Current Neurology and Neuroscience Reports

, Volume 3, Issue 2, pp 173–180

Sleep disturbances in Parkinson’s disease

  • Cynthia L. Comella


Disorders of sleep and daytime alertness are frequent in Parkinson’s disease patients and arise from a number of diverse factors. The most common complaint of night-time sleep disturbance in Parkinson’s disease is sleep fragmentation. Sleep fragmentation can be associated with recurrent parkinsonian symptoms, the effect of medications, concomitant medical disorders such as nocturia, or psychiatric disorders such as depression or anxiety. Likewise, nocturnal sleep disturbance may arise from sleep apnea, periodic limb movements of sleep, or rapid eye movement (REM) sleep behavior disorder. Nocturnal sleep deprivation may lead to excessive daytime sleepiness. Other potential sources of daytime sleepiness include the effects of medications or disruption of central sleep mechanisms due to the pathologic processes of Parkinson’s disease itself. Diagnosis of sleep disturbances and daytime sleepiness requires a direct interview of the patient and the caregiver, and may involve consultation with the sleep specialist or medical physician. Treatment is aimed toward improving night-time sleep and daytime drowsiness by addressing the causative factors.


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References and Recommended Reading

  1. 1.
    ParkinsonJ: An Essay on the Shaking Palsy. London: Whittingham and Rowland, 1817.Google Scholar
  2. 2.
    Tandberg E, Larsen JP, Karlsen K: A community-based study of sleep disorders patients with Parkinson’s disease. Mov Disord 1998, 13:895–899.PubMedCrossRefGoogle Scholar
  3. 3.
    Lees AJ, Blackburn NA, Campbell VL: The night-time problems of Parkinson’s disease. Clin Neuropharm 1988, 11:512–519.CrossRefGoogle Scholar
  4. 4.
    Carter J, Carroll S, Lannon MC: Sleep disruption in untreated Parkinson’s disease. Neurology 1990, 40(suppl 1):220.Google Scholar
  5. 5.
    Karlsen KH, Larsen JP, Tandberg E, Maeland JG: Influence of clinical and demographic variables on quality of life in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999, 66:431–435.PubMedGoogle Scholar
  6. 6.
    Smith MC, Ellgring H, Oertel WH: Sleep disturbances in Parkinson’s disease patients and spouses. J Am Geriatr Soc 1997, 45:194–199.PubMedGoogle Scholar
  7. 7.
    Factor SA, McAlarney T, Sanches-Ramos JR, Weiner WJ: Sleep disorders and sleep effect in Parkinson’s disease. Mov Disord 1990, 5:280–285.PubMedCrossRefGoogle Scholar
  8. 8.
    Stern M, Roffwang H, Duvoisin R: The parkinsonian tremor in sleep. J Nerv Ment Dis 1968, 147:202–210.PubMedCrossRefGoogle Scholar
  9. 9.
    Askenasy JM, Yahr MD: Reversal of sleep disturbance in Parkinson’s Disease by antiparkinsonian therapy: a preliminary study. Neurology 1985, 35:527–532.PubMedGoogle Scholar
  10. 10.
    Laihinen A, Alihanka J, Raitasuo S, Rinne UK: Sleep movements and associated autonomic nervous activities in patients with Parkinson’s disease. Acta Neurol Scand 1987, 76:64–68.PubMedGoogle Scholar
  11. 11.
    Happe S, Schrode B, Faltl M, et al.: Sleep disorders and depression in patients with Parkinson disease. Acta Neurol Scand 2001, 104:275–280.PubMedCrossRefGoogle Scholar
  12. 12.
    Adler CH, Sethi KD, Hauser RA, et al., for the Ropinirole Study Group: Ropinirole for the treatment of early Parkinson’s disease. Neurology 1997, 49:393–399.PubMedGoogle Scholar
  13. 13.
    Shannon KM, Bennett JP, Friedman JH, for the Pramipexole Study Group: Efficacy of pramipexole, a novel dopamine agonist, as monotherapy in mild to moderate Parkinson’s disease. Neurology 1997, 49:724–728.PubMedGoogle Scholar
  14. 14.
    Lesser RP, Fahn S, Snider S, et al.: Analysis of the clinical problems in parkinsonism and the complications of long-term levodopa therapy. Neurology 1979, 29:1253–1260.PubMedGoogle Scholar
  15. 15.
    Wauquier A, Clincke G, van den Broek W, de Prins E:Active and permissive roles of dopamine in sleep-wakefulness regulations. In Sleep: Neurotransmitters and Neuromodulators. Edited by WauquierJM, GaillardJ, MontiM, Radulovacki. New York: Raven Press; 1985:107–120.Google Scholar
  16. 16.
    Hobson DE, Lang AE, Martin WR, et al.: Excessive daytime sleepiness and sudden onset sleep in Parkinson’s disease: s survey by the Canadian Movement Disorders Group. JAMA 2002, 287:455–463. The largest series of Parkinson’s disease patients assessed for excessive daytime sleepiness. This study provides a clinically usable intrument for office evaluation of excessive daytime sleepiness.PubMedCrossRefGoogle Scholar
  17. 17.
    Van Hilten B, Hoff JI, Middelkoop AM, et al.: Sleep disruption in Parkinson’s disease. Arch Neurol 1994, 51:922–928.PubMedGoogle Scholar
  18. 18.
    Gillin JC, Post RM, Wyatt R, et al.: REM inhibitory effect of l-dopa infusion during human sleep. Electroenceph Clin Neurophys 1973, 35:181–186.CrossRefGoogle Scholar
  19. 19.
    Wyatt RJ, Chase TN, Scott J, Snyder F: Effect of l-dopa on the sleep of man. Nature 1970, 228:999–1001.PubMedCrossRefGoogle Scholar
  20. 20.
    Kales A, Ansel RD, Markham CH, et al.: Sleep in patients with Parkinson’s Disease and in normal subjects prior to and following levodopa administration. Clin Pharmacol Ther 1971, 12:397–406.PubMedGoogle Scholar
  21. 21.
    Schmidt HS, Knopp W: Sleep in Parkinson’s Disease: the effect of l-dopa. Psychophysiology 1972, 9:88–89.Google Scholar
  22. 22.
    WaltersAS, and the International Restless Legs Syndrome Study Group: Toward a better definition of the Restless Legs Syndrome. Move Disord 1995, 10:634–642.CrossRefGoogle Scholar
  23. 23.
    Apps M, Shaff P, Ingram D, et al.: Respiration and sleep in Parkinson’s Disease. J Neurol Neurosurg Psychiatry 1985, 48:1240–1245.PubMedGoogle Scholar
  24. 24.
    Ferini-Strambi L, Franceschi M, Pinto P, et al.: Respiration and heart rate variability during sleep in untreated Parkinson patients. Gerontology 1992, 38:92–98.PubMedCrossRefGoogle Scholar
  25. 25.
    Arnulf I, Konofal E, Merino-Amdreu M, et al.: Parkinson’s disease and sleepiness. An integral part of PD. Neurology 2002, 58:1019–1024. This study provides evidence that suggests excessive daytime sleepiness as a part of Parkinsons’s disease rather than solely an effect of external factors.PubMedGoogle Scholar
  26. 26.
    Wetter TC, Collado-Seidel V, Pollmacjer T, et al.: Sleep and periodic leg movement patterns in drug-free patients with Parkinson’s disease and multiple system atrophy. Sleep 2000, 23:361–366. This study is one of the few that applies polysomnography to Parkinson’s disease, multiple system atrophy, and normal aged-matched control subjects. It shows that rapid eye movement disorders are more common in the parkinsonian syndromes than normal subjects.PubMedGoogle Scholar
  27. 27.
    JonesBE: Paradoxical sleep and its chemical structural substrates in the brain. Neuroscience 1991, 40:637–656.PubMedCrossRefGoogle Scholar
  28. 28.
    ColemanJ: Sleep apnea, part 2. Otolaryngol Clin North Am 1999, 32:195–210.PubMedCrossRefGoogle Scholar
  29. 29.
    Hendricks JC, Morrison AR, Mann GL: Different behaviors during paradoxical sleep without atonia depends on pontine lesion site. Brain Res 1982, 239:81–105.PubMedCrossRefGoogle Scholar
  30. 30.
    Schenk CS, Bundie SR, Ettinger MG, Mahowald MW: Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986, 9:293–308.Google Scholar
  31. 31.
    Schenck CH, Mahowald MW: REM sleep behavior disorder: clinical developmental and neuroscience perspectives 16 years after its formal identification in Sleep. Sleep 2002, 25:120–138. This article reviews all of the salient features of rapid eye movement sleep behvior disorder and provides some intriguing suggestions as to pathophysiology.PubMedGoogle Scholar
  32. 32.
    American Sleep Disorders Association: REM sleep behavior disorder. InThe International Classification of Sleep Disorders. Kansas: Allen Press; 1990:177–180.Google Scholar
  33. 33.
    Comella CL, Nardine TM, Diederich NJ, Stebbins GT: Sleeprelated violence, injury, and REM sleep behavior disorder in Parkinson’s disease. Neurology 1998, 51:526–529.PubMedGoogle Scholar
  34. 34.
    Schenck CH, Milner DM, Hurwitz TD, et al.: A polysomnographic and clinical report on sleep-related injury in 100 adult patients. Am J Psychiatry 1989, 146:1166–1173.PubMedGoogle Scholar
  35. 35.
    Arnulf I, Bonnet AM, Damier P, et al.: Hallucinations, REM sleep, and Parkinson’s disease. A medical hypothesis. Neurology 2000, 55:281–288. This study is the first to associate the occurrence of rapid eye movement sleep intrusions with delusions in Parkinson’s disease patients on dopaminergic medications by comparing hallucinating patients to nonhallucinating patients using polysomnography and multiple sleep latency test.PubMedGoogle Scholar
  36. 36.
    Eisensehr I, Lindeiner HV, Jager M, Noachtar S: REM sleep behavior disorder in sleep-disordered patients with versus without Parkinson’s disease:is there a need for polysomnography. J Neurol Sci 2001, 186:7–11.PubMedCrossRefGoogle Scholar
  37. 37.
    Boeve BF, Silber MH, Ferman TJ, et al.: REM sleep behavior disorder and degenerative dementia. An association likely reflecting Lewy body disease. Neurology 1998, 51:363–370.PubMedGoogle Scholar
  38. 38.
    Plazzi G, Corsini R, Peirangeli G, et al.: REM sleep behavior disorders in multiple system atrophy. Neurology 1997, 48:1094–1097.PubMedGoogle Scholar
  39. 39.
    Culebras A, Moore JT: Magnetic resonance findings in REM sleep behavior disorder. Neurology 1989, 39:1519–1523.PubMedGoogle Scholar
  40. 40.
    Albin RL, Koeppe RA, Chervin RD, et al.: Decreased striatal dopaminergic innervation in REM sleep behavior disorder. Neurology 2000, 55:1410–1412.PubMedGoogle Scholar
  41. 41.
    Eisensehr I, Linke R, Noachtar S, et al.: Reduced striatal dopamine transporters in idiopathic rapid eye movement sleep behavior disorder: comparison with Parkinson’s disease and controls. Brain 2000, 123:1155–1160.PubMedCrossRefGoogle Scholar
  42. 42.
    Hirsch E, Graybiel AM, Duyckaerts C, Javoy-Agid F: Neuronal loss in the pedunculopontine nucleus in Parkinson disease and in progressive supranuclear palsy. Proc Natl Acad Sci U S A 1987, 84:5976–5980.PubMedCrossRefGoogle Scholar
  43. 43.
    Comella CL, Tanner CM, Ristanovic RK: Polysomnographic sleep measures in Parkinson’s disease patients with treatment-induced hallucinations. Ann Neurol 1993, 34:710–714.PubMedCrossRefGoogle Scholar
  44. 44.
    Fenelon G, Mahieux F, Huon R, Ziegler M: Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain 2000, 123:733–745. This is one of the largest studies to assess the risk factors for drug-induced hallucinations in Parkinson’s disease.PubMedCrossRefGoogle Scholar
  45. 45.
    Pappert EJ, Goetz CG, Niederman FG, et al.: Hallucinations, sleep fragmentation and altered dream phenomena in Parkinson’s disease. Mov Disord 1999, 14:117–121.PubMedCrossRefGoogle Scholar
  46. 46.
    Nausieda P, Weiner W, Kaplan L, et al.: Sleep disruption in the course of chronic levodopa therapy: an early feature of the levodopa psychosis. Clin Neuropharmacol 1982, 5:183–194.PubMedCrossRefGoogle Scholar
  47. 47.
    Overeem S, van Hilten JJ, Ripley B, et al.: Normal hypocretin-1 levels in Parkinson disease patients with excessive daytime sleepiness. Neurology 2002, 58:498–499.PubMedGoogle Scholar
  48. 48.
    CummingsJL: Depression and Parkinson’s disease: a review. Am J Psychiatry 1992, 149:443–454.PubMedGoogle Scholar
  49. 49.
    Blazer D, Burchett, Service C, George JK: The association of age and depression among the elderly: an epidemiologic exploration. J Gerontol B Psychol Sci Soc Sci 1991, 46:M210-M215.Google Scholar
  50. 50.
    Happe S, Schrode B, Faltl M, et al.: Sleep disorders and depression in patients with Parkinson disease. Acta Neurol Scand 2001, 104:275–280.PubMedCrossRefGoogle Scholar
  51. 51.
    Araki I, Kitahara M, Oida T, Kuno S: Voiding dysfunction and Parkinson’s disease: urodynamic abnormalities and urinary symptoms. J Urol 2000, 164:1640–1643.PubMedCrossRefGoogle Scholar
  52. 52.
    UK Madopar CR Study Group: A comparison of Madopar CR and standard Madopar in the treatment of nocturnal and early-morning disability in Parkinson’s Disease. Clin Neuropharmacol 1989, 12:498–505.Google Scholar
  53. 53.
    Pahwa R, Lyons K, McGuire D, et al.: Early morning akinesia in Parkinson’s disease: effect of standard carbidopa/levodopa and sustained-release carbidopa/levodopa. Neurology 1996, 46:1059–1062.PubMedGoogle Scholar
  54. 54.
    Earley CJ, Yaffee JB, Allen RP: Randomized, double-blind, placebo-controlled trial of pergolide in restless legs syndrome. Neurology 1998, 51:1599–1602.PubMedGoogle Scholar
  55. 55.
    OndoW: Ropinirole for restless legs syndrome. Movement Dis 1999, 14:138–140.PubMedCrossRefGoogle Scholar
  56. 56.
    Ringman JM, Simmons JH: Treatment of REM sleep behavior disorder with donepezil: a report of three cases. Neurology 2000, 55:870–871.PubMedGoogle Scholar
  57. 57.
    Goetz CG, Blasucci LM, Leurgans S, Pappert EJ: Olanzapine and clozapine: comparative effects on motor function in hallucinating PD patients. Neurology 2000, 55:789–794.PubMedGoogle Scholar
  58. 58.
    Targun SD, Abbott JL: Efficacy of quetiapine in Parkinson’s patients with psychosis. J Clin Psychopharmacol 2000, 20:54–60.CrossRefGoogle Scholar
  59. 59.
    Tandberg E, Larsen JP, Karlsen K: Excessive daytime sleepiness and sleep benefit in Parkinson’s disease: a community based study. Mov Disord 1999, 14:922–927.PubMedCrossRefGoogle Scholar
  60. 60.
    Frucht S, Rogers JD, Greene PE, et al.: Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology 1999, 52:1908–1910.PubMedGoogle Scholar
  61. 61.
    Ondo WG, Dat Vuong K, Kahn H, et al.: Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology 2001, 57:1392–1396.PubMedGoogle Scholar
  62. 62.
    Rye DB, Bliwise DL, Dihenia B, Gurecki P: Daytime sleepiness in Parkinson’s disease. J Sleep Res 2000, 9:63–69.PubMedCrossRefGoogle Scholar
  63. 63.
    Rascol O, Brooks D, Korcyn AD, et al., for the 056 Study Group: A five-year study of the incidence of dyskinesia in patients with early Parkinson’s disease who were treated with ropinirole or levodopa. N Engl J Med 2000, 342:1484–1491.PubMedCrossRefGoogle Scholar
  64. 64.
    Parkinson Study Group: Pramipexole vs. levodopa as initial treatment for Parkinson’s disease: a randomized controlled trial. JAMA 2000, 284:1931–1938.CrossRefGoogle Scholar
  65. 65.
    Pal S, Bhattacharya KF, Agapito C, Chaudhuri KR: A study of excessive daytime sleepiness and its clinical significance in three groups of Parkinson’s disease patients taking pramipexole, cabergoline and levodopa mono and combination therapy. J Neural Transm 2001, 108:71–77. This study finds that both Parkinson’s disease patients and normal control subjects report sudden onset of sleep or "sleep attacks," suggesting that the phenomenon is more frequent but not unique to the Parkinson’s disease population taking dopaminergic medications.PubMedCrossRefGoogle Scholar
  66. 66.
    Tan EK, Lum SY, Fogle-Chong SM, et al.: Evaluation of somnolence in Parkinson’s disease: comparison with age- and sex-matched controls. Neurology 2002, 58:465–468.PubMedGoogle Scholar
  67. 67.
    Gjerstad MD, Aaesland D, Larsen JD: Development of daytime somnolence over time in Parkinson’s disease. Neurology 2002, 58:1544–1546.PubMedGoogle Scholar
  68. 68.
    Tracik F, Ebersbach G: Sudden daytime sleep onset in Parkinson’s Disease: polysomnographic recordings. Mov Disord 2001, 16:500–506.PubMedCrossRefGoogle Scholar
  69. 69.
    Nieves AV, Lang AE: Treatment of excessive daytime sleepiness in patients with Parkinson’s disease with modafinil. Clin Neuropharmacol 2002, 25:111–114.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Cynthia L. Comella
    • 1
  1. 1.Department of Neurological Sciences, Department of PsychologyRush-Presbyterian-St. Luke’s Medical Center, Rush Medical CollegeChicagoUSA

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