Parkinson’s is a disorder of movements characterized by rigidity, tremor, bradykinesia (slow movements), and much more. It is also known as a more generalized neurodegenerative disorder that affects memory, cognitive ability, emotion and sleep.
One of the under reported changes in Parkinson’s is alterations in a patient's sleep pattern. In fact, more than 90% of those living with Parkinson’s have sleep disorders. Patients typically face issues going to sleep and maintaining sleep. It seems that the relationship between Parkinson’s and sleep is dual-sided. Sleep disorders increase the risk of Parkinson’s, while Parkinson’s leads to sleep disturbances.
New research indicates that various sleep disturbances precede the diagnosis of Parkinson’s. Research indicates changes in sleep pattern start occurring several years before the diagnosis of Parkinson’s. Restless sleep usually refers to altered sleep quality.
In healthy individuals, there are five stages of sleep that are repeated several times during the night. First four stages are called slow-wave stages, and they are followed by the fifth stage called REM (rapid eye movement).
When a person starts sleeping, the first stage is drowsiness, second is the initiation of sleep and slow down of brain waves, the third stage is moderate to deep sleep, while the fourth stage is a deep sleep. Low-frequency delta waves characterize deep sleep. After approximately an hour of sleeping, a person reaches the fourth stage. Together these four stages are called non-REM (non-rapid eye movement) sleep. These four stages are followed by REM sleep, which is characterized by dreaming and rapid eye movements as if a person is awake.
It is interesting to note that the duration of REM continually decreases with age, though science cannot say why it happens. REM is almost 8 hours at birth, 2 hours at the age of 20, and just 45 minutes at the age of 75.
New research says that restless sleep may precede Parkinson’s and even dementia
New studies indicate that restless sleep may lead to chronic brain inflammation that may finally lead to dementia or Parkinson’s. So if a person talks while sleeping, acts in a dream, often wakes up with nightmares, all of these may be early signs of ensuing neurodegeneration.
People who talk, punch, yell, or act while sleeping are individuals suffering from a disorder of REM sleep, known as REM sleep behavior disorder (RBD). In RBD a person make noises and movements while they are dreaming as the person has an absence of the so-called paralysis associated with deep sleep.
What causes RBD in some people is not fully known. However, many individuals living with RBD, have a high risk of developing neurodegenerative disorders, and Parkinson’s is one of them. The latest study demonstrated that those who suffer from RBD already have low levels of dopamine in the brain, something that is also characteristic of Parkinson’s.
New research indicates that RBD leads to chronic inflammation in the brain, which accelerates the death of dopamine-producing brain cells and increases the risk of developing Parkinson’s.
The study by Stokholm and colleagues says that it is the first time that inflammation in the brain caused by RBD and risk of developing Parkinson’s has been demonstrated. The study would help to identify the Parkinson’s in the very early stages of the disease. Stokholm says that the idea of the study was to find out what type of people with sleep disorders are at higher risk of developing Parkinson’s later in the life.
Further, researchers say that their finding may help to find the ways of preventing Parkinson’s or discover alternate ways of treating it in very early stages. RBS is typically found at the age of 50 to 70 and is most common in men.
Though the importance of treating various sleep-related disturbances, like insomnia, or an obstructive sleep disorder has long been realized, however, this research indicates that there is more to the problem. There is a need to find out the ways to treat RBD and a need to improve the sleep quality.
At present no medication targets RBD explicitly. However, one way to improve sleep quality is to improve sleep hygiene, which is improving the sleep routine, removing the television from the bedroom, keeping the bedroom free from light and noises. RBD is made worse by certain medications, alcohol, and smoking. A healthy diet, exercise, and practice of mindfulness may improve the sleep quality and lessen the symptoms of RBD.
But, it can be said that if a person is middle-aged and noticed even minor changes in sleep or bed partner notices the symptoms of RBD, it should be taken seriously. Early recognition of such issues and their rectification may finally save a person not only from Parkinson’s but also from many other neurodegenerative disorders.
Stokholm MG, Iranzo A, Østergaard K, et al. Assessment of neuroinflammation in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a case-control study. The Lancet Neurology. 2017;16(10):789-796. doi:10.1016/S1474-4422(17)30173-4
Sleep disorders in Parkinson’s disease: Diagnosis and management. Ann Indian Acad Neurol. 2011;14(Suppl1):S18-S20.
Purves D, Augustine GJ, Fitzpatrick D, et al. Stages of Sleep. 2001. https://www.ncbi.nlm.nih.gov/books/NBK10996/. Accessed April 5, 2018.
Loddo G, Calandra-Buonaura G, Sambati L, et al. The Treatment of Sleep Disorders in Parkinson’s Disease: From Research to Clinical Practice. Front Neurol. 2017;8. doi:10.3389/fneur.2017.00042