two, usually maxing out at six total,” they wrote. “I’m a mess the next day after 1 p.m. or so. I don’t know what PD fatigue is like compared to sleepless fatigue because I can’t tell which I am affected by. Likewise, I don’t know what my new normal is because I seem to always be tired.”

Another member reported having a similar experience. “If I do get sleep, it’s only for a few hours, and then I’m up for the rest of the day,” they posted. They continued, and wrote their insomnia even affected their ability to hold their job. “I had to stop work a few years ago, and that is tough,” they shared.

Insomnia can also affect more than just the person with PD. Caregivers, family members, and bed partners can all suffer from the effects of insomnia and related sleep dysfunction. Treating this problem is important not just for you but also for your loved ones.

Excessive Daytime Sleepiness

Getting through the day without enough sleep is challenging enough. For those dealing with chronic insomnia, this tiredness can evolve into excessive daytime sleepiness (EDS). Having EDS may put a person with Parkinson’s in danger, as it can increase the risk of accidents during tasks like driving.

Cognitive Decline

The relationship between cognitive (thinking) problems and insomnia in PD appears to be bidirectional. Those with Parkinson’s who experience sleep disturbances are at higher risk of cognitive decline. This cognitive decline can, in turn, worsen sleep problems.

What Causes Insomnia in Parkinson’s Disease?

There are several reasons why people with PD may experience insomnia.

Motor Symptoms

Although people with Parkinson’s do not experience tremors in their sleep, motor symptoms can cause difficulty with finding the right position or getting comfortable enough to fall and stay asleep.

Mental Health Issues

Both insomnia and Parkinson’s disease have been correlated with anxiety and depression. People who experience PD psychosis, including hallucinations and/or delusions, are also at higher risk of experiencing sleep problems.

Parkinson’s Disease Medications

Certain medications used to treat Parkinson’s and its complications can cause insomnia, including:

  • Dopamine agonists — Such as ropinirole, rotigotine (Neupro), levodopa/carbidopa (sold as Rytary, Duopa, and Sinemet)
  • Selective Serotonin Reuptake Inhibitors (or SSRI, a class of antidepressants) — Such as fluvoxamine (Luvox), sertraline (Zoloft), and fluoxetine (Prozac)

Disease Progression

Parkinson’s is a progressive disease, meaning its symptoms generally worsen over time. Disease progression has been found to correlate with sleep dysfunction in people with PD. As pain and problems with motor symptoms increase, so do sleep problems.

Age

Research has found that people over 65 years of age are more likely to experience issues with insomnia.

Brain Lesions

The presence of PD lesions in both the upper brainstem and lower midbrain is a risk factor for the development of insomnia in Parkinson’s.

Other Sleep Disorders

Research has found that people with Parkinson’s are at higher risk of developing certain sleep disorders. These disorders can both interfere with sleep and worsen insomnia.

Rapid Eye Movement (REM) Sleep Behavior Disorder

According to the results of a study that compared people with PD and REM disorder, people with PD but no REM issues, and the general population, researchers found REM sleep behavior disorder affected more than 50 percent of the participants with Parkinson’s. (There were more than 200 participants in the study overall.) Such a statistic makes REM sleep disorders one of the most common sleep disorders for people living with PD. This disorder causes a person to physically act out what is happening in their dreams. It typically develops years before a person is diagnosed with PD and has been associated with severe cognitive decline in Parkinson’s.

Obstructive Sleep Apnea

Obstructive sleep apnea is a sleep disorder in which the muscles in the back of the throat relax, partially or completely blocking the airways. This repeatedly occurs throughout the night, disrupting a person’s sleep. People with Parkinson’s often live with other conditions that increase the risk of developing obstructive sleep apnea.

Restless Leg Syndrome

The results of studies looking at people with Parkinson’s and restless leg syndrome (RLS) — a condition that causes a strong, uncomfortable urge to move the legs, often when lying down to rest — vary greatly. Some note as few as 3 percent of those studied have RLS, while others report 80 percent. Regardless of the numbers, when someone with Parkinson’s has RLS, it often shows up in the early stages of PD. A lack of the chemical dopamine in the body is thought to be behind RLS.

Nocturia

Nocturia refers to frequent nighttime urination (peeing) that disrupts sleep. According to the Journal of Sleep Research, nocturia affects between 60 percent to 80 percent of people with Parkinson’s. Though it is not considered a sleep disorder, nocturia interferes with a person’s sleep duration and quality.

Treating Insomnia in Parkinson’s Disease

The way insomnia is treated with Parkinson’s depends on several factors. The first thing your doctor will do is rule out the possibility of other sleep disorders, such as obstructive sleep apnea or REM sleep behavior disorder.

If your doctor diagnoses you with a sleep disorder, they will want to treat that along with your PD. They may order a sleep study (also known as polysomnography), which can be done at home or at a sleep center, to diagnose any potential sleep disorders. A sleep study will help your health care provider understand your sleep patterns and the underlying causes of your sleep disruption. Treatments for sleep disorders can include continuous positive airway pressure (CPAP) machines (to help keep the airways open during sleep), light therapy, and certain sleep medications (over the counter and prescription).

If you don’t have a sleep disorder, your doctor will determine the best way to treat your PD-related insomnia. Interestingly, some of the medications that cause insomnia can also treat it. Your doctor will discuss these medications and their side effects with you in order to determine the best course of action.

Medications

In a small trial of people with Parkinson’s, a medication called eszopiclone (Lunesta) was shown to have good results in treating PD-related insomnia. Another medication, modafinil (Provigil), can help improve daytime wakefulness.

It is important to note that the long-term use of sleep aids can pose certain problems, such as eventual tolerance to the medications. As one MyParkinsonsTeam member noted, “I take some heavy-duty sleep meds, but I guess I’ve just grown accustomed to them, and they don’t work long-term for me anymore. I have such a high tolerance that over-the-counter meds do nothing. Believe me, I’ve tried them all.”

Sleep Hygiene

Non-pharmacological treatments are also an option. Good sleep habits (referred to as sleep hygiene) play an important role in getting more consistent, higher quality sleep. Some strategies for practicing good sleep hygiene include:

  • Maintaining a consistent sleep schedule (going to bed at the same time each and every night)
  • Avoiding electronic devices and bright light at least one hour before sleep
  • Avoiding large meals, caffeine, and alcohol before bed
  • Keeping your bedroom dark, cool, and peaceful

Tracking Your Sleep

Keeping a sleep diary can help improve your sleep hygiene and identify triggers that may be causing sleep disturbances.

Exercise

Research has found that physical activity promotes better sleep quality and can even help you fall asleep more quickly.

Melatonin

Melatonin is a naturally occurring hormone that indirectly promotes sleep. This hormone is also available in over-the-counter sleep aids. As one member shared, “Melatonin helps me to fall asleep, and I tend to sleep more deeply with it. But I still wake periodically to urinate, and sometimes I can’t get back to sleep.”

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is considered the first line of defense against insomnia by the American College of Physicians. With CBT, people overcome negative thought and behavior patterns that contribute to insomnia through a combination of cognitive therapy, sleep restriction, and stimulus control. It’s considered to be a safe and effective treatment for insomnia.

CBT can also help with other issues that accompany PD, such as depression and anxiety. Maintaining your mental health is vital, making CBT an excellent option for many reasons.

Deep Brain Stimulation

For some people, a surgery called deep brain stimulation (DBS) may be an option. It’s the most commonly performed surgery for people with Parkinson’s, but it is only for people who have lived with the disease for at least four years, have dyskinesia (uncontrolled involuntary movements), and have periods where medications don’t work (“off time”). A DBS procedure is done primarily to help improve motor symptoms such as stiffness and tremor. But recent research has shown it to be effective for PD-related insomnia as well. Your doctor will determine if DBS is an option for you.

Get Support

On MyParkinsonsTeam, the social network for people diagnosed with Parkinson’s disease, as well as their loved ones, more than 87,000 members ask questions, share stories, enjoy conversations, and get support from people around the world who know what it’s like to live with the disease.

Have you experienced insomnia with Parkinson’s? How have you managed sleep problems? Share your experience and tips in the comments below or by posting on MyParkinsonsTeam.

References
  1. The Relationship Between Sleep and Cognition in Parkinson’s Disease: A Meta-Analysis — Sleep Medicine Reviews
  2. Insomnia in Parkinson’s Disease: Frequency and Progression Over Time — Journal of Neurology, Neurosurgery & Psychiatry
  3. The Treatment of Sleep Disorders in Parkinson’s Disease: From Research to Clinical Practice — Frontiers in Neurology
  4. Insomnia: Symptoms and Causes — Mayo Clinic
  5. Parkinson’s Disease and Sleep — Sleep Foundation
  6. Treatment of Sleep Dysfunction in Parkinson’s Disease — Current Treatment Options in Neurology
  7. Parkinson’s Disease: Hope Through Research — National Institute on Neurological Disorders and Stroke
  8. Sleep Disturbances and Depression Severity in Patients With Parkinson’s Disease — Brain Behavior
  9. Depression & Anxiety — The Michael J. Fox Foundation for Parkinson’s Research
  10. Parkinson’s Disease: Symptoms and Causes — Mayo Clinic
  11. Insomnia in Parkinson’s Disease: Frequency and Progression Over Time — Journal of Neurology, Neurosurgery and Psychiatry
  12. REM Sleep Behavior Disorder and Cognitive Impairment in Parkinson’s Disease — Sleep
  13. Sleep-Wake Disturbances in the Premotor and Early Stage of Parkinson’s Disease — Current Opinion in Neurology
  14. Sleep Apnea: Symptoms and Causes — Mayo Clinic
  15. Obstructive Sleep Apnea Syndrome in Parkinson’s Disease and Other Parkinsonisms — Functional Neurology
  16. Association Between Restless Legs Syndrome and Other Movement Disorders — Neurology
  17. Prevalence and Clinical Profile of Restless Legs Syndrome in Parkinson’s Disease — Movement Disorders
  18. Nocturia — Urology Care Foundation
  19. An Overview of Sleep and Circadian Dysfunction in Parkinson's Disease — Journal of Sleep Research
  20. Treatment of Insomnia in Parkinson’s Disease: A Controlled Trial of Eszopiclone and Placebo — Movement Disorders
  21. Tips for Better Sleep — Centers for Disease Control and Prevention
  22. Sleep Diary — AASM: Sleep Education
  23. Exercising for Better Sleep — John Hopkins Medicine
  24. Melatonin for Sleep: Does It Work? — John Hopkins Medicine
  25. Practical Evaluation and Management of Insomnia in Parkinson’s Disease: A Review — Movement Disorders Clinical Practice
  26. Cognitive Behavioral Therapy for Insomnia in Parkinson’s Disease: A Case Series — NPJ Parkinson’s Disease
  27. Brief Cognitive Behavioral Therapy for Insomnia in Parkinson's Disease: A Case Series Study — Japanese Psychological Research
  28. Deep Brain Stimulation — The Michael J. Fox Foundation for Parkinson’s Research
  29. The Impact of Deep Brain Stimulation on Sleep in Parkinson’s Disease: An Update — Journal of Parkinson’s Disease

All updates must be accompanied by text or a picture.
Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Dawn Ferchak is a content creator with over 15 years of experience. Her areas of expertise include health and wellness, including clinical areas such as rare diseases, orthopedics, oncology, and mental health. She writes for both professional and consumer audiences. Learn more about her here.

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