| Q: |
I have Parkinson’s disease. How does this affect my sleep?
| | A: |
It is common to have sleep problems in all forms of parkinsonism
but you should discuss them with your doctor. The problems experienced
include insomnia, decreased ability to move at night, and REM-behavior
disorder with sudden, sometimes violent movement and talking or
shouting. Sleep problems increase as Parkinson’s disease worsens.
Daytime drowsiness becomes more common; some people have sleep attacks
during the day. Breathing can also be disturbed in Parkinson’s disease.
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| Q: |
Why can sleep be disrupted in Parkinson’s disease?
| | A: |
There are many different causes of poor sleep in Parkinson’s
disease. Problems with sleep-wake control mechanisms due to
neurochemical imbalances can result in fragmented sleep and a reduction
in REM sleep. Slowed movement and rigidity can lead to a reduction in
the number of normal body shifts during sleep. This in turn may lead to
discomfort and awakenings, as well as problems with getting up to use
the bathroom at night. There is an increased association in Parkinson’s
disease with periodic leg movements, tremors, and jerking movements due
to medication, all of which can lead to increased awakenings. Depression
and anxiety can result in problems falling asleep and staying asleep,
as well as early morning awakenings. Dementia occurring in Parkinson’s
disease can result in episodes of confusion at night. Sleep-disordered
breathing may also occur.
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| Q: |
How can sleep disturbances in Parkinson’s disease be managed?
| | A: |
Sleep disturbances in Parkinson’s disease need to be managed in
conjunction with your doctor. Management involves good control of
symptoms and careful use of your medications. Many of the medications
used to treat Parkinson’s disease can also have adverse effects on sleep
and can worsen some sleep disturbances. Causes of insomnia need to be
investigated and managed as described in Insomnia.
Symptoms of sleep apnea or significant snoring need to be taken
seriously, investigated by a sleep specialist, and treated. Stimulant
medications may be useful in people who experience sleep attacks.
However, any medication changes or adjustments should only be made after
you are thoroughly assessed by your treating doctor or neurologist.
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| Q: |
What sort of sleep disturbances occur in stroke?
| | A: |
Strokes can affect any part of the brain and lead to problems
with sleep and daytime symptoms such as fatigue. Depending on which part
of the brain is affected, various breathing abnormalities can emerge
which may require treatment. About 2 to 4 in 10 patients have increased
sleep needs, excessive daytime sleepiness, and insomnia. Fatigue is
found in up to 3 of 4 patients. Sometimes people with stroke develop
parasomnias and may lose their perception of time. Disruptions in the
circadian rhythm can also occur.
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| Q: |
Does stroke result in sleep-disordered breathing?
| | A: |
About 6 to 7 in 10 people who have a stroke develop
sleep-disordered breathing after the stroke. In many cases, this will
settle with time. It has also been found that many people who have a
stroke have had symptoms of sleep apnea prior to the stroke, but whether
this caused their problems is not yet known with certainty.
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| Q: |
Why can sleep be disrupted in stroke?
| | A: |
Stroke may cause sleep-wake disturbances for many reasons. The
most important is the damage to the brain tissue and the neurochemical
pathways that occurs directly as a result of the stroke. Other factors
can be caused by the hospital environment. These may include noise, too
much light, and intensive medical monitoring. Sleep fragmentation can
result from sleep-disordered breathing, infections, heart problems, lung
disease, seizures, fever, and medications. Mood change in the form of
depression and anxiety can affect the sleep-wake cycle, as does the
psychological stress of coping with the stroke.
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| Q: |
I’ve had brain surgery–why am I so sleepy?
| | A: |
There can be many factors contributing to fatigue after such
major surgery, including damage to the brain tissue and disruption of
neuronal pathways, however subtle, that regulate the sleep-wake cycle.
Fatigue is normal after any major surgery. It may take many months to
overcome this. Of course, sleep-disordered breathing or another primary
sleep disorder should be treated. Some of the anticonvulsant medications
which are used after surgery can also contribute to sleepiness and
increased fatigue.
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| Q: |
My partner has dementia–how does this affect sleep?
| | A: |
There are many different causes of dementia, not just Alzheimer’s
disease, although this is the most common. The types of sleep problems
that people with dementia have tend to fall into a number of categories.
These include: insomnia, excessive daytime sleepiness, changes to the
circadian rhythm, and excessive movement during the night, including
REM-behavior disorder and restless legs syndrome.
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| Q: |
What other sleep problems do people with dementia have?
| | A: |
One of the most noticeable and distressing sleep problems in
people with dementia (most commonly Alzheimer’s disease) is nocturnal
wandering, agitation, and delirium. This is called sun-downing. People
with dementia may also have problems with sleep-disordered breathing,
and other illnesses can contribute to problems with sleep.
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| Q: |
What can be done about sleep problems in dementia?
| | A: |
As with all sleep disturbances, the appropriate treatments outlined in
Sleep promotion
should be tried first before resorting to medication. Eliminate
caffeine, alcohol, and disruptive influences on the sleeping
environment. We often ignore very basic factors that can be distressing
to someone who can no longer communicate well. These include a full
bladder, constipation, heat or cold due to an inappropriate environment
or clothing, pain from infections or pressure sores, inadequate exercise
during the day, or a disruptive bedroom environment. Sometimes a night
light next to the bed can be useful for orientation and may reduce
anxiety. There are many effective medications for treating sleep
disorders associated with dementia and your doctor can advise you about
which ones you can try.
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| Q: |
I have post-polio syndrome–how can this affect my sleep?
| | A: |
Many people with post-polio syndrome experience an increasing
weakness of the muscles that control breathing, especially the rib cage
muscles and sometimes even the diaphragm, as they age. This can lead to
breathing problems at night with a drop in blood oxygen levels and a
rise in carbon dioxide levels. This in turn can lead to symptoms of
increased daytime fatigue, morning headaches, and reduced appetite. Poor
sleep and fatigue can make muscular problems worse.
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