Parkinson’s symptoms can affect your sleep in a variety of ways. Those affecting your body (such as motor symptoms) and those affecting your unconscious system (regulating your senses, your ability to understand or visualise, and basic functions such as your breathing, urination and heart rate). Sleep disturbances can also be caused by treatments for controlling Parkinson's disease, including drugs.
Some sleep disturbances can be alleviated through good sleep hygiene procedures but others might need the help of your doctor, neurologist or Parkinson's nurse. Don't be worried about going to them for advice if your Parkinson's symptoms are impacting on your sleep.
Having some understanding about which of your non-motor functions are stopping you sleep – and why – will be helpful in knowing what you need to talk to your doctor about. Not everyone will have the same problems. If in doubt, consider keeping a simple sleep diary for a week, so that you can develop more of an understanding into what exactly is stopping you sleeping.
You can also receive more professional sleep-related advice by completing either the Parkinson's disease sleep-scale questionaire, or the non-motor symptoms questionnaire and taking it to your doctor or health care professional who can develop a treatment plan for you.
What's keeping you awake at night?
Pain, stiffness or involuntary movement
If you're not on medication to help this already, there are medicines to ease stiffness, muscle cramping and rigidity at night, so it's worth talking to your doctor about how to alleviate your symptoms.
If you're already taking medication, it may be that it stops working at the wrong time of night and your doctor can identify a simple timing adjustment, or a different dose – or even a different medication to resolve it. Painful muscle contractions in the toes, fingers, ankles or wrists (dystonia), can disturb sleep late at night or early in the morning, and could be a sign of medication wearing off. You may also be kept awake by restless legs syndrome, particularly when you are resting during the evening and at night. If your iron levels are low, increasing iron intake can be effective for this.
Massaging your legs, doing relaxation exercises, taking a bath before bedtime or applying hot and cold compresses to your legs might improve these symptoms too. There are studies to suggest that oil derived from the cannabis plant (CBD oil) can be effective for pain and sleep – although research is in its early stages and there are no dosage guidelines, so care needs to be taken.
However, your doctor may be able to prescribe cannabidiol-based substances, which are used to treat seizures and have been shown to help relieve Parkinson's symptoms in some cases.
Parkinson's medication not working properly
Drugs that alleviate Parkinson's symptoms can sometimes end up interfering with sleep – because they either wear off at the wrong time, or they have side effects that keep you awake at night. Drugs such as Amantadine and selegiline can sometimes interfere with sleep, while high doses of levodopa or dopamine agonists (particularly when taken in the evening) can occasionally cause insomnia. Other medications such as diuretics (tablets to promote urine production and flow) and ephedrine (a stimulant used to treat postural hypotension) can also affect sleep. But don't stop taking your medication unless you have consulted your doctor first.
Discuss with your doctor what best suits you and your body, and whether any changes need to be made to your current situation. Getting the timing, dose and type of medication right are the first steps to addressing your sleep issues. There are different types of medication – from quick- or long-acting tablets to slow-release skin patches. If changing your medication doesn’t help, your doctor may refer you to a specialist sleep clinic for further assessment.
Your doctor may also be able to prescribe other medications to help pain or influence sleep. Cannabidiol-based substances such as Epidolex, which are used to treat seizures, have been shown to help relieve Parkinson's symptoms in some cases.
In some instances, your doctor may think sleeping tablets may help break the cycle of insomnia in the short term. But these can make you feel anxious, or drowsy in the morning, and can sometimes worsen your Parkinson’s symptoms, particularly balance, concentration or memory. You may also become emotionally or chemically dependent (depending on the tablets).
Nightmares, sleepwalking and other unusual sleep behaviours
Parasomnias are a group of sleep behaviours that make it difficult to stay asleep. They include the process of acting out your dreams, or thrashing around in bed (part of rapid eye movement behaviour disorder). Rapid eye movement behaviour disorder can lead to injuring yourself or your partner so it's important to tell your doctor if this is affecting either of you. It's also extremely important that your sleeping environment is safe. Try things such as taking the legs off your bed, so your mattress is lower to the ground and you don't injure yourself if you fall out. Or invest in some side rails and padding. If you have a bed partner it may be easier to sleep in separate beds. If that's not an option, talk to your partner and agree a plan of action that involves both of you. Keep your bedroom free of clutter and (if required) remove the furniture and any sharp objects.
Some medications exacerbate parasomnias, and some are able to reduce them. Ask your doctor to investigate whether changing your medication, or prescribing a new one, would help with this.
Anxiety and depression
Having anxiety or depression can affect your sleep. Sometimes changes in your brain chemistry – and some medications (for example levodopa) – can cause anxiety, which in turn can affect your sleep. You may also worry about your health or how people perceive you, which can affect your quality of sleep.
Tell your doctor if something is worrying you, or consider talking to close friends or family – or if your anxiety is Parkinson's-related, speak to another person with Parkinson's, or your neurologist. Your doctor may also offer an antidepressant medication as a short-term solution, depending on how it interacts with your other medications. Or they may be able to refer you to a counsellor, psychiatrist, psychologist or psychotherapist. Cognitive Behaviour Therapy (CBT) has been shown to offer effective psychological treatment for anxiety disorders, as it helps to address the particular thoughts or behaviours producing the anxiety. CBD oil has also been shown to relieve anxiety although it's important to speak to your doctor about whether this may interfere with any other medication, as research on this oil is still in its early stages.
Regular night-time trips to the toilet can interrupt your sleep cycle. Some medications – for example, medications for high blood pressure – can cause nocturia (frequent urination), as can eating salty foods or bladder infections.
Treatment and prescription medications exist to help this and, if nothing seems to be working, you could ask to see a continence specialist. Also try to make simple changes to your nighttime routine to make urinating less likely. Watch your salt intake and have your blood pressure checked as high blood pressure can increase night-time trips to the toilet. In some instances, specific medication for nocturia (frequent urination) can be used. If getting to the toilet is difficult, try using a bedside commode or portable urinal. Protect your bed with absorbent sheets or pads just in case of accidents. Refer to our sleep hygiene section, which discusses fluid intake.
There are various causes for insomnia and not all are related to Parkinson's. So you may benefit from keeping a basic sleep diary for a short period of time to try and identify what is keeping you awake at what times of night before considering how to treat it. Some Parkinson’s medications, such as high doses of levodopa or dopamine agonists, can keep you awake at night, particularly when taken in the evening. Insomnia can sometimes be caused because your medication wears off at the wrong time, so talk to your doctor who may recommend altering this to include dopaminergic drugs or controlled release levodopa.
Insomnia can also be exacerbated by anxiety or depression, so exploring how this can be treated may be helpful. Prescribed sleeping tablets may be a short term option but these need to be managed carefully. Speak to your doctor about whether these may help.
Excessive daytime sleepiness and sleep attacks may cause you to fall asleep or doze frequently during normal waking hours. This can be caused either by Parkinson's medication, or because you're not getting enough sleep at night. If it's medication-related you need to speak to your doctor about adjusting your prescription. In general, try to stay awake during the day as this affects the quality of night-time sleep. If you do need a daytime nap, try to limit it to 20 minutes by setting an alarm clock to wake you. If you find it hard to stay awake you might try doing a bit of exercise outdoors, or use this time to do more alert activities on your technology equipment, as this has shown to increase alertness. If you experience daytime sleepiness, you should be particularly careful when driving or operating machinery or any other activities that may be dangerous. Inform the doctor immediately if you ever have a sudden onset of sleep while driving.
Turning over in bed
Lack of movement in bed can cause stiffness, muscle and joint pain, which also makes it difficult to turn in bed. Speak with your doctor, or Parkinson’s specialist nurse if you have one, so they can help you manage this pain through adjustments of your medication. Satin sheets or nightclothes can also be useful, although using both at the same time makes you more likely to slide off or out of bed unintentionally. If you use satin sheets it's wise to have areas around the bed where you can get some grip. An occupational therapist or Parkinson’s specialist nurse will be able to give you advice.
Sleep apnoea – when you stop breathing for a few seconds during sleep – occurs frequently in people with Parkinson's and causes loud snoring or choking noises, which disturb sleep. If you wake with a headache, or if your bed partner notices any symptoms, you should speak to your doctor for a proper diagnosis and effective treatment. A machine called a PAP machine can be used to improve your breathing during the night.