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Sleep Dysfunction and its Management in Parkinson’s Disease

  • Sleep Disorders (S Chokroverty, Section Editor)
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Opinion statement

Sleep disorders are among the most common non-motor symptoms in Parkinson’s Disease (PD). In some cases, symptoms can precede a diagnosis of PD by many years, but otherwise they are commonly encountered during the clinical care of patients. Unfortunately, sleep problems are under-recognized and subsequently inadequately addressed. In our experience, when properly addressed, physicians and patients are quickly aware of the often-debilitating nature of sleep dysfunction. This does not mean that solutions are easily attainable. Sleep in PD is held in a delicate balance, influenced by the disease process, medications, co-morbid symptoms, and a variety of other factors. For this reason, management of sleep in PD often requires an inter-disciplinary approach. Physicians should have an intimate knowledge of the many sleep problems apparent in PD, as well as appreciate the challenge presented by diverse therapeutic options that can both ameliorate and aggravate symptoms.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Factor SA, McAlarney T, Sanchez-Ramos JR, Weiner WJ. Sleep disorders and sleep effect in Parkinson’s disease. Mov Disord. 1990;5(4):280–5.

    Article  CAS  PubMed  Google Scholar 

  2. Brunner H, Wetter TC, Hogl B, Yassouridis A, Trenkwalder C, Friess E. Microstructure of the non-rapid eye movement sleep electroencephalogram in patients with newly diagnosed Parkinson’s disease: effects of dopaminergic treatment. Mov Disord. 2002;17(5):928–33.

    Article  PubMed  Google Scholar 

  3. Hublin C, Partinen M, Heinonen EH, Puukka P, Salmi T. Selegiline in the treatment of narcolepsy. Neurology. 1994;44(11):2095–101.

    Article  CAS  PubMed  Google Scholar 

  4. Huete B, Varona L. Insomnia during treatment with amantadine. Rev Neurol. 1997;25(148):2062.

    CAS  PubMed  Google Scholar 

  5. Schredl M, Hornung O, Regen F, Albrecht N, Danker-Hopfe H, Heuser I. The effect of donepezil on sleep in elderly, healthy persons: a double-blind placebo-controlled study. Pharmacopsychiatry. 2006;39(6):205–8.

    Article  CAS  PubMed  Google Scholar 

  6. Chung S, Bohnen NI, Albin RL, Frey KA, Müller ML, Chervin RD. Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. J Clin Sleep Med. 2013;9(11):1131–7. A correlative study relating sleep measures to features of PD.

    PubMed Central  PubMed  Google Scholar 

  7. Meindorfner C, Korner Y, Moller JC, Stiasny-Kolster K, Oertel WH, Kruger HP. Driving in Parkinson’s disease: mobility, accidents, and sudden onset of sleep at the wheel. Mov Disord. 2005;20(7):832–42.

    Article  PubMed  Google Scholar 

  8. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

    CAS  PubMed  Google Scholar 

  9. Porter B, Macfarlane R, Walker R. The frequency and nature of sleep disorders in a community-based population of patients with Parkinson’s disease. Eur J Neurol. 2008;15(1):50–4.

    CAS  PubMed  Google Scholar 

  10. Pappert EJ, Goetz CG, Niederman FG, Raman R, Leurgans S. Hallucinations, sleep fragmentation, and altered dream phenomena in Parkinson’s disease. Mov Disord. 1999;14(1):117–21.

    Article  CAS  PubMed  Google Scholar 

  11. Stavitsky K, Neargarder S, Bogdanova Y, McNamara P, Cronin-Golomb A. The impact of sleep quality on cognitive functioning in Parkinson’s disease. J Int Neuropsychol Soc. 2012;18(1):108–17. A case-control study looking at cognitive testing in PD.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Loo HV, Tan EK. Case-control study of restless legs syndrome and quality of sleep in Parkinson’s disease. J Neurol Sci. 2008;266(1–2):145–9.

    Article  PubMed  Google Scholar 

  13. Bhalsing K, Suresh K, Muthane UB, Pal PK. Prevalence and profile of Restless Legs Syndrome in Parkinson’s disease and other neurodegenerative disorders: a case-control study. Parkinsonism Relat Disord. 2013;19(4):426–30.

    Article  PubMed  Google Scholar 

  14. Peeraully T, Tan EK. Linking restless legs syndrome with Parkinson’s disease: clinical, imaging and genetic evidence. Trans Neurodegener. 2012;1(1):6. doi:10.1186/2047-9158-1-6.

    Article  CAS  Google Scholar 

  15. Allen, RP, Garcia-Borreguero D, Ondo W, Walters A, Winkelman J, Zucconi M, et al. Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria – history, rationale, description, and significance. Sleep Med. 2014. doi:10.1016/j.sleep.2014.03.025.

  16. Videnovic A, Noble C, Reid KJ, Peng J, Turek FW, Marconi A, et al. Circadian melatonin rhythm and excessive daytime sleepiness in Parkinson disease. JAMA Neurol. 2014;71(4):463–9.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Bolitho SJ, Naismith SL, Rajaratnam SM, Grunstein RR, Hodges JR, Terpening Z, et al. Disturbances in melatonin secretion and circadian sleep-wake regulation in Parkinson disease. Sleep Med. 2014;15(3):342–7.

    Article  CAS  PubMed  Google Scholar 

  18. Wagner DR. Circadian rhythm sleep disorders. Curr Treat Options Neurol. 1999;1(4):299–308.

    Article  PubMed  Google Scholar 

  19. Muntean ML, Sixel-Döring F, Trenkwalder C. REM sleep behavior disorder in Parkinson’s disease. J Neural Transm. 2014. doi:10.1007/s00702-014-1192-4

  20. Aurora RN, Zak RS, Maganti RK, Auerbach SH, Casey KR, Chowdhuri S, et al. Standards of Practice Committee; American Academy of Sleep Medicine. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 2010;6(1):85–95. Erratum in: J Clin Sleep Med. 2010 Apr 15;6(2):table of contents.

    PubMed Central  PubMed  Google Scholar 

  21. Comella CL. Sleep disorders in Parkinson’s disease: an overview. Mov Disord. 2007;22 Suppl 17:S367–73.

    Article  PubMed  Google Scholar 

  22. Trotti LM, Bliwise DL. No increased risk of obstructive sleep apnea in Parkinson’s disease. Mov Disord. 2010;25(13):2246–9.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Nomura T, Inoue Y, Kobayashi M, Namba K, Nakashima K. Characteristics of obstructive sleep apnea in patients with Parkinson’s disease. J Neurol Sci. 2013;327(1–2):22–4. PSG study examining similarities and differences in OSA between PD patients and controls.

    Article  PubMed  Google Scholar 

  24. Chahine LM, Daley J, Horn S, Duda JE, Colcher A, Hurtig H, et al. Association between dopaminergic medications and nocturnal sleep in early-stage Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(10):859–63.

    Article  PubMed  Google Scholar 

  25. Ataide M, Franco CM, Lins OG. Daytime sleepiness in Parkinson’s disease: perception, influence of drugs, and mood disorder. Sleep Disord. 2014;2014:939713.

    CAS  PubMed Central  PubMed  Google Scholar 

  26. Garcia-Borreguero D, Kohnen R, Silber MH, Winkelman JW, Earley CJ, Högl B, et al. The long-term treatment of restless legs syndrome/Willis-Ekbom disease: evidence-based guidelines and clinical consensus best practice guidance: a report from the International Restless Legs Syndrome Study Group. Sleep Med. 2013;14(7):675–84.

    Article  PubMed  Google Scholar 

  27. Williams AM, Garcia-Borreguero D. Management of restless legs syndrome augmentation. Curr Treat Options Neurol. 2009;11(5):327–32.

    Article  PubMed  Google Scholar 

  28. Razmy A, Lang AE, Shapiro CM. Predictors of impaired daytime sleep and wakefulness in patients with Parkinson disease treated with older (ergot) vs newer (nonergot) dopamine agonists. Arch Neurol. 2004;61(1):97–102.

    Article  PubMed  Google Scholar 

  29. Ferreira JJ, Desboeuf K, Galitzky M, Thalamas C, Brefel-Courbon C, Fabre N, et al. Sleep disruption, daytime somnolence and ‘sleep attacks’ in Parkinson’s disease: a clinical survey in PD patients and age-matched healthy volunteers. Eur J Neurol. 2006;13(3):209–14.

    Article  CAS  PubMed  Google Scholar 

  30. Roth T, Rye DB, Borchert LD, Bartlett C, Bliwise DL, Cantor C, et al. Assessment of sleepiness and unintended sleep in Parkinson’s disease patients taking dopamine agonists. Sleep Med. 2003;4(4):275–80.

    Article  PubMed  Google Scholar 

  31. Schmidt MH, Koshal VB, Schmidt HS. Use of pramipexole in REM sleep behavior disorder: results from a case series. Sleep Med. 2006;7(5):418–23.

    Article  PubMed  Google Scholar 

  32. Kumru H, Iranzo A, Carrasco E, Valldeoriola F, Marti MJ, Santamaria J, et al. Lack of effects of pramipexole on REM sleep behavior disorder in Parkinson disease. Sleep. 2008;31(10):1418–21.

    PubMed Central  PubMed  Google Scholar 

  33. Driver-Dunckley ED, Noble BN, Hentz JG, Evidente VG, Caviness JN, Parish J, et al. Gambling and increased sexual desire with dopaminergic medications in restless legs syndrome. Clin Neuropharmacol. 2007;30(5):249–55.

    Article  CAS  PubMed  Google Scholar 

  34. Trenkwalder C, Kies B, Rudzinska M, Fine J, Nikl J, Honczarenko K, et al. Rotigotine effects on early morning motor function and sleep in Parkinson’s disease: a double-blind, randomized, placebo-controlled study (RECOVER). Mov Disord. 2011;26(1):90–9. Double-blind, randomized, placebo-controlled trial examining effects of rotigotine on PD symptoms, including sleep.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Ray Chaudhuri K, Martinez-Martin P, Antonini A, Brown RG, Friedman JH, Onofrj M, et al. Rotigotine and secific non-motor symptoms of Parkinson’s disease: post hoc analysis of RECOVER. Parkinsonism Relat Disord. 2013;19(7):660–5.

    Article  CAS  PubMed  Google Scholar 

  36. Dohin E, Högl B, Ferini-Strambi L, Schollmayer E, Fichtner A, Bauer L, et al. Safety and efficacy of rotigotine transdermal patch in patients with restless legs syndrome: a post-hoc analysis of patients taking 1-3 mg/24 h for up to 5 years. Expert Opin Pharmacother. 2013;14(1):15–25.

    Article  CAS  PubMed  Google Scholar 

  37. Giladi N, Boroojerdi B, Surmann E. The safety and tolerability of rotigotine transdermal system over a 6-year period in patients with early-stage Parkinson’s disease. J Neural Transm. 2013;120(9):1321–9.

    Article  CAS  PubMed  Google Scholar 

  38. Trotti LM, Bliwise DL. Treatment of the sleep disorders associated withParkinson’s disease. Neurotherapeutics. 2014;11(1):68–77. doi:10.1007/s13311-013-0236-z.

    Article  CAS  PubMed  Google Scholar 

  39. Gugger JJ, Wagner ML. Rapid eye movement sleep behavior disorder. Ann Pharmacother. 2007;41(11):1833–41.

    Article  PubMed  Google Scholar 

  40. Yaltho TC, Ondo WG. The use of gabapentin enacarbil in the treatment of restless legs syndrome. Ther Adv Neurol Disord. 2010;3(5):269–75.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Allen RP, Chen C, Garcia-Borreguero D, Polo O, DuBrava S, Miceli J, et al. Comparison of pregabalin with pramipexole for restless legs syndrome. N Engl J Med. 2014;370(7):621–31. Double-blind, randomized trial comparing high-dose pregabalin to low-dose pramipexole for symptoms of RLS and side effects of augmentation.

    Article  CAS  PubMed  Google Scholar 

  42. Lo HS, Yang CM, Lo HG, Lee CY, Ting H, Tzang BS. Treatment effects of gabapentin for primary insomnia. Clin Neuropharmacol. 2010;33(2):84–90.

    Article  CAS  PubMed  Google Scholar 

  43. Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, Nielsen GH, Nordhus IH. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006 Jun 28;295(24):2851–8.

  44. FDA requires lower dosing of zolpidem. Med Lett Drugs Ther. 2013 Jan 21;55(1408):5. PubMed PMID: 23348358.

  45. Menza M, Dobkin RD, Marin H, Gara M, Bienfait K, Dicke A, et al. Treatment of insomnia in Parkinson’s disease: a controlled trial of eszopiclone and placebo. Mov Disord. 2010;25(11):1708–14.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Chen LF, Lin CE, Chou YC, Mao WC, Chen YC, Tzeng NS. A comparison of complex sleep behaviors with two short-acting Z-hypnosedative drugs in nonpsychotic patients. Neuropsychiatr Dis Treat. 2013;9:1159–62.

    PubMed Central  PubMed  Google Scholar 

  47. Dubois B, Tolosa E, Katzenschlager R, Emre M, Lees AJ, Schumann G, et al. Donepezil in Parkinson’s disease dementia: a randomized, double-blind efficacy and safety study. Mov Disord. 2012;27(10):1230–8.

    Article  CAS  PubMed  Google Scholar 

  48. Massironi G, Galluzzi S, Frisoni GB. Drug treatment of REM sleep behavior disorders in dementia with Lewy bodies. Int Psychogeriatr. 2003;15(4):377–83.

    Article  PubMed  Google Scholar 

  49. Schredl M, Hornung O, Regen F, Albrecht N, Danker-Hopfe H, Heuser I. The effect of donepezil on sleep in elderly, healthy persons: a double-blind placebo-controlled study. Pharmacopsychiatry. 2006;39(6):205–8.

    Article  CAS  PubMed  Google Scholar 

  50. Fernandez HH, Okun MS, Rodriguez RL, Malaty IA, Romrell J, Sun A, et al. Quetiapine improves visual hallucinations in Parkinson disease but not through normalization of sleep architecture: results from a double-blind clinical-polysomnography study. Int J Neurosci. 2009;119(12):2196–205.

    Article  CAS  PubMed  Google Scholar 

  51. Juri C, Chaná P, Tapia J, Kunstmann C, Parrao T. Quetiapine for insomnia in Parkinson disease: results from an open-label trial. Clin Neuropharmacol. 2005;28(4):185–7.

    Article  CAS  PubMed  Google Scholar 

  52. Trosch RM, Friedman JH, Lannon MC, Pahwa R, Smith D, Seeberger LC, et al. Clozapine use in Parkinson’s disease: a retrospective analysis of a large multicentered clinical experience. Mov Disord. 1998;13(3):377–82.

    Article  CAS  PubMed  Google Scholar 

  53. Zolkowska D, Jain R, Rothman RB, Partilla JS, Roth BL, Setola V, et al. Evidence for the involvement of dopamine transporters in behavioral stimulant effects of modafinil. J Pharmacol Exp Ther. 2009;329(2):738–46.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Lou JS, Dimitrova DM, Park BS, Johnson SC, Eaton R, Arnold G, et al. Using modafinil to treat fatigue in Parkinson disease: a double-blind, placebo-controlled pilot study. Clin Neuropharmacol. 2009;32(6):305–10.

    Article  CAS  PubMed  Google Scholar 

  55. Tyne HL, Taylor J, Baker GA, Steiger MJ. Modafinil for Parkinson’s disease fatigue. J Neurol. 2010;257(3):452–6. doi:10.1007/s00415-009-5351-8.

    Article  CAS  PubMed  Google Scholar 

  56. Rugino T. A review of modafinil film-coated tablets for attention-deficit/hyperactivity disorder in children and adolescents. Neuropsychiatr Dis Treat. 2007;3(3):293–301.

    CAS  PubMed Central  PubMed  Google Scholar 

  57. Cicolin A, Lopiano L, Zibetti M, Torre E, Tavella A, Guastamacchia G, et al. Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med. 2004;5(2):207–10.

    Article  PubMed  Google Scholar 

  58. Lyons KE, Pahwa R. Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease. J Neurosurg. 2006;104(4):502–5.

    Article  PubMed  Google Scholar 

  59. Antonini A, Landi A, Mariani C, DeNotaris R, Pezzoli G. Deep brain stimulation and its effect on sleep in Parkinson’s disease. Sleep Med. 2004;5(2):211–4.

    Article  CAS  PubMed  Google Scholar 

  60. Chahine LM, Ahmed A, Sun Z. Effects of STN DBS for Parkinson’s disease on restless legs syndrome and other sleep-related measures. Parkinsonism RelatDisord. 2011;17(3):208–11.

    Article  CAS  Google Scholar 

  61. Peppe A, Pierantozzi M, Baiamonte V, Moschella V, Caltagirone C, Stanzione P, et al. Deep brain stimulation of pedunculopontine tegmental nucleus: role in sleep modulation in advanced Parkinson disease patients: one-year follow-up. Sleep. 2012;35(12):1637–42.

    PubMed Central  PubMed  Google Scholar 

  62. Nascimento CM, Ayan C, Cancela JM, Gobbi LT, Gobbi S, Stella F. Effect of a multimodal exercise program on sleep disturbances and instrumental activities of daily living performance on Parkinson’s and Alzheimer’s disease patients. Geriatr Gerontol Int. 2014;14(2):259–66.

    Article  PubMed  Google Scholar 

  63. Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, et al. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep. 2014;37(1):177–85. Randomized, placebo-controlled, crossover study examining effectiveness of CPAP in PD patient population.

    PubMed Central  PubMed  Google Scholar 

  64. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman Jr J, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499–521. Review.

    PubMed  Google Scholar 

  65. Willis GL, Moore C, Armstrong SM. A historical justification for and retrospective analysis of the systematic application of light therapy in Parkinson’s disease. Rev Neurosci. 2012;23(2):199–226.

    CAS  PubMed  Google Scholar 

  66. Rutten S, Vriend C, van den Heuvel OA, Smit JH, Berendse HW, van der Werf YD. Bright light therapy in Parkinson’s disease: an overview of the background and evidence. Park Dis. 2012;2012:767105.

    Google Scholar 

  67. Paus S, Schmitz-Hübsch T, Wüllner U, Vogel A, Klockgether T, Abele M. Bright light therapy in Parkinson’s disease: a pilot study. Mov Disord. 2007;22(10):1495–8.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Scott J Kutscher and Siavash Farshidpanah declare that they have no conflicts of interest.

Daniel O Claassen declares that he has received personal fees from Lundbeck, grants and personal fees from Teva Neuroscience, personal fees from General Electric, grants from Auspex , personal fees from Chelsea Pharmacutical, and grants from NINDS/ NIH.

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This article does not contain any studies with human or animal subjects performed by the author.

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  1. Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, A-0118 Medical Center North, Nashville, TN, 37232, USA

    Scott J. Kutscher MD, Siavash Farshidpanah MD & Daniel O. Claassen MD

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  1. Scott J. Kutscher MD
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  2. Siavash Farshidpanah MD
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Correspondence to Scott J. Kutscher MD.

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Kutscher, S.J., Farshidpanah, S. & Claassen, D.O. Sleep Dysfunction and its Management in Parkinson’s Disease. Curr Treat Options Neurol 16, 304 (2014). https://doi.org/10.1007/s11940-014-0304-7

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