Problems and Parkinson's Disease
by Kathryn A. Cullen, B.S.N., M.S.
This article is excerpted from the APDA's booklet, Coping With Parkinson's Disease
Like it or not we spend about a third of our life sleeping. Some people think of it as a waste of time and some love it, but regardless of your feelings, we all need it. Unfortunately, Parkinson's disease (PD) in its insidious way can affect sleep patterns too.
Sleep patterns can be disrupted by PD in a number of ways. Many complain that they are tired all day and sleep in naps frequently. Others have trouble falling asleep, awaken several times during the night or wake up early every morning. For some people with PD, the night is dreaded because of vivid dreams, hallucinations, night cramps, restlessness, or trouble getting into, out of or from side to side in bed. Frequent urination can cause sleep disturbance as can depression, anxiety, shortness of breath, heartburn, and discomfort from pain or other sensory complaints such as burning, cool or sensitive extremities. Spouses, too, complain about their mates with PD who kick them when the PD person's leg jumps out uncontrollably or who awaken them with cries or "night terrors.''
No matter what the problem, it is fatiguing enough to struggle with the daily challenges of tremors, stiffness, slowness, impaired coordination and balance problems without the added difficulties encountered when a person does not get a good night's sleep.
The first step in solving the problem is to identify that there is indeed a problem. If you go to bed at 7 p.m. and awaken at 3 a.m., then you slept for 8 hours and maybe you feel refreshed and this is satisfactory. As a person ages, one may not need the same amount of sleep so maybe 5 hours is enough, and if you go to bed at 10 p.m. and awaken at 3 a.m. this would be adequate. However, many may find that sleeping 5 hours or 8 hours is not letting them awaken refreshed. This might be due to poor quality sleep with frequent awakenings, or interruption of the more restful parts of your sleep cycle.
In deciding if sleep is a problem, you also need to ask the question: Who is it a problem for? Is the person with PD happy with the amount of sleep or is it the spouse who has the problem because there is worry that the person with PD will get out of bed and fall?
If you are having sleep problems, it is important to discuss this with your doctor and give him the information to help you. Think about the specifics of your problem as noted above and see if you can see a pattern. For example, if you are having painful cramping, when does it occur? When was your last dose of Sinemet before going to bed? Did the problem start after you began a new medication?
Medications may sometimes be responsible. Sinemet and Parlodel can cause vivid dreams, hallucinations, leg cramps, abnormal movements and daytime drowsiness. If you don't take a diuretic early enough, it can cause frequent night urination. Some tranquilizers and sleep medications commonly used remain in your system a long time and can cause daytime drowsiness that disturbs your evening's sleep. Some breathing, seizure, high blood pressure or allergy medications can cause excitation as can Sinemet on occasion. Do not forget that over-the-counter pills such as decongestants or antihistamines may cause sleep problems too.
Many people forget that food is often a culprit. Avoid stimulants, especially caffeine. Caffeine is found in such things as tea and chocolate as well as coffee. Alcohol may initially make you tired but can ultimately be a stimulant causing early-morning awakening.
There are many things that can be done to improve your sleep once the problem is identified. I have listed some common problems and what you can do:
Bed Mobility Problems
Trying side rails, a trapeze, ropes or a handle to grip; using satin sheets or pajamas; or changing to a firmer, lower or higher mattress may help. Physical therapists may also be able to help with bed mobility, and occupational therapists may recommend adaptations in addition to those noted above.
Trouble Getting to Sleep
Avoid stimulants during the day and in the evening especially. Do not nap excessively during the day and try to have activities that keep you busy. Avoid using your bedroom for other activities such as reading, watching TV or business. The old time remedies such as a warm glass of milk, back rubs or expressions of affection do still work too. If this doesn't work, you should also discuss this with your doctor. Depression can often cause trouble falling asleep. Your doctor may order one of the many antidepressants that can also have anti-Parkinson's and sedative properties too. A short acting sleeping pill that doesn't interact with your PD medications may also be ordered.
Shortness of Breath, Heartburn or Trouble Getting Out of Bed
Raise the head of the bed with blocks or extra pillows. Discuss shortness of breath and heartburn with your doctor.
Foot and Leg Sensitivity or Trouble Turning in Bed
Adapt the bed with a bed hoop, blanket cradle, electric blanket or light down comforter in order to keep the bedcovers off the feet and legs. You |also need to discuss sensory complaints withyour doctor because it couldbe related to another medical problem.
Restless Legs, Painful Cramping or Abnormal Movements
Once again you need to discuss this with yourdoctor who mightchange the times or dosages of yourmedications or order other medications for pain, spasm, cramps or anxiety. Youmight also try going throughsome relaxation techniques or slow, relaxing stretching exercises that won't stimulate you too much.
Fear of Falling
Make your home safer by taking up scatter rugs or putting in a nightlight. You might use a walker at night if you can coordinate one. Make sure you do not get up too quickly or you might become dizzy if you change position too quickly.
Discuss this with your primary doctors neurologist or urologist to correct medical problems such as prostate problems, urinary retention or infections. You also could put a urinal or commode near the bedside.
Sleep disturbances should be taken seriously and should be discussed with your doctor. Getting a good night's sleep will help you and your spouse cope better with the challenges that Parkinson's disease presents.
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