Tuesday, March 16, 2010

Sleep & Parkinson’s Disease

Today the American Academy of Neurology published new guidelines for treating nonmotor symptoms of Parkinson’s disease. The section on sleep dysfunction was endorsed by the AASM board of directors.

reports that Parkinson’s disease is a motor system disorder. These disorders involve problems with muscle control.

One of the primary motor symptoms of PD is tremor. This is trembling or shaking in the hands, arms, legs, jaw or face.

But there are other nonmotor symptoms of PD. These include a variety of sleep-related problems.

The AAN guidelines report that people with PD often struggle with
insomnia. They may be unable to fall asleep. They also may wake up frequently during the night.

Sleep aids such as
melatonin may improve the perception of sleep quality in people with PD. But it is unclear if they produce an objective sleep improvement.

Deep brain stimulation also may cause sleep to improve. DBS is a surgical procedure that is used to treat the motor symptoms of PD.

restless legs syndrome and periodic limb movements are common in people with PD. These problems are classified as sleep related movement disorders.

Treating PD with
carbidopa and levodopa may improve the symptoms of RLS and PLM. The drugs ropinirole (Requip) and pramipexole (Mirapex) are FDA-approved to treat PD and RLS. But it is unclear if they reduce RLS symptoms in people who also have PD.

The parasomnia
REM sleep behavior disorder often occurs in people with PD. People who have RBD act out vivid dreams and nightmares as they sleep.

RBD can be treated with
clonazepam or melatonin. But research needs to evaluate the treatment of RBD in people with PD.

People with PD often struggle with excessive daytime sleepiness. The stimulant
modafinil (Provigil) may help them feel more awake. But it may not produce actual improvements in alertness.

Read a patient summary of the new guidelines on the AAN Web site. Get help for a sleep problem at an AASM-accredited sleep center.

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