Parkinson’s disease and sleep: Why sleep matters more than you may think
[4 min read]
In this article:
- Parkinson’s disease is caused by the gradual loss of the neurons in the brain that play a key role in movement, coordination, and many non-motor functions.
- Sleep problems in people with Parkinson’s disease stem from changes in the brain’s sleep-regulating centers.
- Practicing good sleep hygiene and optimizing medications plays an essential role in managing sleep issues in patients with Parkinson's.
- Movement disorder experts at Providence Swedish can work with you to find the right treatment mix for addressing your Parkinson's and easing your symptoms. Learn more.
Somewhere, someone is tossing and turning while you read this blog at 2 a.m.
Millions of us struggle with getting enough sleep; the U.S. Centers for Disease Control and Prevention estimates that about one third of U.S. adults don’t get the recommended minimum of 7 hours per night.
Sleep is critical for overall health and brain function. Poor sleep has been linked to inflammation and cognitive decline. In people with neurological disorders like Parkinson’s disease, insufficient sleep can worsen motor symptoms, impair attention and memory, increase fall risk, and reduce the effectiveness of treatments.
“Sleep is the foundation of good health,” affirms Pravin Khemani, M.D., medical director of movement disorders program at the Providence Swedish Neuroscience Institute. “And sleep issues are a global concern. They are magnified and heightened with Parkinson’s.”
What is Parkinson’s disease?
Parkinson’s disease is caused by the gradual loss of the neurons in the brain that play a key role in movement, coordination, and many non-motor functions. People with Parkinson’s may experience tremor, muscle stiffness, slowed movement (bradykinesia), and balance problems, along with non-motor symptoms such as mood changes, constipation, cognitive changes and sleep disturbances. More than 1.5 million people in the U.S. are living with Parkinson’s.
While there is no cure, treatments include medications, but also important nonpharmacological measures like physical therapy and lifestyle interventions.
Sleep is essential to brain health
Sleep is especially critical for brain function. Poor sleep has been linked to inflammation, cognitive decline, and worsening neurological symptoms. In people with neurological and movement disorders like Parkinson’s insufficient sleep can worsen symptoms and reduce the effectiveness of treatments.
“I have patients who have been having sleep problems for decades and others whose sleep problems started with medications and have worsened significantly. That will inform the direction we take,” says Dr. Khemani. “I may ask if they have had a formal sleep study, because sleep problems are so ubiquitous and their symptoms overlap. In our clinic we are triaging (not sure what this means) because it’s a very complex issue and all patients want is relief.”
How Parkinson’s affects sleep
Sleep problems in Parkinson’s stem from changes in the brain’s sleep-regulating centers, nighttime motor symptoms such as stiffness or tremor, medication side effects, and non-motor symptoms like anxiety or urinary urgency.
Common sleep-related challenges in Parkinson’s include:
- Insomnia and difficulty staying asleep or excessive daytime sleepiness
- REM sleep behavior disorder (RBD), which can cause people to physically act out dreams
- Restless legs syndrome and nighttime leg movements
- Obstructive sleep apnea, in which the throat muscles collapse, blocking the airway and disrupting breathing during sleep
- Excessive Sleepiness during the day
“Sleep is such a fragile thing,” says Dr. Khemani. “Insomnia is the most difficult to treat. We have to drill down to determine if it’s related to Parkinson’s, because it can be caused by everything from chronic pain, stress or medications. With obstructive sleep apnea, we can send patients for a sleep study. It’s really challenging because sleep is part of our troubleshooting paradigm for Parkinson’s symptoms, but determining the exact cause is difficult because sleep problems are so common.”
RBD can be an early sign of Parkinson’s in some individuals and in its most extreme cases can come with violent acting out of dreams, damage to surroundings and patients injuring themselves or their bed partners. Melatonin is a first line of treatment for the condition.
“With RBD, Parkinson's basically removes that sleep inhibition paralyzing your muscles when dreaming. When the brakes are off in Parkinson's, you're moving around and thrashing around in your sleep,” says Dr. Khemani. “Restless leg syndrome is significantly more common in Parkinson’s patients. They describe an uncomfortable feeling in the legs or other parts of the body that gets amplified at night. It can be a creepy crawly sensation, pins and needles or simply an inner restlessness that makes you want to move. That's problematic because you're not supposed to walk and pace when you need to be sleeping.”
Managing Parkinson’s sleep challenges
Addressing sleep issues is a key part of Parkinson’s care. Strategies may include:
- optimizing medications
- practicing good sleep hygiene and managing nighttime symptoms
- evaluating for specific sleep disorders
Researchers are looking at a host of new medications for Parkinson’s. Unlike Alzheimer’s, we don’t have a disease modifying therapy, clinicians are currently treating symptoms.
“That’s sort of the holy grail of Parkinson’s research,” says Dr. Khemani. “We are working towards a drug that doesn’t just treat symptoms but is a completely disease-modifying medication for both motor and nonmotor symptoms.”
Learn more and find a physician or Advanced Practice Clinician (APC)
To learn more or make an appointment with one of our specialists at Swedish's Movement Disorders Clinic call 206-320-5331. Our experts at the Swedish Neuroscience Institute offer comprehensive, progressive diagnosis and treatment for a wide range of spine, brain and central nervous system conditions. Telehealth options are available.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Contact Swedish Primary Care to schedule an appointment with a primary care provider. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And, with Swedish ExpressCare Virtual, you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections and more. You can use our provider directory to find a specialist or primary care physician near you.
Information for patients and visitors
Additional resources
New Parkinson’s disease test can help refine treatments and support more efficient research
Living well with Parkinson’s disease
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