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CNS Drugs

, Volume 15, Issue 4, pp 267–275 | Cite as

Sleep Disorders in Patients with Parkinson’s Disease

Epidemiology and Management
  • Jan P. Larsen
  • Elise Tandberg
Therapy in Practice

Abstract

Patients with Parkinson’s disease can experience a number of sleep disorders, including insomnia, parasomnias and daytime somnolence [specifically, excessive daytime sleepiness (EDS) and sleep attacks].

Insomnia is a frequent and important complaint of patients with the disease. Both the pathology of Parkinson’s disease and dopaminergic drugs may contribute to the much higher than expected frequency of sleep fragmentation and disrupted sleep among these patients. In addition, coexisting depression seems to be a major and frequent risk factor for insomnia in Parkinson’s disease.

After recognising a sleep problem, the first step in management is to examine and diagnose the type of insomnia and possible medical or psychological factors that may disturb nocturnal sleep. The next step is to give the patient appropriate advice on sleep hygiene.

Increasing the dosage of dopaminergic drug treatment will often increase sleep disruption and should be avoided unless the patient’s sleep is primarily disturbed by the motor manifestations of parkinsonism during the night. Depression should be looked for and if appropriate be treated in any patients with insomnia. If it becomes necessary to treat the patient with an hypnosedative agent, it is important to use a drug with a short half-life and that manifests as few adverse effects as possible the next morning. Up-to-date guidelines for the use of hypnosedatives should be followed.

Patients with Parkinson’s disease experience a wide range of parasomnias. The majority of behaviours may be related to rapid eye movement (REM) sleep behaviour disorder (RBD) or to a spectrum of symptoms ranging from vivid dreaming to psychosis. RBD is effectively treated with clonazepam. In addition, the atypical antipsychotics have given physicians new and better treatment options for psychotic symptoms in individuals with Parkinson’s disease.

EDS is common in Parkinson’s disease, while sleep attacks seem to be rare manifestations of the disease or its treatment. Significant EDS is found in 15% of patients with Parkinson’s disease compared with in 1% of healthy elderly people. Sleep attacks are observed in patients treated with all dopaminergic medications but have recently been brought to prominence because of their association with the newer dopamine agonists ropinirole and pramipexole. Patients with Parkinson’s disease should be informed about the possibility of developing sleep problems during the day when prescribed new drugs. Appropriate actions with regard to driving must be taken if significant and persistent daytime somnolence or sleep attacks appear.

Keywords

Levodopa Sleep Disorder Daytime Somnolence Excessive Daytime Sleepiness Sleep Attack 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Tandberg E, Larsen JP, Nessler EG, et al. The epidemiology of Parkinson’s disease in the county of Rogaland, Norway. Mov Disord 1995; 5: 541–9CrossRefGoogle Scholar
  2. 2.
    Mutch WJ, Dingwall-Fordyce I, Downie AW, et al. Parkinson’s disease in a Scottish city. BMJ 1986; 292: 534–6PubMedCrossRefGoogle Scholar
  3. 3.
    Karlsen KH, Larsen JP, Tandberg, E, et al. Quality of life measurements in patients with Parkinson’s disease: a community-based study. Eur J Neurol 1998; 5: 443–50PubMedCrossRefGoogle Scholar
  4. 4.
    Karlsen KH, Larsen JP, Tandberg, E, et al. The influence of clinical and demographic variables on quality of life in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1999; 66: 431–5PubMedCrossRefGoogle Scholar
  5. 5.
    Hobson JA. Sleep. New York: Scientific American Library, 1989Google Scholar
  6. 6.
    Jouvet M. Biogenic amines and the states of sleep. Science 1969; 163: 32–41PubMedCrossRefGoogle Scholar
  7. 7.
    Roussel B, Bouget A, Bobillier P, et al. Locus ceruleus, paradoxical sleep, and cerebral noradrenaline. C R Seances Soc Biol Fil 1967; 161: 2537–41PubMedGoogle Scholar
  8. 8.
    Hobson JA. Sleep and dreaming. J Neurosci February 1990; 10(2): 371–82Google Scholar
  9. 9.
    Nauseida PA. Sleep disorders. In: Koller WC, editors. Handbook of Parkinson’s disease. New York: Marcel Dekker, Inc., 1987: 371–80Google Scholar
  10. 10.
    Swift CG, Shapiro CM. Sleep and sleep problems in elderly people. BMJ 1993; 306: 1468–71PubMedCrossRefGoogle Scholar
  11. 11.
    Nausieda PA, Weiner WJ, Kaplan LR, et al. Sleep disruption in the chronic levodopa therapy: an early feature of the levodopa psychosis. Clin Neuropharmacol 1982; 2: 183–94CrossRefGoogle Scholar
  12. 12.
    Lees AJ, Blackburn NA, Campbell VL. The night time problems of Parkinson’s disease. Clin Neuropharmacol 1988; 6: 512–9CrossRefGoogle Scholar
  13. 13.
    Tandberg E, Larsen JP, Karlsen K. A community-based study of sleep disorders in patients with Parkinson’s disease. Mov Disord 1998; 13: 895–9PubMedCrossRefGoogle Scholar
  14. 14.
    Cummings JL. Depression and Parkinson’s disease: a review. Am J Psychiatry 1992; 149: 443–54PubMedGoogle Scholar
  15. 15.
    Tandberg E, Larsen JP, Aarsland D, et al. The occurrence of depression in Parkinson’s disease. A community-based study. Arch Neurol 1996; 53: 175–9PubMedCrossRefGoogle Scholar
  16. 16.
    Zarcone VPJ. Sleep hygiene. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. Philadelphia (PA): W.B. Saunders Company, 1994: 542Google Scholar
  17. 17.
    Pal PK, Calne S, Samii A, et al. A review of normal sleep and its disturbances in Parkinson’s disease. Parkinsonism and Related Disorders 1999; 5: 1–17PubMedCrossRefGoogle Scholar
  18. 18.
    De Keyser J, Ebinger G, Vauquelin G. Evidence for a widespread dopaminergic innervation of the human cerebral neocortex. Neurosci Lett 1989; 104: 281–5PubMedCrossRefGoogle Scholar
  19. 19.
    Oningi E, Caporali MG, Massotti M. Stimulation of dopamine D-1 receptors by SKF 338393 includes EEG desynchronisaton and behavioral arousal. Life Sci 1985: 37: 2327–33CrossRefGoogle Scholar
  20. 20.
    Trampus M, Ferri N, Monopoli A, et al. The dopamine D1 receptor is involved in the regulation of REM sleep in the rat. Eur J Pharmacol 1991; 194: 189–94PubMedCrossRefGoogle Scholar
  21. 21.
    Cianchetti C. Dopamine agonists and sleep in man. In: Wauquier A, Gaillard JM, Monti JM, et al., editors. Sleep: neurotransmitters and neuromodulators. New York: Raven Press, 1985: 121Google Scholar
  22. 22.
    Jansen ENH, Meerwaldt JD. Madopar HBS in parkinsonian patients with nocturnal akinesia. Clin Neurol Neurosurg 1988; 90: 35–9PubMedCrossRefGoogle Scholar
  23. 23.
    Lees AJ. A sustained-release formulation of L-dopa (Madopar HBS) in the treatment of nocturnal and early morning disabilities in Parkinson’s disease. Eur Neurol 1987; 27Suppl. 1: 126–34PubMedCrossRefGoogle Scholar
  24. 24.
    van Hilten B, Hoff JI, Middelkoop HAM, et al. Sleep disruption in Parkinson’s disease. Assessment by continuous activity monitoring. Arch Neurol 1994; 51: 922–8PubMedCrossRefGoogle Scholar
  25. 25.
    Zesiewicz TA, Hauser RA. Depression in patients with Parkinson’s disease: Epidemiology, pathophysiology and treatment options. CNS Drugs 2000; 13: 253–64CrossRefGoogle Scholar
  26. 26.
    Laine K, Anttila M, Heinonen E, et al. Lack of adverse interactions between concomitantly administered selegiline and citalopram. Clin Neuropharmacol 1997; 20: 419–33PubMedCrossRefGoogle Scholar
  27. 27.
    Aarsland D, Larsen JP, Lim NG, et al. Citalopram plus mianserin for depression in patients with Parkinson’s disease and depression: an open-label study. Nord J Psychiatry 1998; 52: 115–6Google Scholar
  28. 28.
    Kupfer DJ, Reynolds CF. Management of insomnia. N Engl J Med 1997; 336: 341–6PubMedCrossRefGoogle Scholar
  29. 29.
    Schenck CH, Mahowald MW. REM sleep parasomnias. Neurol Clin 1996; 14: 697–720PubMedCrossRefGoogle Scholar
  30. 30.
    Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 2000; 123: 331–9PubMedCrossRefGoogle Scholar
  31. 31.
    Moskovitz C, Moses K, Klawans HL. Levodopa-induced psychosis: a kindling phenomenon. Am J Psychiatry 1978; 135: 669–75PubMedGoogle Scholar
  32. 32.
    Factor SA, McAlarny T, Sandchez-Ramos JR, et al. Sleep disorders and sleep effect in Parkinson’s disease. Mov Disord 1990; 5: 280–5PubMedCrossRefGoogle Scholar
  33. 33.
    Sharf B, Moskovitz C, Lupton MD, et al. Dream phenomena induced by chronic levodopa therapy. J Neural Transm 1978; 43: 143–51PubMedCrossRefGoogle Scholar
  34. 34.
    van Hilten JJ, Weggeman M, van der Velde EA, et al. Sleep, excessive daytime sleepiness and fatigue in Parkinson’s disease. J Neural Transm 1993; 5: 235–44CrossRefGoogle Scholar
  35. 35.
    Aarsland D, Larsen JP, Cummings JL, et al. Prevalence and clinical correlates of psychosis in Parkinson’s disease. Arch Neurol 1999; 56: 595–601PubMedCrossRefGoogle Scholar
  36. 36.
    Aarsland D, Larsen JP, Tandberg E, et al. Predictors of nursing home placement in Parkinson’s disease. A population-based, prospective study. JAGS 2000; 48: 938–42Google Scholar
  37. 37.
    Schenck CH, Mahowald MW. Polysomnographic, neurologic, psychiatric, and clinical outcome report on 70 consecutive cases with the REM sleep behavior disorder (RBD): Sustained clonazepam efficacy in 89.5% of 57 treated patients. Clev Clin J Med 1990; 57: 10–24Google Scholar
  38. 38.
    Friedman JH, Factor SA. Atypical antipsychotics in the treatment of drug-induced psychosis in Parkinson’s disease. Mov Disord 2000; 15: 201–11PubMedCrossRefGoogle Scholar
  39. 39.
    Aarsland D, Larsen JP, Lim NG, et al. Olanzapine for psychosis in patients with Parkinson’s disease with and without dementia. J Neuropsychiatry Clin Neurosci 1999; 11: 392–4PubMedGoogle Scholar
  40. 40.
    Tandberg E, Larsen JP, Karlsen K. Excessive daytime sleepiness and sleep benefit in Parkinson’s disease. Mov Disord 1999; 14: 922–7PubMedCrossRefGoogle Scholar
  41. 41.
    Andreu N, Chalé JJ, Senard JM, et al. L-dopa-induced sedation: a double-blind cross-over controlled study versus triazolam and placebo in healthy volunteers. Clin Neuropharm 1999; 22: 15–23CrossRefGoogle Scholar
  42. 42.
    Frucht S, Rogers JD, Greene PE, et al. Falling asleep at the wheel: Motor vehicle mishaps in persons taking pramipexol and ropinirole. Neurology 1999; 52: 1908–10PubMedCrossRefGoogle Scholar
  43. 43.
    Frucht S, Greene PE, Fahn S. Sleep episodes in Parkinson’s disease: a wake-up call. Mov Disord 2000; 15: 601–3PubMedCrossRefGoogle Scholar
  44. 44.
    Olanow CW, Schapira AHV, Roth T. Waking up to sleep episodes in Parkinson’s disease. Mov Disord 2000; 15: 212–5PubMedCrossRefGoogle Scholar
  45. 45.
    Ebersbach G, Nordon J, Tracik F. Sleep attacks in Parkinson’s disease: polysomnographic recordings. Mov Disord 2000; 15Suppl. 3: 89Google Scholar
  46. 46.
    Hauser RA, Gauger L, McDowell Anderson W, et al. Pramipexole-induced somnolence and episodes of daytime sleep. Mov Dis 2000; 15(4): 658–63CrossRefGoogle Scholar
  47. 47.
    Schapira AH. Sleep attacks (sleep episodes) with pergolide. Lancet 2000; 355: 1332–3PubMedCrossRefGoogle Scholar
  48. 48.
    Ferreira JJ, Galitzky M, Montastruc JL, et al. Sleep attacks and Parkinson’s disease treatment. Lancet 2000; 355: 1333–4PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2001

Authors and Affiliations

  • Jan P. Larsen
    • 1
  • Elise Tandberg
    • 1
  1. 1.Department of NeurologyCentral Hospital of RogalandStavangerNorway

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