Up to 70 percent of patients with Parkinson’s disease (PD) experience sleep difficulties that negatively affect their quality of life, according to a new review in the Journal of Parkinson’s Disease.
For example, some patients have unhealthy sleep/wake patterns, such as having a difficult time falling asleep or staying asleep or sudden and involuntary episodes of falling asleep during the day.
In extreme cases, patients may suffer from REM-sleep behavior disorder (RBD), which involves vivid, violent dreams or dream re-enactment, even before PD motor symptoms appear.
“Diagnosis and effective treatment and management of these problems are essential for improving the quality of life and reducing institutionalization of these patients,” says lead author Wiebke Schrempf, M.D., from Dresden University of Technology in Germany.
In PD patients, sleep problems can have a variety of negative effects, and these can worsen in later stages of the disease.
Sleepiness can weaken cognition and concentration, intensify depression, interfere with employment, and cause mood instabilities that are exhausting to caregivers. It also causes patients to lose driving privileges, puts them at risk of falling, and is socially isolating.
In the paper, the researchers describe some of the complexities associated with treating sleep problems in PD patients. For example, sleep problems typically become worse when the patients are given dopaminergic medications to treat their motor symptoms.
The presence of other symptoms common in PD patients such as depression, dementia, hallucinations, and psychosis may also contribute to sleep problems.
Unfortunately, some antidepressants can also impair sleep. The researchers report on the importance of changing medication, dose, duration of treatment, or timing of administration in order to improve sleep problems.
Sleep difficulties may also predict future neurodegenerative disease. Patients with RBD experience sporadic loss of normal muscle relaxation during REM sleep and engage in dream enactment behavior during which they may shout, laugh, or kick.
“RBD seems to be a good clinical predictor of emerging neurodegenerative diseases with a high specificity and low sensitivity, whereas other early clinical features of PD, such as olfactory dysfunction and constipation, are less specific,” said Schrempf.
“These early clues may help identify PD patients before motor symptoms appear, when disease-modifying therapies may be most beneficial.”
The most common symptoms of PD are movement-related, such as involuntary shaking and muscle stiffness. Non-motor symptoms, such as worsening depression, cognition, and anxiety, olfactory dysfunction, and sleep disturbances, can appear before the onset of motor symptoms.
Source: IOS Press BV