Skip to main content

Advertisement

SpringerLink
Log in

Excessive daytime sleepiness and unintended sleep in Parkinson’s disease

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Patients with Parkinson’s disease and parkinsonian syndromes (eg, dementia with Lewy body disease, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. This sleepiness is common and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, namely narcolepsy/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. Male patients 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 exacerbate sleepiness in a small subset of patients in a dose-dependent fashion. Nonetheless, the primary pathologies involved in parkinsonism appear to be the greatest contributors to daytime sleepiness. Sleepiness in parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents such as bupropion, modafinil, or traditional psychostimulants.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Rye D, Bliwise D: Movement disorders specific to sleep and the nocturnal manifestations of waking movement disorders. InMovement Disorders: Neurologic Principles and Practice, edn 2. Edited by Watts R, Koller W. New York: McGraw-Hill; 2004:855–890.

    Google Scholar 

  2. Rye DB, Bliwise DL, Dihenia B, Gurecki P: FAST TRACK: daytime sleepiness in Parkinson’s disease. J Sleep Res 2000, 9:63–69. First objective documentation of sleepiness and a narcolepsy-like phenotype in PD.

    Article  PubMed  CAS  Google Scholar 

  3. Arnulf I, Konofal E, Merino-Andreu M, et al.: Parkinson’s disease a sleepiness: an integral part of PD. Neurology 2002, 58:1019–1024. First confirmation and extension of the objective findings of sleepiness and a narcolepsy-like phenotype in PD.

    PubMed  CAS  Google Scholar 

  4. Frucht S, Rogers J, Greene P, Gordon M, Fahn S, et al.: Falling asleep at the wheel: motor vehicle mishaps in persons taking pramipexole and ropinirole. Neurology 1999, 52:1908–1910.

    PubMed  CAS  Google Scholar 

  5. Rye D, Daley J, Freeman A, Bliwise D: Daytime sleepiness and sleep attacks in idiopathic Parkinson’s Disease. In Mental and Behavioral Dysfunction in Movement Disorders. Edited by Bedard M-A, Agid Y, Chouinard S, et al. Totawa, NJ: Humana Press; 2003:527–538.

    Chapter  Google Scholar 

  6. Schapira A: Excessive daytime sleepiness in Parkinson’s disease. Neurology 2004, 63(8 Suppl 3):S24-S27.

    PubMed  Google Scholar 

  7. Arnulf I: Excessive daytime sleepiness in parkinsonism. Sleep Med Rev 2005, 9:185–200. An excellent and complete review of sleepiness in PD and atypical PD.

    Article  PubMed  Google Scholar 

  8. Hobson DE, Lang AE, Martin WR, et al.: Excessive daytime sleepiness and sudden-onset sleep in Parkinson disease. JAMA 2002, 287:455–463. A large survey of the frequency, subjective assessment, clinical correlates, and relevance of PD-related sleepiness to driving.

    Article  PubMed  Google Scholar 

  9. Tan EK, Lum SY, Fook-Chong SM, et al.: Evaluation of somnolence in Parkinson’s disease: comparison with age and sex matched controls. Neurology 2002, 58:465–468.

    PubMed  CAS  Google Scholar 

  10. Brodsky M, Godbold J, Roth T, Olanow C: Sleepiness in Parkinson’s disease: a controlled study. Mov Disord 2003, 18:668–672.

    Article  PubMed  Google Scholar 

  11. Ondo WG, Vuong KV, Khan H, et al.: Daytime sleepiness and other sleep disorders in Parkinson’s disease. Neurology 2001, 57:1392–1396.

    PubMed  CAS  Google Scholar 

  12. Sanjiv CC, Schulzer M, Mak E, et al.: Daytime somnolence in patients with Parkinson’s disease. Park Rel Disord 2001, 7:283–286.

    Article  Google Scholar 

  13. O’Suilleabhain PE, Dewey RB: Contributions of dopaminergic drugs and disease severity to daytime sleepiness in Parkinson disease. Arch Neurol 2002, 59:986–989.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Gjerstad MD, Aarsland D, Larsen JP: Development of daytime somnolence over time in Parkinson’s disease. Neurology 2002, 58:1544–1546.

    PubMed  CAS  Google Scholar 

  16. Montastruc JL, Brefel-Courbon C, Senard JM, et al.: Sleep attacks and antiparkinsonian drugs: a pilot prospective pharmacoepidemiologic study. Clin Neuropharmacol 2001, 24:181–183.

    Article  PubMed  CAS  Google Scholar 

  17. Kumar S, Bhatia M, Behari M: Sleep disorders in Parkinson’s disease. Mov Disord 2002, 17:775–781.

    Article  PubMed  Google Scholar 

  18. Razmy A, Lang A, Shapiro C: Predictors of impaired daytime sleep and wakefulness in patients with Parkinsons disease treated with older (ergot) vs newer (nonergot) dopamine agonists. Arch Neurol 2004, 61:97–102. A detailed objective assessment of sleepiness and alterness in PD and and their clinical correlates.

    Article  PubMed  Google Scholar 

  19. Stevens S, Comella C, Stepanski E: Daytime sleepiness and alertness in patients with Parkinson disease. Sleep 2004, 27:967–972.

    PubMed  Google Scholar 

  20. Baumann C, Ferini-Strambi L, Waldvogel D, et al.: Parkinsonism with excessive daytime sleepiness-a narcolepsy like disorder? J Neurol 2005, 252:139–145.

    Article  PubMed  Google Scholar 

  21. Roth T, Rye D, Borchert L, et al.: Assessment of sleepiness and unintended sleep in Parkinson’s disease patients taking dopamine agonists. Sleep Med 2003, 4:275–280. Objective demonstration that unintended sleep in sleepy PD patients on dopamine agonists lacks a distinctive "fingerprint" by objective sleep laboratory testing.

    Article  PubMed  Google Scholar 

  22. Kaynak D, Kiziltan G, Kaynak H, et al.: Sleep and sleepiness in patients with Parkinson’s disease before and after dopaminergic treatment. Eur J Neurol 2005, 12:199–207.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    PubMed  CAS  Google Scholar 

  24. Manni R, Terzaghi M, Sartori I, et al.: Dopamine agonists and sleepiness in PD: a review of the literature and personal findings. Sleep Med 2004, 5:189–193.

    Article  PubMed  Google Scholar 

  25. Pacchetti C, Martignoni E, Terzaghi M, et al.: Sleep attacks in Parkinson’s disease: a clinical and polysomnographic study. Neurol Sci 2003, 24:195–196.

    Article  PubMed  CAS  Google Scholar 

  26. Agid Y: Parkinson’s disease: pathophysiology. Lancet 1991, 337:1321–1324.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

    PubMed  CAS  Google Scholar 

  28. Sakata M, Sei H, Toida K, et al.: Mesolimbic dopaminergic system is involved in diurnal blood pressure regulation. Brain Res 2002, 928:194–201.

    Article  PubMed  CAS  Google Scholar 

  29. Decker M, Keating G, Freeman A, Rye D: Parkinsonian-like sleep-wake architecture in rats with bilateral striatal 6-OHDA lesions. Soc Neurosci Abstracts 2000, 26:1514.

    Google Scholar 

  30. 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 

  31. Silber MH, Rye DB: Solving the mysteries of narcolepsy. Neurology 2001, 56:1616–1618.

    PubMed  CAS  Google Scholar 

  32. 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.

    PubMed  CAS  Google Scholar 

  33. 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.

    Article  PubMed  CAS  Google Scholar 

  34. Jellinger K: Pathology of Parkinson’s disease. Changes other than the nigrostriatal pathway. Mol Chem Neuropathol 1991, 14:153–197.

    Article  PubMed  CAS  Google Scholar 

  35. Overeem S, van Hilten JJ, Ripley B, et al.: Normal hypocretin-1 levels in Parkinson’s disease patients with excessive daytime sleepiness. Neurology 2002, 58:465–468.

    Google Scholar 

  36. Drouot X, Moutereau S, Nguyen J, et al.: Low levels of ventricular CSF orexin/hypocretin in advanced PD. Neurology 2003, 61:540–543.

    PubMed  CAS  Google Scholar 

  37. Rye D: Contributions of the pedunculopontine region to normal and altered REM sleep. Sleep 1997, 20:757–788.

    PubMed  CAS  Google Scholar 

  38. Frauscher B, Hogl B, Maret S, et al.: Association of daytime sleepiness with COMT polymorphism in patients with parkinson disease: a pilot study. Sleep 2004, 27:733–736.

    PubMed  Google Scholar 

  39. Paus S, Seeger G, Brecht H, et al.: Association study of dopamine D2, D3, D4 receptor and serotonin transporter gene polymorphisms with sleep attacks in Parkinson’s disease. Mov Disord 2004, 19:507–509.

    Article  Google Scholar 

  40. Rissling I, Korner Y, Geller F, et al.: Preprohypocretin polymorphisms in Parkinson disease patients reporting "sleep attacks". Sleep 2005, 28:871–875.

    PubMed  Google Scholar 

  41. Abbott R, Ross G, White L, et al.: Excessive daytime sleepiness and subsequent development of Parkinson disease. Neurology 2005, 65:1442–1446.

    Article  PubMed  CAS  Google Scholar 

  42. 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 

  43. Olanow CW, Schapira AH, Roth T: Waking up to sleep episodes in Parkinson’s disease. Mov Disord 2000, 15:212–215.

    Article  PubMed  CAS  Google Scholar 

  44. Ryan M, Slevin J, Wells A: Non-ergot dopamine agonistinduced sleep attacks. Pharmacotherapy 2000, 20:724–726.

    Article  PubMed  CAS  Google Scholar 

  45. Hauser RA, Gauger L, Anderson WM, Zesiewicz TA: Pramipexole-induced somnolence and episodes of daytime sleep. Mov Disord 2000, 15:658–663.

    Article  PubMed  CAS  Google Scholar 

  46. Ferreira J, Galitzky M, Montastruc J, Rascol O: Sleep attacks and Parkinson’s disease treatment. Lancet 2000, 355:1333–1334.

    Article  PubMed  CAS  Google Scholar 

  47. Bares M, Kanovsky P, Rektor I: Excessive daytime sleepiness and ‘sleep attacks’ induced by entacapone. Fundam Clin Pharmacol 2003, 17:113–116.

    Article  PubMed  CAS  Google Scholar 

  48. Tracik F, Ebersbach G: Sudden daytime sleep onset in Parkinson’s disease: polysomnographic recordings. Mov Disord 2001, 16:500–506.

    Article  PubMed  CAS  Google Scholar 

  49. 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.

    Article  PubMed  Google Scholar 

  50. Contin M, Provini F, Martinelli P, et al.: Excessive daytime sleepiness and levodopa in Parkinson’s disease: polygraphic, placebo-controlled monitoring. Clin Neuropharmacol 2003, 26:115–118.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  Google Scholar 

  52. 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.

    PubMed  CAS  Google Scholar 

  53. Santamaria J: How to evaluate excessive daytime sleepiness in Parkinson’s disease. Neurology 2004, 63(8 Suppl 3):S21-S23.

    PubMed  Google Scholar 

  54. 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.

    Article  PubMed  Google Scholar 

  55. Meindorfner C, Korner Y, Moller J, et al.: Driving in Parkinson’s disease: mobility, accidents, and suddern onset of sleep at the wheel. Mov Disord 2005, 20:832–842.

    Article  PubMed  Google Scholar 

  56. Merino-Andreu M, Arnulf I, Konofal E, et al.: Unawareness of naps in Parkinson’s disease and in disorders with excessive daytime sleepiness. Neurology 2003, 60:1553–1554.

    PubMed  CAS  Google Scholar 

  57. Young T, Blustein J, Finn L, Palta M: Sleep-disordered breathing and motor vehicle accidents in a population-based sampel of employed adults. Sleep 1997, 20:608–613.

    PubMed  CAS  Google Scholar 

  58. Del Dotto P, Gambaccini G, Caneparo D, et al.: Bedtime cabergoline in Parkinson’s disease patients with excessive daytime sleepiness induced by dopamine agonists. Neurol Sci 2003, 24:170–171.

    Article  PubMed  Google Scholar 

  59. 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.

    Article  Google Scholar 

  60. Nieves AV, Lang AE: Treatment off excessive daytime sleepiness in patients with Parkinson’s disease with modafinil. Clin Neuropharmacol 2002, 25:111–114.

    Article  PubMed  CAS  Google Scholar 

  61. Hauser RA, Wahba MN, Zesiewicz TA, Anderson WM: Modafinil treatment of pramipexole-associated somnolence. Mov Disord 2000, 15:1269–1271.

    Article  PubMed  CAS  Google Scholar 

  62. Happe S, Pirker W, Sauter C, et al.: Successful treatment of excessive daytime sleepiness in Parkinson’s disease with modafinil. J Neurol 2001, 248:632–634.

    Article  PubMed  CAS  Google Scholar 

  63. Adler C, Caviness J, Hentz J, et al.: Randomized trial of modafinil for treating subjective daytime sleepiness in patients with Parkinson’s disease. Mov Disord 2003, 18:287–293.

    Article  PubMed  Google Scholar 

  64. Hogl B, Saletu M, Brandauer E, et al.: Modafinil for the treatment of daytime sleepiness in Parkinson’s disease: double-blind, randomized, cross-over, placebo-controlled polygraph trial. Sleep 2002, 25:905–909.

    PubMed  CAS  Google Scholar 

  65. Cooper B, Wang C, Cox R, et al.: Evidence that the acute behavioral and electrophysiological effects of bupropion (Wellbutrin) are mediated by a noradrenergic mechanism. Neuropsychopharmacology 1994, 11:133–141.

    PubMed  CAS  Google Scholar 

  66. Miller E, Nieburg H: Amphetamines. Valuable adjunct in treatment of Parkinsonism. NY State J Med 1973, 73:2657–2661.

    CAS  Google Scholar 

  67. Parkes JD, Tarsy D, Marsden CD, et al.: Amphetamines in the treatment of Parkinson’s disease. J Neurol Neurosurg Psychiatry 1975, 38:232–237.

    Article  PubMed  CAS  Google Scholar 

  68. 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.

    PubMed  CAS  Google Scholar 

  69. Chaudhuri KR, Ellis C, Love-Jones S, et al.: Postprandial hypotension and parkinsonian state in Parkinson’s disease. Mov Disord 1997, 12:877–884.

    Article  PubMed  CAS  Google Scholar 

  70. Yang JJ, Lin MT: Arterial baroreceptor information affects striatal dopamine release measured by voltammetry in rats. Neurosci Lett 1993, 157:21–24.

    Article  PubMed  CAS  Google Scholar 

  71. Wisor J, Nishino S, Sora I, et al.: Dopaminergic role in stimulant-induced wakefulness. J Neurosci 2001, 21:1787–1794.

    PubMed  CAS  Google Scholar 

  72. Rye D, Dihenia B, Bliwise D: Reversal of atypical depression, sleepiness, and REM-sleep propensity in narcolepsy with bupropion. Depression Anxiety 1998, 7:92–95.

    Article  CAS  Google Scholar 

  73. Goetz C, Tanner C, Klawans H: Bupropion for Parkinson’s disease. Neurology 1984, 34:1092–1094.

    PubMed  CAS  Google Scholar 

  74. 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.

    Article  PubMed  CAS  Google Scholar 

  75. Ascher J, Cole J, Colin JN, et al.: Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry 1995, 56:395–401.

    PubMed  CAS  Google Scholar 

  76. Arnulf I, Bejjani B, Garma L, et al.: Improvement of sleep architecture in PD with subthalamic nucleus stimulation. Neurology 2000, 55:1732–1734.

    PubMed  CAS  Google Scholar 

  77. 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.

    Article  PubMed  CAS  Google Scholar 

  78. Hjort N, Ostergaard K, Dupont E: Improvement of sleep quality in patients with advanced Parkinson’s disease treated with deep brain stimulation of the subthalamic nucleus. Mov Disord 2004, 19:196–199.

    Article  PubMed  Google Scholar 

  79. Lopiano L, Rizzone M, Bergamasco B, et al.: Daytime sleepiness improvement following bilateral chronic electrical stimulation of the subthalamic nucleus in Parkinson’s disease. European Neurol 2001, 46:49–50.

    Article  CAS  Google Scholar 

  80. 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 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, WMRB-Suite 6000, PO Drawer V, 30322, Atlanta, GA, USA

    David B. Rye MD, PhD

Authors
  1. David B. Rye MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David B. Rye MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rye, D.B. Excessive daytime sleepiness and unintended sleep in Parkinson’s disease. Curr Neurol Neurosci Rep 6, 169–176 (2006). https://doi.org/10.1007/s11910-996-0041-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-996-0041-8

Keywords

Search

Navigation