Sleep Disorder in Patients with Parkinson Disease (1)

8/7/2019 Sleep Disorder in Patients with Parkinson Disease (1)

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Sleep Disorder inSleep Disorder in

Patients withPatients withParkinson DiseaseParkinson Disease

By KenBy Ken--Ucheonye EdohanUcheonye Edohan


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Parkinson??Parkinson?? P

arkinson'sP

arkinson's isis aa progressiveprogressive neurologicalneurological conditioncondition.. PeoplePeople withwith Parkinson'sParkinson's don'tdon't havehave enoughenough ofof aa chemicalchemical

calledcalled dopaminedopamine becausebecause somesome nervenerve cellscells inin theirtheir brainbrain havehavedieddied (basal(basal gangliaganglia andand thethe extraextra pyramidalpyramidal areaarea ))

WithoutWithout dopaminedopamine peoplepeople cancan findfind thatthat theirtheir movementsmovementsbecomebecome slowerslower soso itit takestakes longerlonger toto dodo thingsthings..

TheThe lossloss ofof nervenerve cellscells inin thethe brainbrain causescauses thethe symptomssymptoms ofofParkinson'sParkinson's toto appearappear..

EveryoneEveryone withwith Parkinson'sParkinson's hashas differentdifferent symptomssymptoms..

TheThe mainmain symptomssymptoms ofof Parkinson'sParkinson's areare tremor,tremor, rigidityrigidity andandslownessslowness ofof movementmovement..

AsAs wellwell asas affectingaffecting movement,movement, peoplepeople withwith Parkinson'sParkinson's cancanfindfind thatthat otherother issues,issues, suchsuch asas tiredness,tiredness, pain,pain, depressiondepression andandconstipation,constipation, cancan havehave anan impactimpact onon theirtheir dayday--toto--dayday liveslives..

TheThe symptomssymptoms someonesomeone hashas andand howhow quicklyquickly thethe conditionconditiondevelopsdevelops willwill differdiffer fromfrom oneone personperson toto thethe nextnext..


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Parkinson Disease and Sleep ProblemsParkinson Disease and Sleep Problems

An early survey found that more than 85 percentAn early survey found that more than 85 percentof patients suffering from Parkinson's diseaseof patients suffering from Parkinson's disease(PD) also have sleep disorders, which include(PD) also have sleep disorders, which include

abrupt and agitated arousal throughout the night.abrupt and agitated arousal throughout the night.These sleep disruptions often occur as many asThese sleep disruptions often occur as many asfive times during the night. PD patients often findfive times during the night. PD patients often findthat their sleep disturbances result from athat their sleep disturbances result from acombination of medication (excessive and suddencombination of medication (excessive and sudden

onset of sleep), cognitive function and severeonset of sleep), cognitive function and severemood fluctuation associated with the disease.mood fluctuation associated with the disease.((LeesLees et al,1998). It could be depression oret al,1998). It could be depression oranxiety, and if identified should be the focus ofanxiety, and if identified should be the focus ofthe treatmentthe treatment


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In addition, sleep disturbances in PD patientsIn addition, sleep disturbances in PD patients

are divided into three different categories:are divided into three different categories:

1.1. sleep onset insomnia,sleep onset insomnia,

2.2. sleep maintenance problems andsleep maintenance problems and

3.3. daytime sleepiness.daytime sleepiness.

There are, however, other sleep relatedThere are, however, other sleep related

disorders associated with PD.disorders associated with PD.


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Sleep Onset InsomniaSleep Onset Insomnia

Sleep onset problems are often associated withSleep onset problems are often associated with

anxiety or agitated depression. Anticipation ofanxiety or agitated depression. Anticipation of

P

DP

D--related symptoms and restless legrelated symptoms and restless legsyndrome are also contributing factors.syndrome are also contributing factors.

Patients with sleep onset insomnia cannotPatients with sleep onset insomnia cannot

initially fall asleep. Commonly patientsinitially fall asleep. Commonly patients

complain of feeling extremely tired, but theycomplain of feeling extremely tired, but theyare still unable to fall asleep once they lieare still unable to fall asleep once they lie

down.down.


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Daytime SleepinessDaytime Sleepiness

Daytime sleepiness encompasses theDaytime sleepiness encompasses the

continued fatigue that follows a restlesscontinued fatigue that follows a restless

night. In addition to general sleepiness,night. In addition to general sleepiness,patients often find themselves falling asleeppatients often find themselves falling asleep

suddenly throughout the day. This can besuddenly throughout the day. This can be

especially dangerous for patients who drive.especially dangerous for patients who drive.

It also reduces the quality of a patient's lifeIt also reduces the quality of a patient's lifewhen the disease is otherwise under control.when the disease is otherwise under control.


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Rapid Eye Movement BehaviouralRapid Eye Movement Behavioural

DisorderDisorderHealth Central, an online health resource,Health Central, an online health resource,

characterizes rapid eye movement behaviouralcharacterizes rapid eye movement behavioural

disorder (RBD) as the acting out of violent dreamsdisorder (RBD) as the acting out of violent dreams

during REM sleep. The patient may scream, shoutduring REM sleep. The patient may scream, shoutor even strike during an outburst. This disorder canor even strike during an outburst. This disorder can

occur frequently prior to the onset ofPD. In peopleoccur frequently prior to the onset ofPD. In people

without PD, when you have violent dreams, nervewithout PD, when you have violent dreams, nerve

impulses (atonia) going to your brain are blocked soimpulses (atonia) going to your brain are blocked soyou cannot act out those dreams but in patients withyou cannot act out those dreams but in patients with

PD, this inhibition is gone.PD, this inhibition is gone.


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Restless Leg SyndromeRestless Leg Syndrome

This is when you feel this irresistible urge toThis is when you feel this irresistible urge to

move your legs at night. Although restlessmove your legs at night. Although restless

leg syndrome (RLS) is not always associatedleg syndrome (RLS) is not always associated

with sleep disorders, PD patients often havewith sleep disorders, PD patients often have

trouble sleeping due to uncomfortabletrouble sleeping due to uncomfortable

sensations in the legs. When PD patients aresensations in the legs. When PD patients are

able to fall asleep, RLS can awaken them byable to fall asleep, RLS can awaken them bycausing sever twitching.causing sever twitching.


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Treatment OptionsTreatment Options

Behavioural TherapyBehavioural Therapy

1.1. Sleep Restriction Therapy: This is trying toSleep Restriction Therapy: This is trying torestrict the amount of time spent in Bed byrestrict the amount of time spent in Bed by

Patients with PD. (Spielman et al ,1987)Patients with PD. (Spielman et al ,1987)


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Stimulus Control TherapyStimulus Control Therapy

This is a Cognitive Behavioural TherapyThis is a Cognitive Behavioural Therapy

where Patients with PD are taught and advisedwhere Patients with PD are taught and advisedto keep a fixed time for sleeping, waking up,to keep a fixed time for sleeping, waking up,

avoid activities in bedavoid activities in bed--except sleep.(Smith &except sleep.(Smith &

Neubauer, 2003)Neubauer, 2003)


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Sleep Hygiene EducationSleep Hygiene Education

PD Patients are advised and trained on how toPD Patients are advised and trained on how tokeep bedroom comfortable, free fromkeep bedroom comfortable, free fromdisturbances, light and noise, avoidingdisturbances, light and noise, avoiding

stimulants such as caffeine, alcohol, heavystimulants such as caffeine, alcohol, heavymeals, and smoking in the evening before bedmeals, and smoking in the evening before bedand also getting regular exercise during theand also getting regular exercise during theday. Research has shown that this tends today. Research has shown that this tends towork with patients with mild to mid stagework with patients with mild to mid stageParkinson Disease( EngleParkinson Disease( Engle--Friedman et al,Friedman et al,1992)1992)


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Safety is also a big issue with PD patients whoSafety is also a big issue with PD patients who

get Rapid Eye Movement Behaviouralget Rapid Eye Movement BehaviouralDisorder. They risk injuring themselves andDisorder. They risk injuring themselves andtheir sleep partners. The frequency andtheir sleep partners. The frequency andintensity ofRBD episodes are sometimes toointensity ofRBD episodes are sometimes too

much for a sleep partner to endure. This ismuch for a sleep partner to endure. This isoften hard for those who suffer from RBD tooften hard for those who suffer from RBD tounderstand, because they usually don'tunderstand, because they usually don'tremember the episode because they sleepremember the episode because they sleep

through it. Sleeping in a big bed can minimizethrough it. Sleeping in a big bed can minimizethe chance a sleep partner will be injured, butthe chance a sleep partner will be injured, butsleep partners often end up sleeping insleep partners often end up sleeping indifferent beds or even in different rooms.different beds or even in different rooms.


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Pharmacologic TherapyPharmacologic Therapy

Sedating Antidepressants may be used but withSedating Antidepressants may be used but with

caution and in Low Dosage.caution and in Low Dosage.

Muscle relaxant and also Gabapentin can alsoMuscle relaxant and also Gabapentin can also

be used with Caution and in Lowbe used with Caution and in Low

Dosage.(GarciaDosage.(Garcia--Borreguero, 2002)Borreguero, 2002)


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References UsedReferences Used Lees AJ, Blackburn NA, Campbell VL. The nighttime problems ofLees AJ, Blackburn NA, Campbell VL. The nighttime problems of

Parkinsons disease. Clin Neuropharmacol. 1988; 11: 512Parkinsons disease. Clin Neuropharmacol. 1988; 11: 51299

Spielman AJ, Saskin P, Thory MJ(1987) Treatment of Chronic Insomia bySpielman AJ, Saskin P, Thory MJ(1987) Treatment of Chronic Insomia byrestriction of time in Bed. Sleep. 1987; 10:45restriction of time in Bed. Sleep. 1987; 10:45--5656

Smith MT, Neubauer DN(2003). Cognitive Behaviour TherapySmith MT, Neubauer DN(2003). Cognitive Behaviour TherapyfornChronic insomia. Clin Cornerstone. 2003;5(3): 28fornChronic insomia. Clin Cornerstone. 2003;5(3): 28--4040

EngleEngle--Friedman M, Bootzin RR, Hazelwood L, Tsao C(1992). AnFriedman M, Bootzin RR, Hazelwood L, Tsao C(1992). Anevaluation of behavioural treatment for insomia in the older Adult. J Clinevaluation of behavioural treatment for insomia in the older Adult. J ClinPsychol. 1992: 48:77Psychol. 1992: 48:77--9090

GarciaGarcia--Borreguero D, Larrosa O, De La Llave Y, et al.(2002). Treatment ofBorreguero D, Larrosa O, De La Llave Y, et al.(2002). Treatment ofrestless legs syndrome with Gabapentin. A Doublerestless legs syndrome with Gabapentin. A Double--Blind, cross over study.Blind, cross over study.Neurology. 2002;59:1573Neurology. 2002;59:1573--15791579

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Sleep Disorder in Patients with Parkinson Disease (1)