October 24, 2013

Sleep and Parkinson's

This is the third in a continuing weekly series about sleep.

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According to a recent “PatientsLikeMe” survey, nearly 2/3 of all responders thought they had sleep problems.

For people with Parkinson’s (PWPs) – like me – the percent is surely higher. Insomnia is a typical issue for us, along with depression and constipation. I take 5-HTP – an OTC serotonin booster – every day, and that supplement helps me with all three of those roadblocks to well-being.

In a recent bulletin from the Parkinson Foundation of the National Capitol Area, Dr. Stephen Reich wrote:
I find it uncommon to encounter someone with PD who consistently sleeps well through the night and is not drowsy at some point during the day. It is important to appreciate that insomnia is a symptom, not a disease, and that the approach to treating insomnia is to determine its cause(s) rather than simply writing out a prescription for a sleeping pill.
God knows, I’ve gone the route of sleeping aids and paid dearly, as I’ve described in what I call my "summer from hell." 

Reich urges PWPs to first determine the nature of their insomnia. Is the issue getting to sleep, staying asleep, or waking too early? Is the problem PD-related, like:
  • Difficulty moving in bed
  • Getting comfortable
  • Being able to adjust bedcovers
  • Tremor
Is There a Medication Problem?
If the sleep issue appears PD-related, then a medication change – type, timing, dose -- might be appropriate. If PD is interfering with your ability to fall asleep, taking levadopa a half hour before bedtime can help. If PD issues make it difficult for you to stay asleep, taking controlled-release levadopa might help. For PWPs who wake and can’t get back to sleep, an extra hit of levadopa at that time can be useful.

Restless leg syndrome (RLS) often plagues PWPs, preventing and disrupting sleep. Doctors typically prescribe dopamine drugs for this problem.

PWPs deal with depression and anxiety at higher-than-average rates. Those mental issues – as millions of people know too well – make sleep very difficult. Insomnia is, again, the symptom, and now-common drugs like Prozaz -- and a whole new generation of other medications – can bring relief.

Then there’s “nocturia,” waking up in the middle of the night to urinate. It’s an annoyance to more men than women, and it affects men with Parkinson’s in greater degrees. For some), it’s a simple matter: go to the bathroom, return to bed, fall asleep. But for many, it’s not that easy. There are no-brainer strategies, of course, like limiting fluid intake (especially alcohol and caffeine) during the second half of the day and going to the bathroom right before bed. But for PWPs, it’s usually an issue of bladder control, a common problem now treated with many different medications and/or kegel exercises.

IMHO, "nocturia" is a problem if we view it as a problem.  In the past, I thought waking at 3 or 4 a.m. and not being able to get back to sleep was a problem because I needed to get at least seven hours of interrupted  sleep,  Now I realize that two separate periods of sleep is perfectly OK and may even be more natural that the uninterrupted sleep we've been sold on..After my middle-of-the-night bathroom visit, I enjoy spending an hour or so in mindfulness meditation, It's a favorite time of day (and night) for me.

So Many Possibilities
There are also other medical conditions – like acid reflux, sleep apnea, heart or kidney disease, obesity -- that impact sleep quality. Again, insomnia is a symptom of the larger problem, which needs to be addressed.

PWPs often experience something called “REM sleep behavioral disorder,” because our muscles fail to relax normally during sleep. People with this disorder end up “acting out" their dreams – screaming, moving, talking, even hitting and kicking their bed partners. Sufferers are usually unaware of the behavior.

As with all aspects of our well-being, we need to act as our own healthcare CEO if we’re having trouble sleeping . . . especially if PD is part of the problem. What’s really going on? How can I address the cause? As I have learned, sleeping well is at the very heart of the well-being I feel most of these days.

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There are many helpful sources for information about the relationship between sleep and Parkinson's disease. Here are just a few:

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