Parkinsons disease Sleep disorders

Sleep disorders in Parkinson's disease, including insomnia and excessive daytime sleepiness, can impact patients' quality of life. Management involves education, light therapy, exercise, and medication adjustments. Restless leg syndrome may require lifestyle changes and medication.

2024-01-07 01:29:42 - Editor

General Sleep Disorders:

Sleep disorders may also occur in the course of Parkinson disease and they include sleep fragmentation, insomnia, rapid eye movement (REM) sleep disorder, excessive daytime sleepiness (EDS) and restless leg syndrome. (1)

Non-Pharmacological Measures:

Non pharmacological measures include patient education, driving cessation which may be appropriate. Also, Bright light therapy administered twice daily in one-hour intervals for 14 days improved Epworth Sleepiness Scale (ESS) scores as per clinical trials. (1, 2) Also, exercise has shown benefits to decrease sleep disorders in Parkinson disease patients. (3)

Levodopa and Adjunctive Therapy:

Poor self- hygiene and nocturia may lead to sleep disorders and they should be considered when managing sleep disorders in Parkinson patients. (1, 3) Levodopa, if taken in the morning; can be sedating, but it can only be reduced to a certain limit. Adjunctive therapy with ropinirole prolonged release as an adjunctive therapy to levodopa, significantly improved sleep disorders related to levodopa. (4)

Rotigotine and MAOB Inhibitors:

Additionally, adding rotigotine as a transdermal patch to levodopa showed significant, improvement in sleep parameters. (5) Also, monoamine oxidase (MAOB) inhibitors; selegiline, rasagiline may help combat daytime sleepiness. (6)

Pharmacotherapy for Refractory Symptoms:

If refractory symptoms; pharmacotherapy has to be considered including modafinil (100 mg/day) and methylphenidate (10 - 20 mg/day in 2 divided doses), although, data is lacking from clinical trials to support the use of these agents in Parkinson disease. (6, 7, 8) Also, eszopiclone 1mg, zolpidem 5-10mg, trazodone (25-50 mg once daily), and melatonin could be useful although there is insufficient evidence regarding their efficacy in parkison disease. (9)

Sodium Oxybate and Restless Leg Syndrome:

Recently, it was suggested that Sodium oxybate (2.25 g at bedtime), which is used to treat cataplexy in narcolepsy, can be helpful on the basis that improving night-time sleep could help daytime sleepiness. However, it was associated with significant side effects including obstructive sleep apnoea and hallucination in clinical trials. (10) For restless leg syndrome, it was suggested that patients may obtain temporally relief by massaging the affected limb, bathing in cold water, physical activity, and change to long acting dopamine agonists instead of short acting formula. If medical treatment is required, then, pregabalin 50-75 mg as needed, gabapentin 100-300mg are useful. Low doses of opioids such as oxycodone or methadone should be also considered. (11)

References

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