• Parkinson’s disease disrupts normal sleep patterns in the brain.
• Lack of proper sleep can worsen dyskinesia, a side effect of Parkinson’s medications.
• Better sleep quality can improve quality of life in people with Parkinson’s.

Parkinson’s disease is a movement disorder that can cause stiffness and tremor, and it can also impact sleep. In recent years, research has shown that poor sleep in people with Parkinson’s is linked to increased dyskinesia, a side effect of levodopa medications.

What Is Dyskinesia?

Dyskinesia causes abnormal involuntary movements. Dyskinesia can cause slow and fluid movements, such as writhing, or it can cause sudden jerking movements and muscle spasms. Symptoms can range from mild, causing minimal inconvenience, to severe, dramatically impacting quality of life.

Dyskinesia is a side effect of levodopa/carbidopa medications for Parkinson’s disease. While levodopa is extremely effective at controlling Parkinson’s symptoms, it can be very short-acting. Because of this, levels of levodopa in the body can rise and fall dramatically with each dose. Dyskinesia usually occurs when levels of levodopa are highest (peak dose dyskinesia). In some people, dyskinesia occurs as levodopa begins to work and again as it wears off (called diphasic dyskinesia).

The Importance of Sleep

Proper sleep is essential to everyone’s good health, regardless of whether you have Parkinson’s disease. Getting enough quality sleep is important for the body. In fact, poor sleep has been linked to the development of chronic diseases, including heart disease, high blood pressure, diabetes, obesity, and depression.

Although the whole body benefits from proper rest, the brain may benefit the most. During sleep, the brain can be very active. Sleep is an essential part of maintaining proper brain function, including forming long-term memories. Lack of sufficient, good quality sleep can impair memory and thinking when awake.

Parkinson’s disease can disrupt normal sleep, leading to additional problems, such as worsening levodopa-induced dyskinesia.

Parkinson’s and Sleep

Parkinson’s disease can significantly impact the amount and the quality of sleep a person gets. The condition can disrupt sleep in many ways, causing insomnia, abnormal movement during sleep, pain, and nocturia (getting up to urinate at night). Additionally, Parkinson’s can cause abnormal brain activity during sleep.

Movement During Sleep

Parkinson’s disease can negatively impact sleep by causing excessive movement. Levodopa medications help control abnormal movements caused by Parkinson’s. However, as the medication wears off between doses, these symptoms can return. If this occurs during sleep, abnormal movements can prevent you from getting proper rest.

Parkinson’s is also associated with rapid eye movement (REM) sleep behavior disorder. This disorder can cause a person to act out their dreams during the REM phase of sleep, potentially causing injury to themselves and anyone else in bed with them. Other sleep disorders also occur with Parkinson’s, such as restless legs syndrome. In addition to movement in bed, Parkinson’s is associated with nightmares, sleepwalking, and hallucinations at night. All of this can lead to excessive daytime sleepiness and impaired brain function during waking hours.

Brain Activity During Sleep

Sleep is controlled by the brain. During normal sleep, the brain goes through different stages of electrical activity. Research has shown that people with Parkinson’s do not have normal patterns of brain waves (electrical activity) during sleep. Some of these disruptions in brain activity are related to levodopa dyskinesia.

Research has found that Parkinson’s alters slow wave activity in the brain during sleep. Normally, slow wave activity decreases as the brain gets enough rest, but research has shown that this does not occur in people who experience dyskinesia from levodopa.

Sleep and Dyskinesia

Researchers have established a link between poor sleep and increased dyskinesia, but it’s poorly understood. Not all people with Parkinson’s experience the same changes in brain wave activity during sleep, and only certain patterns of brain activity appear to be strongly linked with worse dyskinesia.

Conflicting study results further complicate our understanding of how sleep and levodopa-induced dyskinesia are related. Fortunately, however, researchers have found ways to improve sleep with Parkinson’s and ways to improve dyskinesia related to levodopa.

Regardless of whether or not poor sleep is contributing to their dyskinesia symptoms, people with Parkinson’s should take steps to improve sleep in order to enhance their quality of life.

Improving Levodopa-Induced Dyskinesia

Certain medications can improve dyskinesia in many people with Parkinson’s. Your neurologist or other health care provider can help you understand the treatment options for dyskinesia.

Medication Changes for Dyskinesia

Dyskinesia can be improved in some cases by carefully adjusting one’s levodopa dosage. Decreasing levodopa dosage can improve dyskinesia, but doctors must take care to find a dosage that adequately controls symptoms while limiting side effects.

Changing the timing of levodopa administration or using an extended-release formulation may also improve dyskinesia. Amantadine (sold as Gocovri) can be added to levodopa to help control dyskinesia.

Additionally, it may be necessary to discontinue certain Parkinson’s drugs that can worsen dyskinesia, including monoamine oxidase B (MAO-B) inhibitors and catechol-O-methyltransferase (COMT) inhibitors.

If drug treatments are not helpful, your doctor may consider recommending more invasive options, like deep brain stimulation. These approaches can improve dyskinesia and other symptoms of Parkinson’s as well.

How Can You Improve Your Sleep?

While Parkinson’s can have a dramatic impact on sleep, several things can improve your ability to fall asleep and stay asleep. Good sleep hygiene — habits that help promote a good night’s sleep — can improve sleep quality. Improved sleep quality may reduce levodopa-induced dyskinesia and improve your quality of life.

Tips for Improving Sleep

The following activities and techniques can help improve your sleep:

• Maintain a consistent sleep schedule and routine.
• Dim lights in the evening.
• Wind down before going to bed.
• Use relaxation techniques.
• Get some sunlight during the day.
• Exercise.

Avoiding the following can help improve sleep:

• Taking daytime naps
• Using nicotine and alcohol
• Consuming caffeine in the evening
• Eating before bed
• Using electronics with screens, such as smartphones and tablets, at bedtime
• Reading or watching television in bed

Talk With Others Who Understand

MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. On MyParkinsonsTeam, more than 86,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s.

Are you or is someone you care for living with dyskinesia and sleep disturbances due to Parkinson’s? Share your experience in the comments below, or start a conversation by posting on your Activities page.