Sleep and Night-Time PROBLEMS in PARKINSON's

SLeep and night-time PROBLEMS IN PARKINSON’S

1 Sleep and night-time It may be difficult sometimes, but problems can be a symptom if you’re a carer it’s important to of Parkinson’s. They can have good sleeping habits. This will affect you at any stage of help improve your health, wellbeing the condition and may leave and general quality of life. Much you feeling tired and drowsy of the information in this booklet during the day. applies to you as well as the person you care for. This booklet looks at the difficulties you may have with sleep, why they happen and what can help.

A note for family and carers Sleep and night-time problems are very common among carers of people with Parkinson’s too.

If you’re caring for someone with Parkinson’s, these sleep disturbances may lead to an increased risk of depression and stress. Contents

Sleep patterns...... 4 How sleep can be disturbed...... 4 Insomnia...... 4

Sleep problems linked with Parkinson’s ...... 6 Parkinson’s medication...... 6 Getting in and out of bed...... 6 Turning over in bed ...... 7 Akinetic pain...... 7 Nocturia...... 7 Low blood pressure or hypotension...... 8 Dystonia...... 8 Restless legs syndrome...... 9 Periodic leg movements...... 9 Panic attacks, anxiety and depression...... 10 Parasomnias...... 10 Excessive daytime sleepiness...... 11 Sleep apnoea...... 11

Treating sleep problems in people with Parkinson’s ...... 12 Improving sleep hygeine...... 12 Reducing time in bed awake...... 13

Treatments for sleep problems ...... 16 Sleeping tablets...... 16 Psychological treatments...... 17

More information and support ...... 19 Sleep patterns

Most people have a ‘normal’ sleep How sleep can be disturbed pattern. This means they have a When routines and habits are regular time when they’re tired and disturbed, sleep is too. This often need roughly the same amount of happens when you go away on sleep each night. holiday, or when you’re ill. Usually these episodes don’t last for more Sleep patterns are set by your body than a night or two, and routines and clock. Moods and feelings also affect sleep patterns soon return to normal. your sleep pattern. This is why, even if it’s your usual bedtime, you If there are other things affecting can stay alert and awake for longer your sleep, your habits and routines if you’re enjoying the company of may also be disturbed. If this happens, friends or family, or you’re busy with you may stop feeling tired at bedtime an activity that interests you. It also and your bedroom may not feel like explains why it can be hard to fall a place of calm and security. It then asleep at your usual time if there’s becomes difficult to get into the right something on your mind or you’re in frame of mind for sleep. This means an unfamiliar place. that sometimes, even if the original cause of your sleep problem is In everyday life, habits and routines sorted out or reduced, you can support normal sleep patterns. still have difficulties. Keeping regular hours and getting up at the same time every day Insomnia helps set your body clock, making Insomnia is a sleep disorder that you feel tired at roughly the same causes problems getting to sleep time each night. Bedtime routines or staying asleep at night, so you’re help you get ready to fall asleep likely to feel tired during the day. and a familiar bed and bedroom add a sense of calm and security. If you’re having trouble sleeping, This is called good ‘sleep hygiene’. a cycle can develop. If you can’t 4 get to sleep, then you can become Disturbed sleep can also be a direct irritated, fed up, or even anxious symptom of Parkinson’s, without about how you’ll cope the next day. these other symptoms. These feelings tend to make you more alert, which keeps you awake, (See the section ‘Specific sleep and so on. For many people, this is problems linked with Parkinson’s’ to the start of insomnia. find out more.)

Insomnia symptoms Side effects of medication Insomnia is common in many Some medications can act as long-term conditions. People with stimulants and keep you awake Parkinson’s can be more prone to (or make you sleepy). Speak to insomnia because of Parkinson’s your GP, specialist or Parkinson’s symptoms, such as tremor, stiffness, nurse for advice about Parkinson’s pain and restless legs syndrome, symptoms or medication if you think which can all disturb sleep. these are stopping you sleeping.

5 Sleep problems linked with parkinson’s

Disturbed sleep can be a direct (a tube that pumps levodopa symptom of Parkinson’s, or it can directly into your stomach). The be related to other symptoms of the continuous delivery means you get condition, like tremor. It can also be constant treatment throughout the linked to Parkinson’s medication. night. Speak to your specialist or Parkinson’s nurse to find out if any This section looks at some of the of these options might be suitable causes of disturbed sleep and what for you. can be done to help. If changing your medication doesn’t Parkinson’s medication help, your GP, specialist or Parkinson’s Parkinson’s symptoms may be nurse may suggest referring you worse during an ‘off’ period, when to a specialist hospital centre or your medication level is low and sleep clinic for a sleep test. But it’s isn’t working so well. This may lead important that you don’t stop taking to stiffness, tremor, pain and being your medication before you talk to a unable to move and turn in bed. health professional, as this could When you take your medication, be dangerous. your symptoms may be less noticeable because you are Find out more: see our information ‘on’ again. on drug treatments for Parkinson’s.

If your medication often wears off Getting in and out of bed during the night and causes you Some people with Parkinson’s suffer problems, you may need to switch from severe movement problems. to a form that’s delivered to your This may mean you need help to body continuously. This could be get in and out of bed. through slow release levodopa, skin patches, an apomorphine infusion If you find getting in and out of bed or an intrajejunal levodopa infusion difficult, there is a range of different

6 aids available to help. They can speak to an occupational therapist. make the process less strenuous In some cases they may be able to for your carer. provide bed aids, mattresses and specialist beds free of charge. If you don’t have a carer but need help getting in and out of bed, Find out more: see our information you can contact social services to on occupational therapy and arrange for a night-time carer. Parkinson’s.

Turning over in bed You can also contact the Disabled Turning over in bed can be difficult for Living Foundation for more people with Parkinson’s because of information about aids and rigidity. Changes to your medication equipment (see the end of this may help stop this, so speak to your information to find out more). specialist or Parkinson’s nurse. Akinetic pain Using satin pyjamas or satin sheets Akinetic pain is caused by a may also help. The shiny material lack of movement. If this is a can help you to turn over, but problem for you, it may interfere try not to use satin sheets and with your sleep. Symptoms may satin pyjamas at the same time. include severe stiffness, pain in Together, they can increase the risk muscles and joints, headache and, of sliding out of bed too quickly. sometimes, pain in your whole If you use satin sheets or panels, body. Speak to your GP, specialist make sure there is an area of or Parkinson’s nurse to find out friction either at the end or sides about ways they can help you to of the bed, so that you can get deal with this type of pain. some grip. Your Parkinson’s nurse or occupational therapist should Nocturia be able to give you advice. Nocturia is waking up at night with the urge to urinate. It can be a There’s no specific bed or mattress common problem for people with recommended for people with Parkinson’s. If this urge happens in Parkinson’s. What’s best for you an ‘off’ period, some people find depends on your individual needs they can’t control their bladder and preferences. If you feel you and can’t get to the toilet in time. need a new bed, mattress, or aids There are other possible causes to help you get in and out of bed, 7 of nocturia, such as a bladder handheld urinals or sheaths may infection. Some medications can also help you if you’re having cause nocturia, for example some problems getting to the toilet. anti-depressants and medications for high blood pressure. yySome medication may help with bladder hyperactivity. Your If you have this problem, speak to continence advisor may be able to your GP, specialist or Parkinson’s help with this. nurse to work out the cause. They can suggest ways to treat and manage it. You may also be Find out more: see our referred to a continence advisor information on looking after your – a specialist nurse who assesses bladder and bowels when you have and manages incontinence. Parkinson’s.

If you’re having problems sleeping Low blood pressure or because of an increased urge to hypotension pass urine at night, you can try the A sudden or abnormal fall in your following: blood pressure when standing up quickly can make you feel light- yyFor bladder problems, it’s headed – for example, when important not to cut down too getting out of bed to go to the much on the amount you drink toilet. If this happens, take care overall. This may leave you and move slowly. Speak to your dehydrated and may make your health professional about ways of bladder more irritable. But try to managing low blood pressure. reduce the amount you drink in the evening and make sure you go Find out more: see our information to the toilet before you go to bed. on low blood pressure and Parkinson’s. yyAvoid drinking alcohol or drinks containing caffeine, such as coffee Dystonia and tea, in the evening, and try to limit these during the day too. Dystonia is involuntary contractions of the muscles in the toes, fingers, yyUse bed protection, such as ankles or wrists that cause the absorbent sheets and bed pads, body to go into spasm. It may, for just in case. Appliances such as example, cause the feet to turn 8 inwards, or toes to curl downwards. To get some relief you could also It can feel like a painful cramp and try: it often occurs in the early morning, or at night as the effects of your yymassaging your legs Parkinson’s medication wear off. yyrelaxation exercises, such as yoga If you have any of these symptoms, or tai chi your medication may need to be yytaking a warm bath in the evening adjusted. Speak to your specialist or Parkinson’s nurse for advice. yyapplying a hot or cold compress to your legs Find out more: see our information on pain in Parkinson’s yywalking and stretching and muscle cramps and dystonia. Rarely, your sleep may be disturbed Restless legs syndrome because you have produced more Restless legs syndrome is an dopamine than you need due to overwhelming desire to move your Parkinson’s medication. your legs when you’re awake. It The effect is similar to restless happens mainly when you’re resting, legs syndrome, but the abnormal usually in the evening and at night. involuntary movements (dyskinesias) Symptoms can include tingling, are due to your medication. burning, itching and throbbing in your legs. You may also have pins If this happens, your medication and needles in your calf muscles may need to be adjusted. Speak to and need to walk around to get relief. your specialist or Parkinson’s nurse for advice. To help with restless legs syndrome, your healthcare professional may Periodic leg movements advise you to increase your iron ‘Jumping’ of the legs, arms or body levels by taking a supplement or during sleep can by a symptom of eating iron-rich foods, such as dark Parkinson’s. It’s known as ‘periodic leg green vegetables, prunes or raisins. (or limb) movements’. Some people Medication can treat moderate or get it with restless legs syndrome severe symptoms. (see above), but it can also happen on its own.

9 It can respond to treatment with Find out more: see our levodopa and dopamine agonists. information on anxiety and Parkinson’s, and depression and Find out more: see our Parkinson’s. information on restless legs syndrome and Parkinson’s. Parasomnias Parasomnias are abnormal Panic attacks, anxiety and movements or behaviours that depression happen when you’re asleep. They A panic attack is an overwhelming also occur as you’re waking up or feeling of fear or terror that comes when light sleep changes to deep out of the blue. sleep. They include nightmares and sleepwalking. You may also experience physical symptoms such as sweating, a One problem is called ‘rapid eye racing heart and shortness of movement (REM) sleep behaviour breath. Anxiety may be caused by disorder’. During REM sleep excessive worry or stress. But it’s (commonly known as deep or also a symptom of Parkinson’s. dream sleep) people with the disorder may move their arms and Anxiety and panic attacks can legs vigorously, possibly injuring cause sleep disruption, so if you’re themselves or their bed partner. affected by these, speak to your They may be acting out a violent GP, specialist or Parkinson’s nurse, dream, which they may or may not as there are a number of ways to be able to remember. REM sleep treat anxiety. behaviour disorder is more common in people with Parkinson’s and can Depression is usually diagnosed be an early sign of Parkinson’s when someone has feelings of before other symptoms develop. extreme sadness for a long period of time. Symptoms may include Some people may also have insomnia and other sleep disorders, hallucinations, wander around, such as too much sleep. There are get agitated or talk loudly during also a number of ways to treat sleep. Night-time hallucinations depression. Speak to your health can be a side effect of medication, professional for advice. or be due to other causes, such as an infection.

10 If you or your bed partner notice Medication may help, so speak to any unusual behaviour during sleep, your GP, specialist or Parkinson’s you should discuss this with your nurse. GP, specialist or Parkinson’s nurse. In some cases you may be referred Find out more: see our to a neurologist with a special information on driving and interest in sleep disorders. Parkinson’s.

Find out more: see our Sleep apnoea information on hallucinations and Sleep apnoea is a condition where a Parkinson’s. person momentarily stops breathing while asleep. This makes them wake Excessive daytime sleepiness up, take a few breaths and go back Drowsiness is a side effect of some to sleep again. The person has no Parkinson’s drugs and this can memory of this happening, as it’s sometimes be severe. This is also so brief, but it disturbs their sleep. known as ‘daytime hypersomnia’. Parkinson’s medications can cause Symptoms of sleep apnoea excessive daytime sleepiness or include loud snoring, choking sudden onset of sleep. This may noises while asleep and excessive be more likely in people whose daytime sleepiness. Parkinson’s has progressed and who are on multiple medications. If you or your bed partner notice It can also occur when increasing any of the symptoms, you should medication, particularly dopamine seek treatment from a sleep agonists. specialist. Speak to your GP, specialist or Parkinson’s nurse. Excessive feelings of sleepiness during the day can also happen if you’re not getting enough sleep at night. This can cause people to fall asleep or doze off during normal waking hours. In some cases, it can even lead to the sudden onset of sleep. This can be dangerous if you’re doing certain things, like driving or operating machinery.

11 Treating Sleep problems in people with parkinson’s

Improving sleep hygiene have the opposite effect and make If you’re having trouble sleeping, you feel restless. This can mean you there are simple things you can do wake up during the night. Another that may help. One of the first is to effect of drinking alcohol at night is improve your ‘sleep hygiene’. This nocturia – the need to get up and means dealing with the simple things go to the toilet – which again will that help or stop you sleeping. disturb your sleep. 3. Try not to smoke around Here are 10 sleep hygiene ‘rules’: bedtime or when awake during 1. Don’t have caffeine before bed. the night. This includes tea, coffee, chocolate Like caffeine, nicotine is a stimulant and cocoa. Many soft drinks also and the effects are similar, even if contain caffeine, so check the labels. you feel smoking relaxes you. Caffeine is a stimulant, which means it can make you feel more awake. 4. Try to relax before going to bed. Its effects can last for three to four If you’re in a relaxed mindset before hours. If caffeine is affecting your you go to bed you may find it easier body at bedtime, it can increase to drift off. the time it takes to get to sleep and make sleep lighter and more 5. Avoid vigorous exercise within restless. It’s also important to four hours of bedtime. limit the total amount of caffeine Increasing exercise can help you take during the day too – or you manage your Parkinson’s eliminate it altogether. symptoms, but it’s best to avoid vigorous activity within four hours 2. Avoid eating a big meal or of bedtime. This is because the drinking alcoholic drinks four to effects of the activity may make you six hours before bedtime. less able to fall asleep. Alcohol can make you feel sleepy. But as its effects wear off it can 12 6. Keep your bedroom calm 10. Try to keep to a regular and comfortable. routine. Try to reduce clutter and furniture A regular routine is the key to and keep your bedroom tidy. better sleep. Try to stick to a regular pattern of times for bed, 7. Avoid excessively hot or cold getting up, meals, exercise and temperatures. other routine activities. High room temperatures (24°C or higher) may disturb normal sleep Reducing time in bed awake and make you restless. Most people Reducing the amount of time sleep better if their bedroom is you spend in bed awake can help cool. If possible, it’s best to keep strengthen or re-establish the your bedroom temperature around ‘triggers’ for sleepiness. 16°C to 18°C. It may be tempting to stay in bed 8. Reduce noise and light in the bedroom. until you fall asleep. And it may Light and noise can disturb sleep. help in the short term, but it’s not Try to close windows, use ear plugs effective in the long run. As you or move to a quieter room if noise spend longer in bed, sleep becomes is a problem. It’s important to have more ‘broken’ and restless, and the a dark bedroom with curtains or insomnia symptoms carry on. blinds that keep out street lights and daylight. If light is a particular Even if you don’t think you’re problem, try using an eye mask. spending too much time in bed, Also, don’t watch television or use there is no reason to stay in bed devices right before going to bed – if you’re not asleep. the bright light can make you feel Leave time to unwind more awake. Try to leave at least an hour

9. Keep your bedroom mainly for to unwind before you go to bed. sleeping. Activities such as reading, watching Ideally, bedrooms should be calm television, listening to music or spaces for sleeping. Keep your talking may help. bedroom for sleep, so your mind associates it with activities that When it’s time for bed try not to lead to sleep. Try to avoid things think too much about the day or like watching television or using your plans for tomorrow. computers or tablets in bed. 13 Set aside time earlier in the evening room and do something quiet to think about any issues. It may be and calm, such as reading. helpful to write down any worries or concerns during this time and If you need help getting out of bed, then plan how you’ll deal with them talk to your partner or carer about at a later date. There isn’t anything what you’re doing, and what help wrong with thinking about the you need from them, to make it things going on in your life and easier for you both. trying to solve problems, but try to put any concerns or negative Go back to bed only when you thoughts to one side before you feel sleepy. Try not to leave your go to bed. bedroom only to fall asleep in a chair or on the sofa as this doesn’t Only go to bed when you’re help to build the link between your sleepy bed and sleep. First, it’s important to be aware of the difference between being You may have to get up several tired and being sleepy. Tiredness times during the night if you can’t is a feeling of exhaustion. But it fall asleep at bedtime or you wake doesn’t always involve the need during the night and can’t get back to sleep. Sleepiness means being to sleep. This can be difficult at ready to fall asleep. Signs of first, but if you keep trying with sleepiness may include yawning, this method your mind will soon link having ‘heavy’ eyelids or sore eyes, your bed and bedroom with getting or even feeling a little unsteady. to sleep quickly.

Waiting to be sleepy before going One common problem is going to bed can help you fall asleep back to bed too soon after getting faster. Going to bed too early up. Some people think that if you can give you time to worry about stay up too long, you’ll never get problems or being unable to fall back to sleep. In fact, the opposite asleep, which can keep you awake. is true: the longer you stay up, the quicker you fall asleep when you go If you don’t fall asleep, try to get back to bed. up. Lying in bed trying to get to sleep can make you feel anxious or You may not feel like leaving the frustrated. So try getting up after comfort of your bed, particularly about 20 minutes, go to another if you think you could be cold or 14 bored while waiting to get sleepy. It’s common to ‘lie in’ to make up If this is the case, try keeping a for lost sleep. This can help in the warm blanket or dressing gown short term, but it’s best to stick near your bed, have a comfortable to a regular routine. place to sit in the house and keep things to do there. These shouldn’t Try not to nap during the day be so interesting that your mind For many people, napping during becomes too active, but not so the day affects their quality of boring that you have no motivation night-time sleep, and reduces the to get up. For example you could try amount of deep sleep they get. reading, watching television or doing a crossword puzzle. Try to avoid Some people with Parkinson’s find things like housework or exercise. they need a nap during the day. Certain medication, for example, Use an alarm clock can make people very sleepy. If Set an alarm clock and, if possible, this is the case, try to nap for a get out of bed at about the same short time only, perhaps around time every morning, including 20 minutes. This shouldn’t have weekends. This will help reset much of an impact on your night- your body clock and restore time sleep. Set an alarm clock to your sleep-wake pattern. wake you after 20 minutes if you’re worried you’ll sleep for longer.

15 Treatments for sleep problems

If you have long-term problems in people with Parkinson’s. sleeping, it’s possible that you’re either taking, or have thought Understanding the side effects about taking, sleep medication of sleeping tablets such as sleeping tablets. Sleeping tablets don’t just affect sleep – they may also make you In this section we look at the feel drowsy the next day. effects sleeping tablets can have on your sleep, becoming dependent They may interfere with your ability on sleep medication and how to to perform some everyday tasks come off sleeping tablets. (like driving a car). Any effects will depend on the type of medication and dose taken. Older people are Sleeping tablets often given lower doses of sleeping Sleeping tablets can help in the tablets as they tend to be more short term (up to three or four sensitive to their effects. weeks) in some situations. For example: Rather than improving your alertness during the day, some yyif you have a short spell of sleeping tablets may actually insomnia due to severe stress, make your memory and such as a bereavement, or after concentration worse. surgery Rebound insomnia yyif you have temporary Sleeping tablets may cause rebound insomnia caused by a change in insomnia. This is when your insomnia environment or circumstances, symptoms briefly become much such as being in hospital worse when you try to stop taking the sleeping tablets. You might also have feelings of anxiety. However, they are rarely a long- lasting solution to sleep problems 16 Although rebound insomnia is You may come to depend on always temporary, the effects the medication long after it has may last long enough to convince stopped working. a person that they can’t sleep without medication. So, you may Coming off sleeping tablets start taking sleep medication again, When reducing or coming off even after you’ve decided to stop. sleeping tablets you’ll need support This can lead to the long-term use from your specialist or GP. They of sleeping tablets. may advise you to reduce your sleeping tablets gradually (this is Dependency on sleeping tablets called ‘tapering’), and they can In general, prescription sleeping also help you with this. If you’re tablets are safe and effective. using sleeping tablets regularly, Dependence on these medicines never stop taking them without does not develop over just a few discussing it with your health nights, it develops gradually with professionals first. long-term use. Psychological treatments Most people are given sleeping Using sleeping tablets alone is tablets by their GP during periods rarely an effective way of dealing of illness, stress, when in hospital or with long-lasting sleep problems when they can no longer cope with as they don’t treat the underlying their insomnia symptoms. problems causing your insomnia.

If you use sleeping tablets regularly Scientific studies have compared your body slowly gets used to the the effects of sleep medication drug, and you develop what is with psychological treatments, called ‘tolerance’. This means the such as cognitive behavioural medication has less effect on you, therapy (CBT). so you have to increase the dose to get the same effect. Sleeping tablets produce faster results than psychological Eventually, sleeping tablets may no treatments. But psychological longer work. But, if you try to stop treatments also produce more taking the tablets you can’t sleep permanent improvements that because of rebound insomnia. can have lasting benefits for your sleep. These treatments may help you to 17 manage your habits, routines and to yykeeping to a regular bedtime and deal with insomnia. You may also be getting-up time able to discuss your sleep problem with a psychological practitioner. yyavoiding worrying in bed Ask your GP about being referred. Remember that Parkinson’s varies from person to person. Many treatments for insomnia The symptoms you have and the look at making helpful changes to rate it progresses are different habits and feelings that may affect for everyone. So there isn’t a our sleep. ‘one size fits all’ solution to sleep problems. But the ideas discussed Simple changes can include: in this information may offer some practical ways to help you get yyspending less time in bed awake better sleep. yygoing to bed only when you’re sleepy

18 more information and support

Disabled Living Foundation 01737 245 638 The Disabled Living Foundation www.britishsnoring.co.uk provides information and advice on aids and equipment. Sleep Apnoea Trust 020 7289 6111 The Sleep Apnoea Trust aims to Helpline 0845 130 9177 improve the lives of sleep apnoea Textphone 020 7432 8009 patients, their partners and their www.dlf.org.uk families. They publish a regular newsletter, run a helpline and have Insomniacs information on sleep apnoea and Insomniacs was formed to offer lists of support groups. a reference point on how to 0845 038 0060 overcome insomnia, sleeping www.sleep-apnoea-trust.org problems and sleep disorders. Their website has case studies and Parkinson’s nurses expert guidance on dealing with Parkinson’s nurses provide expert sleep issues. advice and support to people with www.insomniacs.co.uk Parkinson’s and those who care for them. They can also act as a liaison British Snoring and Sleep Apnoea between other health and social care professionals to make sure Association your needs are met. A not-for-profit organisation dedicated to helping snorers and Parkinson’s nurses may not be their bed partners improve their available in every area, but your sleep. There’s information on GP or specialist can tell you about causes and treatments on their local services. website and they also have a helpline.

19 You can find out more at Our website has information parkinsons.org.uk/nurses about your local support team and how to contact them at Information and support parkinsons.org.uk/localtoyou from Parkinson’s UK You can call our free confidential You can find details of our local helpline for general support and groups and your nearest meeting at information. Call 0808 800 0303 parkinsons.org.uk/localgroups (calls are free from UK landlines and most mobile networks) or email You can also visit [email protected] parkinsons.org.uk/forum to chat to other people with similar Our helpline can also put you experiences on our online in touch with one of our local discussion forum. advisers, who provide one-to-one information and support to anyone affected by Parkinson’s. They can also provide links to local groups and services.

20 Thank you to everyone who please contact our Supporter contributed to or reviewed this Services team on 0800 138 6593 booklet: or visit our website at parkinsons. org.uk/donate. Thank you. Huw Morris, Professor of Clinical Neurosciences, UCL Queen Our information Square Institute of Neurology. All of our most up-to-date Monty Silverdale, Consultant information is available at Neurologist and movement parkinsons.org.uk/ disorder specialist, Salford Royal informationsupport Foundation Trust. If you’d prefer to read one of our printed leaflets or booklets, Thanks also to our information find out how to place an order review group and other people at parkinsons.org.uk/ affected by Parkinson’s who orderingresources or by calling provided feedback. 0300 123 3689. All of the photographs in this We make every effort to ensure booklet feature either people affected by Parkinson’s, health and that our services provide current, social care professionals involved in unbiased and accurate information. caring for people with Parkinson’s We hope that this will add to any or Parkinson’s UK staff. Thank you professional advice you receive and to everyone involved for letting us help you to make any decisions you use their photograph. may face. Please do continue to talk to your health and social care Can you help? team if you are worried about any At Parkinson’s UK, we are totally aspect of living with Parkinson’s. dependent on donations from individuals and organisations to If you’d like to find out more about fund the work that we do. There how we put our information are many ways that you can help us together, including references and to support people with Parkinson’s. the sources of evidence we use, please contact us at If you would like to get involved, [email protected] Sleep and night-time problems in Parkinson’s (PKB070/2019)

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 23 Every hour, two people in the UK are told they have Parkinson’s – a brain condition that turns lives upside down, leaving a future full of uncertainty.

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