![]() ![]() Sleep disorders in PD are also influenced by and interact with other common non-motor symptoms. Medications used to treat PD can improve these motor symptoms, but can also contribute to nocturnal sleep problems and EDS. Additionally, tremor can reemerge during microarousals and sleep stage transitions, contributing to sleep maintenance insomnia. For example, bradykinesia and rigidity can lead to impaired bed mobility and nocturnal dystonia can cause nocturnal pain and discomfort. The motor symptoms of PD can contribute to sleep fragmentation and insomnia. Sleep dysfunction in PD is multifactorial, influenced by various factors related to the disease and its treatment. Sleep dysfunction adversely affects quality of life (QOL), increases caregiver burden, and, in the case of EDS, can result in inability to safely complete tasks such as driving. ![]() Sleep complaints include sleep fragmentation, insomnia, parasomnias such as rapid eye movement (REM) sleep behavior disorder (RBD), excessive daytime sleepiness (EDS), circadian dysfunction, and restless legs syndrome and periodic limb movements of sleep. Sleep dysfunction is one of the most common of these non-motor symptoms, affecting up to 98% of PD patients. Circadian disruption has emerged as an important etiology of impaired sleep-wake cycles in PD, and circadian-based interventions hold promise for novel treatment approaches.Īlthough Parkinson’s disease (PD) is diagnosed by its motor symptoms of bradykinesia, rigidity, rest tremor, and postural instability, non-motor symptoms are also prevalent and are often more disabling than the motor symptoms. The treatment algorithm for RLS associated with PD mirrors that used for idiopathic RLS. Continuous positive airway pressure is an effective treatment for SDB in PD. Safety measures, clonazepam, and melatonin are the mainstay of treatment for RBD. While the optimal treatment for insomnia in PD has not been established, available strategies include cognitive-behavioral therapy, medications with soporific properties, and light therapy. Prompt diagnosis and treatment of co-existent primary sleep and psychiatric disorders are critical, as this may significantly improve sleep and alertness. Providing education about sleep hygiene and strategies for its implementation represents the initial step in management. There is thus a great need but also opportunity for development of well-designed clinical trials for impaired sleep and alertness in PD. Evidence supporting the efficacy of pharmacological and non-pharmacological treatment strategies in PD is limited. Therefore, we aim to review available evidence and outline treatment strategies for improvement of disorders of sleep and wakefulness in PD patients. Despite its high prevalence in the PD population, there is a paucity of clinical studies that have investigated treatment of sleep dysfunction associated with PD. Sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep disordered breathing (SDB), restless legs syndrome (RLS), and circadian disruption. The primary neurodegenerative process of PD involves brain regions that regulate the sleep-wake cycle, such as brainstem and hypothalamic nuclei. The etiology of impaired sleep-wake cycle in PD is multifactorial and encompasses medication side effects, nocturnal PD motor symptoms, and presence of co-existent sleep and neuropsychiatric disorders. Impaired sleep and alertness affect the majority of Parkinson’s disease (PD) patients, negatively impacting safety and quality of life. ![]()
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