Sleep Disturbances Worsen as Parkinson’s Disease Progresses

Bottom line first:  For many Parkies, sleep problems worsen over time.

Yes, we already knew this first hand.  But some recent research, which followed 218 newly-diagnosed Parkies for five years and compared them to 102 healthy controls, details just how bad it gets, and teases out the varieties of sleep problems you can suffer from.

The researchers tracked three kinds of sleep disturbances:

• excessive daytime sleepiness (EDS)
• insomnia
• probable rapid eye movement (REM) sleep behavior disorder (pRBD)

They also considered the medications the volunteer subjects were taking – both to fight PD and to ameliorate sleep problems.

I’ll excerpt the key points from the article:

At baseline, PD patients and HCs [healthy controls] were similar in age, body mass index, and use of sleep-related medications.

For PD patients, the prevalence of insomnia increased from 21% at baseline to 56% at 5 years. The prevalence of EDS increased from 17% to 32%; pRBC showed the least increase in prevalence, going from 22% to 30%. Whereas 2 years from baseline, the increases in EDS and pRBD mainly leveled off, insomnia steadily increased yearly from baseline to year 5.

“What is real striking is that…at the end of this 5-year period, about one third of patients do remain free of any sleep complaints, and surprisingly, there was only a very, very small percentage of patients who had all three sleep complaints,” [researcher] Xu said. There was little overlap even among two forms of sleep disturbance.

Finally, dopamine agonists may play a role in sleep disturbances:

…insomnia often increases when treatment starts because of the dopamine agonists…dopamine agonist drugs in low doses can be sedative but in high doses can be alerting.

The researchers also believe that each kind of sleep disturbance may have its own etiology – further confounding how to fix it.

In my own case, I’ve suffered from insomnia off and on.  There were periods in my post-diagnosis life when I would often wake up in the middle of the night, alert and hungry.  I’d go to the kitchen, eat a bowl of breakfast cereal, which would make me drowsy again, and with luck I’d be able to go back to sleep.  There were some awful nights, however, when I would lie awake in bed from 2:00 a.m. until my alarm went off and I had to get up for work.  Those awful nights turned into horrible days.

What works for me now is the following:

• Work out at the gym more often to get my body tired.
• Eat a full dinner that will last me through the night.  Usually I have a grilled chicken breast (which is heavy), a lot of raw vegetables that will take time to digest, like broccoli or bell peppers, and perhaps an apple.

My sense is that when I sleep, my anxiety and my general metabolism go into overdrive, burning up calories and causing me to wake up and replenish.

I have one other tip for myself and maybe some of my readers:

• If I read in bed before going to sleep, I choose fiction, not nonfiction.  Fiction puts my mind into a dreamy state that smoothly carries me into the Land of Nod.  However, when I read nonfiction my mind perks up to pay attention because it’s so compelling, and my eyes and mind refuse to shut down.