The low dopamine levels caused by Parkinson’s disease interfere with regular sleep patterns. People with PD often have trouble falling asleep, waking frequently during the night, and staying up for hours in the middle of the night. This condition is known as sleep fragmentation. Just as people with Parkinson’s have good days and bad, we also have good nights and bad.
“Rest is a problem,” said James, 51. “I suffer from insomnia. I get about two to three hours of sleep a night; sometimes I’m up for two or three days at a time. I’ve gotten used to it. If I get more than four hours of sleep, I feel stiff, almost frozen. It takes two doses of medication before I’m up and able to move enough to do anything. About a month ago, I slept 12 hours, and it took almost 24 hours to get over that.”
Sometimes we can blame the Parkinson’s symptoms. It’s hard to sleep through a muscle spasm or cramp. Some people with Parkinson’s find that their bodies quiet down at night, saving the tremors for morning; others are awakened by the twitching and quivering of the bedsheets after the medication has worn off. Sometimes muscle aches and pains make it impossible to get comfortable, no matter how soft and supportive the mattress may be. Muscle rigidity can affect the bladder, leading to frequent trips to the bathroom throughout the night. Trust me, there’s no rest for the weary.
Many people with PD suffer from a condition known as restless-leg syndrome. The name tells it all—when you’re lying in bed at night, your legs feel restless and fidgety; you desperately want to get up and walk around. Some people also report feeling a creeping or crawling sensation in their legs.
The restlessness goes away when you move, but it typically returns when you lie down again. I am sometimes able to outsmart my legs by taking a warm bath and then shuffling off to bed as soon as I get out of the water. (If I take a side trip to the bathroom or to the kitchen, my legs seem to wake up and feel restless again.)
People with Parkinson’s sometimes suffer from REM Sleep Behavior Disorder (RSBD). These lively bedfellows physically act out their dreams, often kicking, screaming, sitting up, or walking around while asleep. As you might imagine, this condition can result in injury to the people with PD or anyone else around. Sometimes people with Parkinson’s roam the neighborhood in their sleep, which can present its own set of hazards, especially for older people.
RSBD afflicts people with and without PD, but some researchers believe the two conditions could be linked. A study published in March 2006 in the journal Neurology found that RSBD could serve as an early marker of PD; studies estimate that approximately half of patients with RSBD will eventually develop PD. (The researchers observed this link, but did not explain how RSBD and PD may be related.)
Of course, medications can affect sleep, too. In an ironic twist, most drugs for PD bear warning labels indicating that they may cause drowsiness, yet they also tend to cause insomnia—you’ll be sleepy and tired, but unable to fall asleep, which more or less sums up the nighttime hours for many of us. Sinemet and many antidepressant medications can cause nightmares or vivid dreams that may interfere with a restful night’s sleep.
In addition, as we get older, we awaken more often than we used to, and we spend more time fully awake in the middle of the night whether or not we have Parkinson’s disease. Sleep studies have found that by age 65, most people wake up at least a dozen times a night and spend only about half an hour in the most restful periods of deep sleep. A 20-year-old, on the other hand, snoozes virtually without waking and accumulates about two hours of high-quality deep sleep.
Interestingly, people with Parkinson’s who have had deep brain stimulation surgery tend to sleep better than those who have not had surgery. A study reported in the April 2006 issue of the Journal of Neurology found that DBS increased total sleep time and reduced sleep problems for up to 24 months after treatment. Despite reduction in the use of medication, DBS did not reduce excessive daytime sleepiness.
Michael L., 48, sleeps better since he had DBS. “After the surgery, I started sleeping better than I had my entire life,” he said. “I’ve dreamed dreams that were so real I didn’t want to wake up. Sleep is enjoyable now. The nights used to be so long, and now they go by so fast.”
Ultimately, it’s up to you to determine if you have a sleep problem. Our sleep demands change throughout our lives. If you’re getting less sleep than you used to a few years ago, but you feel rested during the day, you don’t have a problem. On the other hand, if you’re tired during the day, you aren’t getting enough rest, regardless of how many hours you spend in bed.