A restless night can throw off far more than energy levels for people living with Parkinson’s disease. Sleep problems are common with the condition, and research suggests they may be linked to dyskinesia, the involuntary movements that can appear as a side effect of levodopa treatment.

This article looks at how Parkinson’s disrupts sleep, what researchers currently know — and don’t know — about the connection between poor sleep and dyskinesia, and what steps can help with both.

How Does Parkinson’s Disrupt Sleep?

Parkinson’s disease can significantly affect the amount and quality of sleep a person gets. The condition can disrupt sleep in many ways, causing insomnia, behavioral changes during the night, abnormal movement during sleep, pain, and nocturia (getting up to urinate at night). Parkinson’s can also affect brain systems that regulate the sleep-wake cycle.

Movement During Sleep

Parkinson’s disease can negatively affect sleep by causing excessive movement. Levodopa medications help control movement symptoms caused by Parkinson’s. However, as the medication wears off between doses, these symptoms can return. If this occurs during sleep, Parkinson’s movement symptoms 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 and sleep apnea, a condition where breathing repeatedly stops and starts during sleep.

In addition to movement in bed, Parkinson’s is associated with nightmares, sleepwalking, and hallucinations at night. These sleep problems may contribute to excessive daytime sleepiness.

Brain Activity During Sleep

Sleep is controlled by the brain. During normal sleep, the brain cycles through different stages. Research has found that people with Parkinson’s have different sleep patterns than people without the condition.

Overnight sleep studies have found that people with Parkinson’s tend to have shorter total sleep time, less time in deep sleep, and more nighttime awakenings than people without the condition. They may also spend less time in REM sleep, the stage most associated with dreaming.

Researchers believe these changes may be tied to the gradual loss of nerve cells that drives Parkinson’s disease. As the condition affects brain regions and chemical messengers that help regulate the sleep-wake cycle, it may disrupt the networks responsible for starting and maintaining sleep — though more research is needed to fully understand this relationship.

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What Is Dyskinesia?

Dyskinesia is a type of abnormal involuntary movement — different from the rhythmic shaking of a Parkinson’s tremor, which is a symptom of the disease itself rather than a medication side effect.

Dyskinesia may appear as slow and fluid movements, such as writhing, or as sudden jerking movements and muscle spasms. Symptoms can range from mild, causing minimal inconvenience, to severe, dramatically affecting quality of life.

Dyskinesia is usually a side effect of levodopa treatment for Parkinson’s disease. Levodopa, which is often combined with carbidopa, is converted into dopamine in the brain to help control movement. While levodopa is highly effective at controlling Parkinson’s symptoms, immediate-release formulations can be short-acting.

With immediate-release levodopa, levels in the body can rise and fall between doses. Dyskinesia usually occurs when levodopa levels are highest (peak-dose dyskinesia). In some people, dyskinesia occurs as levodopa begins to work and again as it wears off. This is called diphasic dyskinesia.

Improving Levodopa-Induced Dyskinesia

Certain medications can improve dyskinesia in many people with Parkinson’s. Your neurologist or other healthcare 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 Parkinson’s symptoms while limiting side effects.

Changing the timing of levodopa doses can help some people.

Amantadine, including its extended-release form sold as Gocovri, can help reduce dyskinesia. Gocovri is approved by the U.S. Food and Drug Administration (FDA) specifically for treating levodopa-induced dyskinesia in people with Parkinson’s.

Other Parkinson’s drugs, including monoamine oxidase B (MAO-B) inhibitors and catechol-O-methyltransferase (COMT) inhibitors, can worsen dyskinesia. Your doctor may consider adjusting these medications if they are contributing to your symptoms.

If drug adjustments or 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?

Although 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 restful sleep — can improve sleep quality.

While there hasn’t been enough evidence yet to say that improving sleep directly reduces dyskinesia, good sleep remains important for overall health and quality of life with Parkinson’s.

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 long or late-day naps
• Using nicotine and alcohol
• Consuming caffeine in the evening
• Eating heavy meals close to bedtime
• Using electronics with screens, such as smartphones and tablets, at bedtime
• Reading or watching television in bed

If daytime sleepiness makes napping necessary, try to keep naps short and earlier in the day.

Small Steps Toward Better Rest

Poor sleep and dyskinesia can occur together with Parkinson’s disease, even though researchers are still working out exactly how the two connect. What’s clear is that both are worth paying attention to — for your rest and for your day-to-day symptoms.

You don’t have to change everything at once. Try jotting down how you sleep each night and how your dyskinesia symptoms felt — that pattern can be useful information to bring to your care team.

If sleep problems or dyskinesia are affecting your daily life, talk with your neurologist or healthcare provider. They can help you find an approach — whether that means adjusting medication, addressing a specific sleep disorder, or both.