Current Treatment Options in Neurology

, Volume 5, Issue 3, pp 231–239 | Cite as

Sleepiness and unintended sleep in Parkinson’s disease

  • David B. Rye

Opinion statement

Patients with Parkinson’s disease (PD) and parkinsonian syndromes (eg, dementia with Lewy bodies, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. Sleepiness in PD is common (10% to 50% of patients) and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, viz, and narcolepsy with cataplexy. Physicians need to be vigilant in assessing parkinsonian patients for sleepiness, because treatment can dramatically enhance quality of life and prevent the significant morbidity and mortality that attends daytime sleepiness. Men with advanced disease, cognitive impairment, drug-induced psychosis, and orthostatic hypotension are most at risk for developing pathologic sleepiness. Because primary sleep disorders can coexist with Parkinsonism (eg, sleep apnea, insufficient or interrupted sleep), these potential causes should be carefully assessed with polysomnography and treated appropriately. Dopaminomimetics may exacerbate sleepiness in a small subset of patients. The primary pathologies involved in Parkinsonism appear to be the greatest contributors to the development of daytime sleepiness. Sleepiness in Parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents, such as bupropion, modafinil, or traditional psychostimulants.


Obstructive Sleep Apnea MPTP Bupropion Daytime Sleepiness Modafinil 
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References and Recommended Reading

  1. 1.
    Rye D, Bliwise D: Movement disorders specific to sleep and the nocturnal manifestations of waking movement disorders. In Movement Disorders: Neurologic Principles and Practice. Edited by Watts R, Koller W. New York: McGraw-Hill, Inc.; 1997:687–713.Google Scholar
  2. 2.
    Rye DB, Bliwise DL, Dihenia B, Gurecki P: FAST TRACK: daytime sleepiness in Parkinson’s disease. J Sleep Res 2000, 9:63–69. A good article.PubMedCrossRefGoogle Scholar
  3. 3.
    Rye DB, Jankovic J: Emerging views of dopamine in modulating sleep/wake state from an unlikely source: PD. Neurology 2002, 58:341–346. An excellent review.PubMedGoogle Scholar
  4. 4.
    Frucht S, Rogers J, Greene P, et al.: Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology 1999, 52:1908–1910.PubMedGoogle Scholar
  5. 5.
    Ondo WG, Vuong KV, Khan H, et al.: Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology 2001, 57:1392–1396.PubMedGoogle Scholar
  6. 6.
    Sanjiv CC, Schulzer M, Mak E, et al.: Daytime somnolence in patients with Parkinson’s disease. Park Rel Disord 2001, 7:283–286.CrossRefGoogle Scholar
  7. 7.
    O’Suilleabhain PE, Dewey RB: Contributions of dopaminergic drugs and disease severity to daytime sleepiness in Parkinson disease. Arch Neurol 2002, 59:986–989.PubMedCrossRefGoogle Scholar
  8. 8.
    Hobson DE, Lang AE, Martin WRW, et al.: Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease. JAMA 2002, 287:455–463.PubMedCrossRefGoogle Scholar
  9. 9.
    Tandberg E, Larsen J, Karlsen K: Excessive daytime sleepiness and sleep benefit in Parkinson’s disease: a community based study. Mov Disord 1999, 14:922–927.PubMedCrossRefGoogle Scholar
  10. 10.
    Tan EK, Lum SY, Fook-Chong SMC, et al.: Evaluation of somnolence in Parkinson’s disease: comparison with age and sex matched controls. Neurology 2002, 58:465–468.PubMedGoogle Scholar
  11. 11.
    Gjerstad MD, Aarsland D, Larsen JP: Development of daytime somnolence over time in Parkinson’s disease. Neurology 2002, 58:1544–1546.PubMedGoogle Scholar
  12. 12.
    Montastruc J-L, Brefel-Courbon C, Senard J-M, et al.: Sleep attacks and anti-parkinsonian drugs: a pilot prospective pharmacoepidemiologic study. Clin Neuropharmacol 2001, 24:181–183.PubMedCrossRefGoogle Scholar
  13. 13.
    Kumar S, Bhatia M, Behari M: Sleep disorders in Parkinson’s disease. Mov Disord 2002, 17:775–781.PubMedCrossRefGoogle Scholar
  14. 14.
    Arnulf I, Konofal E, Merino-Andreu M, et al.: Clinical profiles of somnolence in Parkinson’s disease. Neurology 2002, 58:1019–1024.PubMedGoogle Scholar
  15. 15.
    Agid Y: Parkinson’s disease: pathophysiology. Lancet 1991, 337:1321–1324.PubMedCrossRefGoogle Scholar
  16. 16.
    Rye D, Johnston L, Watts R, Bliwise D: Juvenile Parkinson’s disease with REM behavior disorder, sleepiness and daytime REM-onsets. Neurology 1999, 53:1868–1870.PubMedGoogle Scholar
  17. 17.
    Decker M, Keating G, Freeman A, Rye D: Parkinsonianlike sleep-wake architecture in rats with bilateral striatal 6-OHDA lesions. Soc Neurosci Abstracts 2000, 26:1514.Google Scholar
  18. 18.
    Daley J, Turner R, Bliwise D, Rye D: Nocturnal sleep and daytime alertness in the MPTP-treated primate. Sleep 1999, 22(suppl):S218-S219.Google Scholar
  19. 19.
    Silber MH, Rye DB: Solving the mysteries of narcolepsy. Neurology 2001, 56:1616–1618.PubMedGoogle Scholar
  20. 20.
    Bagetta G, Sarro GD, Priolo E, Nisticó G: Ventral tegmental area: site through which dopamine D2-receptor agonists evoke behavioral and electrocortical sleep in rats. Br J Pharmacol 1988, 95:860–866.PubMedGoogle Scholar
  21. 21.
    Berridge C, O’Neil J, Wifler K: Amphetamine acts within the medial basal forebrain to initiate and maintain alert waking. Neuroscience 1999, 93:885–896.PubMedCrossRefGoogle Scholar
  22. 22.
    Jellinger K: Pathology of Parkinson’s disease: changes other than the nigrostriatal pathway. Mol Chem Neuropathol 1991, 14:153–197.PubMedCrossRefGoogle Scholar
  23. 23.
    Rye D: Contributions of the pedunculopontine region to normal and altered REM sleep. Sleep 1997, 20:757–788.PubMedGoogle Scholar
  24. 24.
    Mega M, Masterman D, Benson F, et al.: Dementia with Lewy bodies: reliability and validity of clinical and pathologic criteria. Neurology 1996, 47:1403–1409.PubMedGoogle Scholar
  25. 25.
    Schenck C, Bundlie S, Mahowald M: Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder. Neurology 1996, 46:388–393.PubMedGoogle Scholar
  26. 26.
    Frucht S, Rogers J, Greene P, et al.: Falling asleep at the wheel: motor vehicle mishaps in people taking pramipexole and ropinirole [letters to the editor]. Neurology 2000, 54:274–277.Google Scholar
  27. 27.
    Olanow CW, Schapira AHV, Roth T: Waking up to sleep episodes in Parkinson’s disease. Mov Disord 2000, 15:212–215.PubMedCrossRefGoogle Scholar
  28. 28.
    Ryan M, Slevin J, Wells A: Non-ergot dopamine agonist-induced sleep attacks. Pharmacotherapy 2000, 20:724–726.PubMedCrossRefGoogle Scholar
  29. 29.
    Hauser R, Gauaer L, Anderson W, Zesiewicz T: Pramipexoleinduced somnolence and episodes of daytime sleep. Mov Disord 2000, 15:658–663.PubMedCrossRefGoogle Scholar
  30. 30.
    Ferreira J, Galitzky M, Montastruc J, Rascol O: Sleep attacks and Parkinson’s disease treatment. Lancet 2000, 355:1333–1334.PubMedCrossRefGoogle Scholar
  31. 31.
    Tracik F, Ebersbach G: Sudden daytime sleep onset in Parkinson’s disease: polysomnographic recordings. Mov Disord 2001, 16:500–506.PubMedCrossRefGoogle Scholar
  32. 32.
    Ulivelli M, Rossi S, Lombard C, et al.: Polysomnographic characterization of pergolide-induced “sleep attacks” in an idiopathic PD patient. Neurology 2002, 58:462–465.PubMedGoogle Scholar
  33. 33.
    Andreau N, Chale J, Senard J, et al.: L-dopa induced sedation: a double-blind cross-over controlled study versus triazolam and placebo in healthy volunteers. Clin Neuropharmacol 1999, 22:15–23.CrossRefGoogle Scholar
  34. 34.
    Ferreira JJ, Galitzky M, Thalamas C, et al.: Effect of ropinirole on sleep onset: a randomized placebo controlled study in healthy volunteers. Neurology 2002, 58:460–462.PubMedGoogle Scholar
  35. 35.
    Bliwise DL: Is the measurement of sleepiness the Holy Grail of sleep medicine? Am J Resp Crit Care Med 2001, 163:1517–1519.PubMedGoogle Scholar
  36. 36.
    Johns M: A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991, 14:540–545.PubMedGoogle Scholar
  37. 37.
    Fabbrini G, Barbanti P, Aurilia C, et al.: Excessive daytime sleepiness in de novo and treated Parkinson’s disease. Mov Disord 2002, 17:1026–1030.PubMedCrossRefGoogle Scholar
  38. 38.
    Moller JC, Stiasny K, Hargutt V, et al.: Evaluation of sleep and driving performance in six patients with Parkinson’s disease reporting sudden onset of sleep under dopaminergic medication: a pilot study. Mov Disord 2002, 17:474–481.PubMedCrossRefGoogle Scholar
  39. 39.
    Young T, Blustein J, Finn L, Palta M: Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 1997, 20:608–613.PubMedGoogle Scholar
  40. 40.
    Hauser RA, Wahba MN, Anderson WM: Modafinil treatment of pramipexole-associated somnolence. Mov Disord 2000, 15:1269–1271.PubMedCrossRefGoogle Scholar
  41. 41.
    Rabinstein A, Shulman LM, Weiner WJ: Modafinil for the treatment of excessive daytime sleepiness in Parkinson’s disease: a case report. Park Rel Disord 2001, 7:287–288.CrossRefGoogle Scholar
  42. 42.
    Nieves AV, Lang AE: Treatment off excessive daytime sleepiness in patients with Parkinson’s disease with modafinil. Clin Neuropharmacol 2002, 25:111–114.PubMedCrossRefGoogle Scholar
  43. 43.
    Cooper B, Wang C, Cox R, et al.: Evidence that the acute behavioral and electrophysiological effects of bupropion are mediated by a noradrenergic mechanism. Neuropsychopharmacology 1994, 11:133–141.PubMedGoogle Scholar
  44. 44.
    Miller E, Nieburg H: Amphetamines: valuable adjunct in treatment of Parkinsonism. N Y State J Med 1973, 73:2657–2661.PubMedGoogle Scholar
  45. 45.
    Parkes JD, Tarsy D, Marsden CD, et al.: Amphetamines in the treatment of Parkinson’s disease. J Neurol Neurosurg Psychiatry 1975, 38:232–237.PubMedCrossRefGoogle Scholar
  46. 46.
    Hogl BE, Gomez-Arevalo G, Garcia S, et al.: A clinical, pharmacologic, and polysomnographic study of sleep benefit in Parkinson’s disease. Neurology 1998, 50:1332–1339.PubMedGoogle Scholar
  47. 47.
    Wisor J, Nishino S, Sora I, et al.: Dopaminergic role in stimulant-induced wakefulness. J Neurosci 2001, 21:1787–1794.PubMedGoogle Scholar
  48. 48.
    Jenner P, Zeng BY, Smith LA, et al.: Antiparkinsonian and neuroprotective effects of modafinil in the MPTPtreated common marmoset. Exp Brain Res 2000, 133:178–188.PubMedCrossRefGoogle Scholar
  49. 49.
    Rye D, Dihenia B, Bliwise D: Reversal of atypical depression, sleepiness, and REM-sleep propensity in narcolepsy with bupropion. Depress Anxiety 1998, 7:92–95. A good article.PubMedCrossRefGoogle Scholar
  50. 50.
    Cooper BR, Hester TJ, Maxwell RA: Behavioral and biochemical effects of the antidepressant bupropion: evidence for selective blockade of dopamine uptake in vivo. J Pharmacol Exp Ther 1980, 215:127–134.PubMedGoogle Scholar
  51. 51.
    Goetz C, Tanner C, Klawans H: Bupropion for Parkinson’s disease. Neurology 1984, 34:1092–1094.PubMedGoogle Scholar
  52. 52.
    Hansard M, Smith L, Jackson M, et al.: Dopamine, but not norepinephrine or serotonin, reuptake inhibition reverses motor deficits in 1-methyl-4-phenyl-1,2,3, 6-tetrahydropyridine-treated primates. J Pharmacol Exp Ther 2002, 303:952–958.PubMedCrossRefGoogle Scholar
  53. 53.
    Ascher J, Cole J, Colin J-N, et al.: Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry 1995, 56:395–401.PubMedGoogle Scholar
  54. 54.
    Arnulf I, Bejjani B, Garma L, et al.: Improvement of sleep architecture in PD with subthalamic nucleus stimulation. Neurology 2000, 55:1732–1734.PubMedGoogle Scholar
  55. 55.
    Iranzo A, Valldeoriola F, Santamaria J, et al.: Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002, 72:661–664.PubMedCrossRefGoogle Scholar
  56. 56.
    Lopiano L, Rizzone M, Bergamasco B, et al.: Daytime sleepiness improvement following bilateral chronic electrical stimulation of the subthalamic nucleus in Parkinson’s disease. Eur Neurol 2001, 46:49–50.PubMedCrossRefGoogle Scholar
  57. 57.
    Rye D, Dempsay J, Dihenia B, et al.: REM-sleep dyscontrol in Parkinson’s disease: case report of effects of elective pallidotomy. Sleep Res 1997, 26:591.Google Scholar
  58. 58.
    Chaudhuri KR, Ellis C, Love-Jones S, et al.: Postprandial hypotension and parkinsonian state in Parkinson’s disease. Mov Disord 1997, 12:877–884.PubMedCrossRefGoogle Scholar
  59. 59.
    Alexander N, Nakahara D, Ozaki N, et al.: Striatal dopamine release and metabolism in sinoaorticdenervated rats by in vivo microdialysis. Am J Physiol 1988, 254:R396–399.PubMedGoogle Scholar
  60. 60.
    Yang JJ, Lin MT: Arterial baroreceptor information affects striatal dopamine release measured by voltammetry in rats. Neurosci Lett 1993, 157:21–24.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • David B. Rye
    • 1
  1. 1.Department of NeurologyEmory University Sleep Disorders LaboratoryAtlantaUSA

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