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.

The NINDS 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.

Both 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.

Violent Dreams: Who Has REM Sleep Behavior Disorder?

People who have REM sleep behavior disorder act out vivid, action-packed dreams as they sleep. Who is likely to have RBD?

It is most common in men over the age of 50. But a new study from London confirms that it can occur in other people as well.

The study reviewed a sleep center’s case files from the previous seven years. Ninety-one people had been diagnosed with RBD during that time: 62 men and 29 women.

The average age of people with RBD was 52 years; 39 of the people were under the age of 50 years.

In people with RBD over the age of 50, the ratio of men to women was 3:1. The male to female ratio dropped to 1.4:1 in people under 50 years of age.

RBD occurred together with narcolepsy in about 38 percent of people in the younger age group. In the older age group, about 29 percent of people also had a “synucleinopathy.” These are neurological disorders such as Parkinson’s disease and dementia with Lewy bodies.

A person with RBD may punch, kick, jump or get out of bed and run - all while he or she is still asleep. Cuts, bruises or broken bones may occur to the dreamer or to a bedpartner.

Contact an AASM-accredited sleep center if you or someone you know acts out dreams during sleep.

When Dreams Come Alive: REM Sleep Behavior Disorder

Dreams that come to life are the stuff of fantasy novels and horror movies. But it’s also a reality for people who suffer from REM sleep behavior disorder.

People who have RBD act out vivid dreams as they sleep. The dreams tend to be action-packed. The dreamer may punch, kick, jump or get out of bed and run. All of this occurs while he or she is still asleep.

The disorder may sound funny. But injuries are common. Cuts, bruises or broken bones may occur to the dreamer or to a bedpartner.

Why does RBD occur? Normally your brain paralyzes most muscles during the stage of rapid eye movement (REM) sleep. This is the stage of sleep when you have most dreams and nightmares. RBD occurs when the brain fails to tell the muscles to remain still.

RBD is similar to sleepwalking. But a sleepwalker tends to be confused upon waking up. Once awake, a person with RBD usually has clear recall of a vivid dream.

Sleepwalkers also are more likely to get up calmly, have their eyes open and walk out of the room. RBD actions tend to be more intense and dramatic.

RBD was identified and reported in the journal Sleep in 1986. Sixteen years later a follow-up report was published by the same research team. People with RBD are at risk for developing Parkinson’s disease.

RBD appears to be rare, affecting less than one percent of people. It is more common in older men. A new study followed 93 people with RBD. Participants had an average age of 65.4 years; 80 percent were men.

But stand-up comedian Mike Birbiglia is evidence that RBD can strike when you are younger. During his routines he often shares true stories of his RBD episodes. He is even starring in an off-Broadway show called Sleepwalk with Me.

Laughter is good medicine; but people with RBD should seek medical help. Contact an AASM-accredited sleep disorders center if you act out your dreams while you sleep.