Parkinson’s disease may cause daytime sleepiness, particularly in the advanced stages of the disease. Brain changes, medications, and symptoms of the disease may all lead to people sleeping more during the day.
Parkinson’s disease (PD) may cause people to feel sleepier or have periods of sleep during the daytime.
It is common for people with PD to have sleep disorders, and those with advanced stage PD in particular may experience excessive daytime sleepiness.
PD symptoms, such as restless leg syndrome (RLS), side effects of medications, or medications wearing off at night, may all cause sleep disturbances.
Issues with sleep quality may then cause people to feel excessively sleepy when they are awake.
These factors, and the brain changes that occur due to the disease itself, may play a part in daytime sleepiness with PD.
This article will examine the relationship between PD and sleep.
According to the American Parkinson Disease Association (APDA), it is common for people with PD to have sleep disorders, which can occur throughout the different stages of the disease. Sleep disorders may affect how well a person sleeps at night, leading them to feel more tired or sleepy during the daytime.
People with PD might not get enough rest during their sleep. As a result, they might get sleepy or nap during the day. This makes it seem like they are sleeping a lot, despite not getting enough rest.
Disturbed sleep at night and sleeping during the day may also be due to the effects of PD. The condition leads to degeneration in parts of the brain that controls the body’s circadian rhythm and how awake people may feel.
It is very common for people in the advanced stages of PD to have excessive daytime sleepiness (EDS), which can cause them to sleep for periods during the day. Research suggests that EDS increases as PD progresses.
The Michael J. Fox Foundation notes that PD may make people feel sleepy during the day due to the physical changes from:
- the disease itself
- a side effect of PD medication
- a result of certain PD symptoms
Medications
Certain medications for PD may affect sleep. If a person takes certain PD medications too close to bedtime, they may experience insomnia, resulting in feelings of sleepiness during the day. Examples of these medications include:
- amantadine immediate release
- amantadine extended release
- selegiline
Medications may also wear off by the nighttime, so people may experience a return of PD symptoms, such as tremors, which may make it more difficult for them to get to sleep.
PD symptoms
Many PD symptoms may have a negative effect on sleep quality and may increase daytime sleepiness:
- Urinary changes: PD can affect the nerves that help with urinary control, which means people may need to get up to use the toilet more during nighttime. This can disturb sleep.
- Depression: Depression can be a symptom of PD, which can make it difficult to get to sleep. It can also cause people to have
less sleep . - RLS: RLS causes an uncomfortable sensation in the legs that only eases upon moving the legs. It usually occurs in the evening, making it more difficult for people to get to sleep. It can also cause individuals to wake up after they have fallen asleep. RLS can occur due to PD, PD medications, or other conditions, such as an iron deficiency.
- Insomnia: Insomnia is the
most common sleep disorder that affects people with PD, with maintenance insomnia being the most commonly reported issue. Maintenance insomnia is a condition where people do not have trouble falling asleep but wake soon afterward and find it difficult to get back to sleep. - Sleep disorders: People with PD
may experience unintended sleep episodes, or sleep attacks. This is a sleep disorder where a person falls asleep suddenly without warning. - Rapid eye movement sleep behavior disorder (RBD): This is a condition where people have random body movements during their sleep. Research suggests RBD may have associations with increased sleepiness in people with PD.
In people with Parkinson’s and sleep difficulties, the ADPA notes that the goal is to improve sleep without using medications.
This includes creating a routine in the evening to help support better sleep. Generally, doctors only consider medications if nonpharmacological have not worked.
To maintain sleep hygiene, a person should stick to the below routine:
- Aim to go to sleep and wake up at the same time each day, during the week, and at weekends.
- Turn off electronic screens or televisions an hour before bed and start to unwind, such as making a warm noncaffeinated drink or taking a warm bath.
- Try to limit napping in the daytime, and have a nap for 20–30 minutes in the early afternoon if a person is feeling sleepy.
- Avoid caffeine, alcohol, and exercising later in the afternoon or evening, as these can disrupt sleep.
- Take part in regular exercise earlier in the day to help promote good sleep at night.
- Only use the bed for sleep and intimacy, as this will teach the body to associate the bed with sleep rather than staying awake.
To treat the urinary changes, a person should aim to drink less fluid in the afternoons and evenings, providing they drink enough during the day. People may also find it helpful to have a commode or bedside urinal by the bed.
However, if a person is getting up to urinate frequently, a doctor may check to make sure there is no underlying medical cause.
If PD symptoms relating to movement, such as tremors, affect a person’s sleep, silk pajamas or satin sheets can improve a person’s movement in bed.
If people with PD have difficulties with sleep, a doctor may be able to help. For example, they may adjust PD medications to reduce side effects or suggest an alternative.
Treatment options can include:
- medications, cognitive behavioral therapy, or counseling to treat depression
- adjusting PD medications if a person is experiencing EDS
- medications, such as gabapentin, to help relieve RLS
- clonazepam or melatonin to help treat RBD
If a person with PD is experiencing sleep attacks and appropriate sleeping habits are not enough, a doctor may also prescribe modafinil (Provigil) to keep them awake during the day.
A doctor may also prescribe longer-acting PD medications to help relieve symptoms at night and make it easier to sleep.
Increased symptom severity may indicate advanced stage PD, and signs may include:
- hallucinations
- increased difficulty swallowing
- increased difficulty balancing
- becoming more immobile
- increased frailty
- increased risk of falls
- increased confusion
- unable to leave the bed without assistance
- a weak cough, which may increase the risk of choking
- a greater level of cognitive dysfunction
- additional health conditions are present
What are the next steps to take if a carer thinks a person has reached advanced stage PD?
In the advanced stages of PD, a person’s care may become more complex. Carers can work with the person they are caring for as well as social and healthcare professionals and family members to come up with a care plan.
The APDA suggests that if caring duties become too difficult to carry out with one person, they can consider hiring a home health aide to help carry out caring duties.
Feeling excessively sleepy during the day and sleeping more can be a symptom of PD and may increase as the disease progresses.
Medications, symptoms of PD, and the disease itself may all contribute to excessive daytime sleepiness.
If people have concerns about fatigue, lack of energy, and excessive sleeping during the day, they can contact a doctor for treatment options. Changes in medication or practicing good sleep hygiene may help to better regulate sleep.
For people with advanced stage PD, health aides, nursing homes, or hospices may be able to provide extra care and improve quality of life.