Parkinson's Disease

Sleep disorders are very common in patients with Parkinson’s disease including hallucinations, vivid dreams, violent movements during sleep and restless leg syndrome.

Many patients experience daytime sleepiness, which is a side effect of the dopamine agonist medications.

Parkinson’s disease is a slowly progressive condition resulting from deficiency of a chemical in the brain called dopamine.

Dopamine is a chemical messenger that allows the nerve cells to communicate with each other. Without the dopamine, messages from the brain to the muscles are disrupted.

Patients with Parkinson’s disease experience a significantly higher prevalence of frequent awakenings than diabetes patients or healthy elderly controls. The awakenings are related to motor disability, pain or depression.

Awakening can also be caused by sleep disorders such as sleep apnea. People with Parkinson’s disease complained daytime sleepiness and 20% of people were found to have moderate or severe sleep apnea.

REM sleep occurs in brief spurts of increased activity in the brain and is considered as dreaming stage of sleep. In REM sleep, eyes move rapidly beneath the eyelids. Dreaming mostly occurs during REM and the body is essentially paralyzed to avoid the acting out of dreams.

Rapid eye movement behavioral disorder is characterized by the acting out of violent dreams during REM sleep. Sometimes the person with RBD will shout during an episode. Sometimes it will be violent that bed partners will be injured.

Parkinson’s symptoms:

• Tremor or shaking when the body and limbs are at rest.
• Muscle stiffness or rigidity
• Difficulty with maintaining balance or postural instability
• Slowness and difficulty beginning a voluntary movement and difficulty with fine precise movements.
• Reduced manual dexterity.
• Urination at night.

The symptoms progress slow and become unnoticed for several years. Early signs include stiffness of fingers or stiff shoulder accompanied by stiffness of muscles. Symptoms usually affect one side of the body for one to two years and spread to other side.

Parkinson’s disease diagnosis:

The doctor will find out the symptoms and perform clinical examination. There are no specialized tests for Parkinson’s, but brain scans such as SPECT or PET scans support the diagnosis. These procedures help demonstrate the level of dopamine carrying protein within striatum. If Parkinson’s disease is present, the protein level is low.

Parkinson’s patient should undergo a polysomnographic sleep evaluation to characterize the nature of these episodes and to determine whether there is treatable cause. REM behavior disorder responds to treatment with clonazepam and sleep apnea is treated with continuous positive airway pressure.

Parkinson’s disease treatment:

There is no cure but there are options to relieve from symptoms. The missing dopamine should be replaced in the brain. Levodopa is a drug that is converted into dopamine in the brain. Prolong use of this drug causes severe side effects.

Therefore doctors, use other drugs to increase the dopamine levels which are called as dopamine agonists. These drugs are also having side effects and therefore doses should be taken carefully.

Occupational therapy and physiotherapy help people manage their condition by assisting with movement and providing advice on how to maintain independence in everyday life.