Sleeping disorder is a common non-motor symptom of Parkinson’s disease (PD), which becomes evident even before the disease is diagnosed. Due to PD-led physiological changes in the brain, most of the patients experience sleeping disorder. As disease prevails, many encounter trouble sleeping throughout the night as several symptoms like rigidity or tremor make them unconformable to fall asleep. Other PD symptoms such as Postural Instability and Depression – Anxiety may cause physical and mental pain whenever the patient tries to sleep.
Common nighttime sleep difficulties include difficulty falling asleep, difficulty staying asleep, (the return of motor symptoms when medications wear off) and early morning awakening (associated with depressed mood). Every third man with PD develops Rapid Eye Movement Sleep Behavior Disorder (RBD). Since people with RBD do not relax their muscles during sleep, they have restless sleep during the night. Sometimes, the patient experiences kicking, punching, running or getting out of bed due to PD-led RBD.
In more than half of patients with Parkinson’s, sleeping disorder gets converted into Insomnia. Unfortunately, sleep problems associated with PD are under-recognized and subsequently inadequately addressed.
Though several treatment options for sleeping disorder have been studied, their tolerability and effectiveness to improve sleep in patients are under research.
Management of sleep in PD often requires a multi-disciplinary approach. The patient should have an intimate knowledge of all sleep problems apparent in PD, knowing what ameliorate and aggravate the problem(s).
There are a number of medications available for easing non-motor symptoms of PD, including disturbed sleep. By targeting non-motor symptoms such as low blood pressure and anxiety, at times, sleep disorders are treated. Significant research is going on to discover improved medications for non-motor symptoms. A long-acting Levodopa might prevent PD symptoms from returning during the night, while for RBD, Melatonin or Clonazepam may be prescribed. If depression and anxiety are keeping the patient awake at night, Antidepressants can be prescribed to help nighttime sleep.
The psychosocial benefits of Yoga are also important for management of certain PD symptoms. With Pranayama (a collection of breathing exercises), the calming effect of Yoga may lessen perceived stress, relax the brain and promote better sleep.
Certain medical studies hint that Yoga may have a neuroprotective effect. This justifies why yoga practitioners experience a significant increase in pain tolerance and a change in pain thresholds. Increase in pain tolerance enhances relaxation and help the patient correct sleep disorders. Yoga Nidra is such guided meditative, relaxation, visualization practice that aims at resolving common sleep disorders.
A few visualization interventions (Motor Imagery, Virtual Reality Training and Guided Imagery) are emerging as compensatory techniques for managing sleep disorders in PD. By making use of the cognitive function to enhance movement, balance and mobility in individuals with PD, these techniques address sleep disorders.
Guided Imagery (GI) takes stress reduction approach to treat the sleeping disorder in PD. Through GI, the patient concentrates the mind on positive images or thoughts to reduce stress and anxiety. Since sleep can be disturbed by tremors, this relatively new method promises to promote healthy growth of neurotransmitters. When an individual interprets positive images as real, a relaxation response is created to counteract the stress response. GI-led lowered blood pressure and heart rate also result in better sleep management.
Since sound is an important non-verbal means of communication, Music Therapy can produce substantial psychological improvements in PD patients. Mostly, PD fighters experience tremors, which contribute to the uneven sleep pattern. To address these, slow rhythmic music is used to slow down overactive body rhythms and induce relaxation and sleep.