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