Sleep

Many people with Parkinson’s Disease (PD) have trouble sleeping. Good sleep is important not only for your PD, but also for your heart, memory, and overall health. It is important to aim for at least 7 hours of sleep per night.

Common Sleep Problems in PD

1. Trouble Sleeping (Insomnia):

  • Hard to fall asleep, stay asleep, or wake up too early.
  • Causes can include anxiety, stress, pain, frequent bathroom use, tremor, restless legs, or sleep apnea.
  • The best way to treat insomnia is with good “sleep hygiene” (healthy sleep habits).
  • Melatonin (a natural supplement) may help reset your sleep-wake cycle.

2. REM Sleep Behavior Disorder (RBD):

  • Acting out dreams, talking in sleep, or falling out of bed.
  • In PD, your body may not stay “paralyzed” during dreaming, so you may move or speak.
  • Safety tips: Lower your bed, use bed rails, keep the area next to your bed clear, and use pillows to cushion falls.
  • Melatonin can help, but sometimes stronger medications are needed.

3. Daytime Sleepiness:

  • Feeling very sleepy during the day and needing naps.
  • Common in PD, but can also be caused by other conditions or medications.
  • Treating the cause and improving nighttime sleep can help.

4. Restless Legs Syndrome (RLS):

  • Uncomfortable sensations in your legs at night (tingling, crawling, etc.). |
  • Often feels better with movement or stretching.
  • Try stretching, walking, using a weighted blanket, or drinking tonic water before bed.
  • Over-the-counter supplements like magnesium glycinate can be helpful.
  • PD medications can also help with symptoms.

5. Sleep Apnea:

  • Brief pauses in breathing during sleep, loud snoring, or waking up gasping.
  • Diagnosed with a sleep study.
  • Can be treated with a CPAP machine or, in some cases, surgery.
  • Treating sleep apnea is important for your brain, heart, and memory

Sleep hygiene education is the first step towards managing sleep disorders. It is proven to create healthy sleeping habits and improve quality of sleep.

  • Go to bed and wake up at the same time every day, even on weekends.
  • Use your bed only for sleep and intimacy.  Avoid using your bed for watching TV, using your phone, working, or eating.
  • Do not overstimulate yourself close to bedtime.  Try relaxing activities such as reading or listening to music.
  • Keep your bedroom dark, quiet, and a comfortable temperature.
  • Do not watch TV or use your phone in bed.  Try to avoid screen time at least 1 hour before bedtime.
  • Practice relaxation techniques like deep breathing, meditation, or mindfulness if he feels stressed or anxious at bedtime.
  • Avoid caffeine, alcohol, tea, or nicotine within 4 hours of bedtime.
  • Avoid self-medicating with alcohol to make yourself sleepy.
  • Exercise regularly throughout the day, but avoid vigorous exercise close to bedtime.

You may also look into Cognitive Behavioral Therapy for Insomnia (CBT-I).

CBT-I is a structured, evidence-based treatment that helps people overcome chronic insomnia. It works by retraining the brain with techniques like sleep restriction, stimulus control, relaxation training, and cognitive restructuring to improve sleep quality and duration. It is considered the first-line treatment for insomnia and has been shown to be effective for both short-term and long-term sleep problems.

  • Level 1: free resources and introductory tools that are likely effective in those with mild insomnia.
    – Download “insomnia coach” app.
    – Look at insomniacoach.com (different than the above app) and utilize the free emails and podcast.
  • Level 2:
    – Read “Say Goodnight to Insomnia,” by Gregg Jacobs, PhD.
    – Online CBT-I courses:
    thesleepreset.com
    drlullaby.com
    insomniacoach.com
  • Level 3: best evidence-based therapy for chronic insomnia.
    – Go to behavioralsleep.org and select a sleep therapist certified in CBT-I.
    – Complete a full course with them (usually one visit per week for 5-8 weeks).

Over-the-counter medications can occasionally be helpful:

If you have difficulties falling asleep (sleep-onset insomnia), you can try Immediate Release Melatonin 2-5mg tablets 1 hour before desired bedtime.

If you also have difficulties staying asleep (sleep-maintenance insomnia), early awakening, and/or mixed insomnia (combination of sleep-onset insomnia, sleep-maintenance insomnia, and early awakening), you can try Prolonged Release Melatonin 2-5mg tablets 1 hour before desired bedtime.

  • This medication helps reset your circadian rhythm (when your body knows it is time for sleep) and can help promote sustained sleep.
  • While melatonin does not sedate you, it can make you more tired.
  • The most common side effect is morning sleepiness.
  • It may take 4 to 6 weeks for each dose to take maximum effect.
  • You can safely increase dosage up to 15 mg (or even 20 mg) nightly if needed.
  • Melatonin needs to be used in combination with good sleep hygiene.

Author Mick Reedy, MD, is a Movement Disorders Specialist with
Inova Parkinson’s and Movement Disorders Center (IPMDC)