Sleep problems
People with Parkinson's may experience a range of sleep conditions.
Some conditions impact sleep directly. These may be caused by your Parkinson’s, Parkinson’s medication, or another reason.
Excessive daytime sleepiness (hypersomnia)
If you feel very tired during the day, a doctor might diagnose you with hypersomnia.
Hypersomnia can happen if you’re not getting enough sleep at night. In some cases, it can make you fall asleep suddenly. This can be dangerous, especially if you are driving. Medication may help, so if you’re feeling very tired or fall asleep suddenly, speak to your GP, specialist or Parkinson’s nurse.
Hypersomnia might be more likely in people whose Parkinson’s has progressed or those with Parkinson’s dementia. It can also occur when increasing some medications, such as certain dopamine agonists.
Driving and excessive daytime sleepiness
If you’re diagnosed with excessive daytime sleepiness you must inform the Driver and Vehicle Licensing Agency (DVLA), or the Driver and Vehicle Agency (DVA) if you’re in Northern Ireland, straight away.
You may not be allowed to drive. If you’re concerned that your symptoms or side effects of your medication might make driving less safe, speak to your doctor immediately.
Parasomnias
Parasomnias are unusual movements, behaviours or experiences that happen when you’re asleep.
Some people may have hallucinations, get agitated, or talk loudly during sleep. Night-time hallucinations can be a Parkinson’s symptom or a side effect of Parkinson’s medication.
If you or your partner notice any unusual behaviour during sleep, you should discuss this with your GP, specialist or Parkinson’s nurse.
Read more about hallucinations and delusions in Parkinson’s.
Rapid eye movement (REM) sleep behaviour disorder
Usually, when you’re asleep, your body will be in a state of "atonia", which stops you from moving. But changes in the brain due to Parkinson’s may disrupt this process, so you may act out your dreams while you’re asleep.
This is called rapid eye movement (REM) sleep behaviour disorder. REM sleep behaviour disorder is thought to affect around half of people with Parkinson’s. It can also be an early sign of Parkinson’s before movement (motor) symptoms develop.
While you’re dreaming, it may cause you to:
- kick
- speak or shout
- punch
- thrash around in bed or fall out of bed
- injure yourself or your partner.
You may not remember anything about it when you wake up.
Many people are not aware that they have REM sleep behaviour disorder. You may go to your GP, specialist or Parkinson’s nurse with symptoms including:
- having realistic, vivid dreams
- falling out of bed at night
- waking up with unexplained injuries or bruises from kicking, punching or bumping into things while acting out your dreams
- very disrupted sleep.
Often, REM sleep behaviour disorder is first noticed by a partner.
Speak to your GP, specialist or Parkinson’s nurse if you or your partner are worried about your movements or behaviours when you’re asleep. Your specialist may suggest sleep hygiene measures or medication, such as melatonin or clonazepam.
They may suggest some changes to help reduce the risk of hurting yourself at night. This could include:
- removing potentially dangerous items from your bedroom
- adding protective padding to the corners of bedside tables
- moving furniture with sharp edges away from your bed
- placing pillows to stop you falling out of bed, or striking the wall
- sleeping alone until your symptoms are under control.
Your Parkinson’s nurse can help you work out what changes to your sleeping environment might help, taking into account your personal circumstances and any other Parkinson’s symptoms you might have.
Waking up to urinate at night (nocturia)
Nocturia is waking up at night with the urge to urinate (wee). It’s more common as people get older and can be a common problem for people with Parkinson’s.
If this urge happens while you’re experiencing motor symptoms of Parkinson’s, or during an "off" period, it may be more difficult to get to the toilet in time.
Nocturia can be caused by your Parkinson’s symptoms. People with Parkinson’s may find that their bladder holds less urine, and that they have less control over the muscles and reflexes that empty it.
There are other possible causes of nocturia, such as bladder problems.
Some medications can cause nocturia, for example:
- medications for high blood pressure
- hormone replacement therapy (HRT).
If waking up to urinate is disrupting your sleep, speak to your GP, specialist or Parkinson’s nurse.
You may also be referred to a continence advisor. This is a specialist nurse who assesses and manages incontinence.
If you’re having problems sleeping because of needing to urinate, try to:
- reduce how much you drink in the evening and make sure you use the toilet before you go to bed. However, it’s important not to cut down too much on the amount you drink overall. This may leave you dehydrated, which can increase the risk of bladder problems, including kidney stones or urinary tract infections
- avoid alcohol and drinks with caffeine in, such as coffee and tea, in the evening. Try to limit these during the day too. You could try caffeine-free versions of your favourite drinks
- use bed protection, such as absorbent sheets and bed pads, just in case. Appliances such as handheld urinals or sheaths may also help you if you’re having problems getting to the toilet
- use nightlights in your bedroom to help with getting to the toilet in the dark
- have a clear path to the bathroom to reduce the risk of bumping into things or falling at night.
Read more about looking after your bladder and bowels when you have Parkinson’s.
Sleep apnoea
Sleep apnoea is a condition where a person stops breathing for a moment while asleep. It can affect anyone but is more common in older people. People with Parkinson’s are more likely to have sleep apnoea than the general population, so it’s important to know the symptoms.
It’s sometimes called obstructive sleep apnoea (OSA).
If you have sleep apnoea, you might wake up, take a few breaths, and go back to sleep again. You might not remember this happening. But these interruptions can disturb your sleep.
Symptoms include:
- snoring loudly
- choking or gasping noises while asleep
- often not sleeping through the night
- being very sleepy during the day
- sweating at night
- waking up with a headache.
Sleep apnoea needs to be treated to prevent other problems, including heart disease and high blood pressure.
Devices to help your breathing, such as a machine which gently sends air through a face mask, may be offered as part of your treatment.
Treatment for sleep apnoea may include support and advice to help you:
- stop smoking
- reduce how much alcohol you drink
- lose weight if you are overweight
- get enough exercise.
Less often, surgery might be an option.
If you or someone you live with notices any of the symptoms, speak to your GP, specialist or Parkinson’s nurse.
Clinical guidelines say that you should be seen by a sleep specialist if your healthcare team thinks you may have sleep apnoea. The sleep specialist may give you a monitoring device to wear at home, which can check things like your breathing and heart rate overnight. More rarely, they may ask you to spend the night at a sleep clinic and examine you there. Seeing a sleep specialist may not be possible in every area. Speak to your GP or Parkinson's nurse about services available near you.
Driving and obstructive sleep apnoea
You must tell the Driving and Vehicle Licensing Agency (DVLA) or the Driver and Vehicle Agency in Northern Ireland (DVA) if you have sleep apnoea.
If you’re not sure whether your symptoms will affect your driving, your doctor can advise you.
You are allowed to drive only when your symptoms are under control and you’re strictly following your treatment.
Fatigue
Fatigue is sometimes described as an overwhelming tiredness. Up to half of people with Parkinson’s experience fatigue at some point.
If you have fatigue, you may feel exhausted and lack energy. It’s more than a one-off feeling of tiredness that goes away after a good night’s sleep or nap.
Fatigue can be caused by your Parkinson’s, or by another sleep or night-time problem, like sleep apnoea.
Excessive daytime sleepiness
Excessive daytime sleepiness is a non-motor symptom of Parkinson’s, but researchers aren’t sure whether it’s part of how Parkinson’s progresses or if it’s caused by Parkinson’s medication. Evidence suggests that it’s more common if you are taking Parkinson’s drugs, especially dopamine agonists.
Parkinson’s nurse Lee Kieft explains more.
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