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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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