Sleep and parkinsonism

Introduction
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By Robert L Rodnitzky MD

The significant impact of Parkinson disease on sleep was clearly noted in James Parkinson’s remarkable description of the illness in his 1817 monograph, “An Essay on the Shaking Palsy.” He correctly noted that the motoric symptoms of Parkinson disease, such as severe nocturnal emergent tremor or nocturnal immobility, have great potential to interrupt sleep. Today, we are aware that the sleep-Parkinson disease interaction takes many other forms, including the effect of Parkinson drugs or Parkinson-associated behavioral symptoms (depression and psychosis) on sleep, and the (mostly beneficial) effect of sleep on the symptoms of the disease. One of the most striking sleep problems in Parkinson disease is excessive daytime sleepiness, which is in part due to the administration of dopamine agonists or other dopaminergic medications but also is highly correlated with age and duration of disease. We have also learned that some sleep disorders that are moderately common in the general population, such as restless legs syndrome and REM sleep behavior disorder, are even more prevalent among Parkinson patients, the former condition sometimes antedating clinical Parkinson disease by years.

Key points

  • REM sleep behavior disorder is one of the most common sleep disorders associated with Parkinson disease and often antedates the motoric features of Parkinson disease by years.
  • Daytime sleepiness is one of the most common complaints in Parkinson disease patients, especially in the elderly and in men.
  • The common notion that parkinsonian tremor disappears entirely during sleep is not completely true as tremor can re-emerge, sometimes significantly, during sleep arousals.
  • Bedtime dosages of dopaminergic medications, especially long-acting preparations, are very useful to combat nocturnal re-emergent parkinsonian symptoms, such as high-amplitude tremor or severe akinesia, while in bed, which can significantly disrupt sleep.