Sleeping with PD. Jean Tsai, MD PhD September 27, 2014
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1 Sleeping with PD Jean Tsai, MD PhD September 27, 2014
2 Evaluation of sleep Assessment at least annually recommended by Agency for Healthcare Research and Quality (AHRQ) of the US Dept of Health and Human Services Daytime sleepiness: Epworth sleepiness scale, Inappropriate sleep composite score (ISCS) Pittsburgh sleep quality index (PSQI) Medical outcomes study sleep scale (MOS) SCOPA-sleep Parkinson s disease sleep scale (PDSS)
3 Common sleep problems in PD Insomnia (sleep fragmentation 80%) Excessive daytime sleepiness - 50% REM sleep behavior disorder - > 40% Restless leg syndrome/willis-ekbom Disease 20% Periodic limb movements of sleep Sleep apnea Circadian rhythm disorder
4 Insomnia prolonged sleep onset Pain Medication effect Depression Treatment is multifactorial. Avoid over the counter sleep aids which often contain anti-histamine
5 Insomnia sleep fragmentation Motor symptoms Hallucinations Nocturia (frequent night time urination) Medication effect Other sleep disorders like sleep apnea, restless leg syndrome, and periodic limb movements of sleep
6 Fatigue/Excessive daytime sleepiness Quality of life Age Female sex Duration and severity of disease Depression Social and psychological dysfunction Sleep disorders Sleep attack/narcolepsy
7 REM sleep behavior disorder A dissociated state characterized by violent dream-enacting behavior during REM sleep Also associated with other neuro-degenerative disorders Thought to be an early, pre-motor manifestation of PD Up to 65% of patients with REM behavior disorder later develop a Parkinsonian disorder Some medications can worsen symptoms: antidepressants, beta-blockers
8 Cartoonist: Theresa McCracken
9 Restless leg syndrome/willis-ekbom disease An awake sensory phenomenon with a volitional motor response 1. Discomfort described as a crawling sensation and urge to move 2. Symptom worse towards the end of the day 3. Symptom exacerbated by rest 4. Symptom eased by movement of legs 5. No other process could account for the symptoms above Potential mechanism is impaired central dopaminergic function
10 Periodic limb movements of sleep An involuntary sleep-related motor phenomenon Stereotyped limb movements during sleep Legs > >arms involved
11 Sleep apnea Mechanism is intermittent collapse of upper airway during sleep Snoring, waking up gasping, headache, and dry mouth Diagnosis made by sleep study Primary treatments are continuous positive airway pressure (CPAP) and weight loss
12 Circadian rhythm disorder Normal patterns of biological rhythm throughout the day are disturbed in PD Flattened motor activity pattern Blunted blood pressure and heart rate Animal models of PD demonstrate parkinsonism, sleep disruption, and circadian abnormality Dopamine Promotes wakefulness, sometimes rebound sleepiness regulation of circadian rhythm Circadian genes: effect on dopamine in brain stem
13 Tips to sleeping well with PD Maintain a regular sleep-wake schedule. Schedule alerting medications earlier in the day and sedating medications close to bed time. If changing body position is difficult in bed, use satin sheets and pajamas to help with getting in and out of bed. Minimize beverages before bedtime to help avoid Aerobic exercise and exposure to light early in the day. Avoid them in the evening. If needed, schedule naps earlier in the day and limit duration to 30 minutes.
14 Care-giver s sleep Care-giver burden increased by PD motor impairment, depression, and sleep disturbance Michael J Fox Foundation: Guide for loved ones and care givers, edited by care givers contains resources on everything, from marriage to elder care to grief support. National Sleep Foundation: This organization offers information on the factors that can affect the quality of sleep. To find information on PDrelated sleep problems, treatments and coping strategies, visit the 'Sleep Topics'.
15 Sleeping with PD Look at the choices you have, not the choices that have been taken away from you. In them, there are whole worlds of strength and new ways to look at things. - Michael J Fox interviewed in Good Housekeeping, October 2013
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