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Treatment of Sleep Dysfunction in Parkinson’s Disease

  • Movement Disorders (A Videnovic, Section Editor)
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Opinion statement

Impaired sleep and alertness affect the majority of Parkinson’s disease (PD) patients, negatively impacting safety and quality of life. The etiology of impaired sleep-wake cycle in PD is multifactorial and encompasses medication side effects, nocturnal PD motor symptoms, and presence of co-existent sleep and neuropsychiatric disorders. The primary neurodegenerative process of PD involves brain regions that regulate the sleep-wake cycle, such as brainstem and hypothalamic nuclei. Sleep disorders in PD include insomnia, REM sleep behavior disorder (RBD), sleep disordered breathing (SDB), restless legs syndrome (RLS), and circadian disruption. Despite its high prevalence in the PD population, there is a paucity of clinical studies that have investigated treatment of sleep dysfunction associated with PD. Therefore, we aim to review available evidence and outline treatment strategies for improvement of disorders of sleep and wakefulness in PD patients. Evidence supporting the efficacy of pharmacological and non-pharmacological treatment strategies in PD is limited. There is thus a great need but also opportunity for development of well-designed clinical trials for impaired sleep and alertness in PD. Providing education about sleep hygiene and strategies for its implementation represents the initial step in management. Prompt diagnosis and treatment of co-existent primary sleep and psychiatric disorders are critical, as this may significantly improve sleep and alertness. While the optimal treatment for insomnia in PD has not been established, available strategies include cognitive-behavioral therapy, medications with soporific properties, and light therapy. Safety measures, clonazepam, and melatonin are the mainstay of treatment for RBD. Continuous positive airway pressure is an effective treatment for SDB in PD. The treatment algorithm for RLS associated with PD mirrors that used for idiopathic RLS. Circadian disruption has emerged as an important etiology of impaired sleep-wake cycles in PD, and circadian-based interventions hold promise for novel treatment approaches.

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Acknowledgements

The authors receive funding from NIH NINDS (K23NS080912, A.W.A.; P50NS053488, L.M.C.; R01NS099055, A.V.; K23NS07228, A.V.).

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  1. Division of Movement Disorders, Department of Neurology, University of Alabama at Birmingham, SC 360A, 1720 2nd Ave S, Birmingham, AL, 35294-0017, USA

    Amy W. Amara MD, PhD

  2. Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Lana M. Chahine MD

  3. Neurobiological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Aleksandar Videnovic MD

Authors
  1. Amy W. Amara MD, PhD
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  2. Lana M. Chahine MD
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  3. Aleksandar Videnovic MD
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Corresponding author

Correspondence to Amy W. Amara MD, PhD.

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Conflict of Interest

L.M.C. declares no conflict of interest.

A.W.A. is a site investigator for clinical trials sponsored by AbbVie and another by Axovant. No information related to these trials was included in this publication.

A.V. reports a grant from NIH/NINDS.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

Additional information

The editors would like to thank Dr. Myrna Rosenfeld for taking the time to review this manuscript.

This article is part of the Topical Collection on Movement Disorders

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Amara, A.W., Chahine, L.M. & Videnovic, A. Treatment of Sleep Dysfunction in Parkinson’s Disease. Curr Treat Options Neurol 19, 26 (2017). https://doi.org/10.1007/s11940-017-0461-6

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  • DOI: https://doi.org/10.1007/s11940-017-0461-6

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