Sleep


Sleep Disturbances – from PDF.org

read more at http://www.pdf.org/sleep_disturbance

Sleep Disturbances

Many people with Parkinson’s disease (PD) have trouble sleeping through the night.

In some cases, PD symptoms like rigidity or tremor keep people awake. The brain changes that are part of PD also can cause sleep difficulties, and some people have problems sleeping even before movement symptoms develop and PD is diagnosed. In addition, some PD medications can disrupt sleep at night, and others make people sleepy during the day.

A good night’s rest is essential to feeling well. Disrupted sleep can affect your health, mood and overall quality of life. Furthermore, when people with PD don’t sleep well, the sleep of their care partners is disrupted too. Care partners also need restful sleep to stay healthy.

Symptoms

Nighttime Sleep Difficulties

  • Difficulty going to sleep, because PD symptoms like rigidity make it hard to get comfortable or turn over.
  • Difficulty falling asleep due to symptoms of anxiety or depression.
  • Difficulty staying asleep, because of a need to use the bathroom during the night, the return of motor symptoms when medications wear off, pain or hot flashes with night sweats.
  • Noise produced by tremor against a pillow.
  • Vivid dreams or nightmares caused by levodopa medications.
  • Early morning awakening, from a too-early bedtime or associated with depressed mood.
  • An overwhelming urge to move or an unpleasant sensation in the legs caused by restless legs syndrome.
  • Loud snoring, restless sleep and pauses in breathing during the night caused by sleep apnea. Although sleep apnea is usually associated with being overweight, this is not the always the case for people with PD. As many as 40 percent of people with PD have sleep apnea.
  • Activity, sometimes violent movements such as kicking, punching, running or getting out of bed due to rapid eye movement (REM) sleep behavior disorder. People with REM sleep behavior disorder do not relax their muscles normally during sleep, and thus act out violent dreams. This affects about a third of men with PD, but is less frequent in women with PD.
  • Disruption in the normal sleep-wake cycle caused by excessive sleepiness during the day or taking long naps during the day.

Troublesome Daytime Sleepiness

  • Excessive sleepiness during the day may be a symptom of PD and may even start before the characteristic movement symptoms appear.
  • Many PD medications can cause sleepiness during the day and may even cause sudden sleepiness with potentially dire consequences, such as falling asleep while driving.
  • Too much napping during the day makes it hard to sleep through the night.

Therapies

Good sleep is a foundation for good health. Not only does it contribute to tiredness and fatigue, it can also worsen any cognitive issues you are experiencing. If you have trouble sleeping, remember that you don’t have to “just live with it.” Medical therapies can help some sleep difficulties:

  • A long-acting levodopa medication might prevent PD symptoms from returning during the night. Talk to your doctor about adjusting your PD medications to maximize wakefulness during the day and sleep at night, while controlling your symptoms.
  • For REM sleep behavior disorder, doctors may prescribe melatonin or clonazepam (Klonopin®), which is a long-acting sedative.
  • For sleep apnea, wearing a CPAP device (Continuous Positive Airway Pressure device) at night can help prevent obstruction of the airways. You need to have an overnight sleep evaluation for a sleep apnea diagnosis to be made.
  • Talk to your doctor about over-the-counter sleep aids, such as melatonin, as well as those available with a prescription. It is important to balance the benefits of sleep medications with the risks, especially of daytime sleepiness, cognitive decline and increased falls.
  • Antidepressants are sometimes prescribed to help nighttime sleep.
  • If urinary frequency keeps you up at night, be sure your doctor rules out causes other than PD. In addition, there are several medications that can be helpful, including oxybutynin (Ditropan®), tolterodine (Detrol®), trospium (Sanctura®), solifenacin succinate (VESIcare®), darifenacin (Enablex®), mirabegron (Myrbetriq®) and fesoterodine fumarate (Toviaz®). If your doctor has difficulty managing bladder symptoms, you may be referred to a bladder specialist (urologist).
  • Some physicians prescribe stimulants to help people with PD stay awake during the day.

Tips for Better Sleep

People with PD — and their care partners too — can take these steps to get to sleep faster and stay asleep:

  • Keep a regular sleep schedule — go to bed at the same time each night and get up at the same time each morning.
  • Choose your bedtime based on when you want to get up and plan to spend seven to eight hours a night in bed.
  • Make a bedtime routine — for example, snack, bath, tooth-brushing, toileting — and follow it every evening.
  • Spend time outdoors and exercise every day, in the morning if possible. Avoid exercise after 8:00 PM.
  • If you can’t get outdoors, consider light therapy — sitting or working near a light therapy box, available at drug stores and department stores.
  • If you nap, try to do so at the same time every day, for no more than an hour, and not after 3:00 pm.
  • Avoid stimulants like caffeine, nicotine and alcohol, especially six hours before bedtime. While alcohol can initially cause sleepiness, it actually disrupts sleep.
  • Avoid heavy meals in the evening.
  • If you take PD medications at night, keep your dose and a glass of water close by so you don’t have to get up in the middle of the night.
  • Sleep in a cool dark place and use the bed only for sleeping and sexual activity. Do not read or watch television in bed.
  • Avoid “screen time” — television, phones, tablets such as your iPAD — one or two hours before bed.

In addition, people with PD can:

  • Use satin sheets and pajamas to make moving in the bed easier.
  • Minimize drinking liquids for three hours before bedtime to help prevent frequent nighttime urination.
  • Go to the bathroom immediately before retiring.
  • Place a commode next to the bed, to minimize the effort, and the light needed, to get up during the night.

Sleep Advice from Davis Phinny Foundation

From https://www.davisphinneyfoundation.org/living-well/sleep/

What causes sleep problems in Parkinson’s?

Difficulties with sleep can be caused by a number of factors. Some are directly related to Parkinson’s and its treatments, while others are completely unrelated. While many common issues can be improved with minor medication changes or other tweaks, it is important to understand the causes of common sleep issues associated with Parkinson’s and to discuss with your neurologist and other members of your care team to get the best sleep you possibly can.

read more

MEDICATIONS read more

PAIN read more

ANXIETY, DEPRESSION AND OTHER PSYCHOLOGICAL ISSUES read more

NIGHTTIME TRIPS TO THE BATHROOM (NOCTURIA) read more

CAUSES NOT RELATED TO PARKINSON’S read more

pain not connected to Parkinson’s or sleep apnea.

You Might Also Like

Making the Best of a Bad Night’s Sleep

MAKING THE BEST OF A BAD NIGHT’S…

Tips for When You’re Awake in the Night

TIPS FOR WHEN YOU’RE AWAKE IN THE…

Living Well with REM Sleep Behavior Disorder

LIVING WELL WITH REM SLEEP BEHAVIOR…

9 Easy Tips for a Better Night’s Sleep

9 EASY TIPS FOR A BETTER NIGHT’S…


Simple Relaxation Techniques

From parkinsonsnewstoday.com

If  you have Parkinson’s disease, you are likely to feel stress related to your tremors. Sometimes, you may feel self-conscious. That alone is stressful. These simple relaxation solutions open up natural relaxation responses which can help improve your mood and ease your mind.

The National Institutes of Health (NIH) considers relaxation exercises to be safe for most people. However, just like with exercise routines, people with serious physical health problems such as Parkinson’s should discuss the techniques with their healthcare provider before starting a relaxation routine.

There are many viable techniques for relaxing. These include deep breathing exercises, self-hypnosis, and guided imagery. Each relaxation technique goal is to produce a natural reaction from the body. This should include: lower blood pressure, slower breathing, and a sense of well-being.

We found five easy relaxation exercises that are simple enough for most people to do1 in a chair or while lying in bed.

The first two relaxation tips come from Harvard University and the last three are from the University of Michigan.

Place your hand just beneath your navel so you can feel the gentle rise and fall of your belly as you breathe. Breathe in. Pause for a count of three. Breathe out. Pause for a count of three. Continue to breathe deeply for one minute, pausing for a count of three after each inhalation and exhalation.

While sitting comfortably, take a few slow deep breaths and quietly repeat to yourself, “I am” as you breathe in and, “at peace” as you breathe out. Repeat slowly two or three times. Then, feel your entire body relax into the support of your chair.

Raise eyebrows up and tense the muscles across the forehead and scalp. Feel the tension build and hold. Take a deep breath. As you exhale say “relax” while letting the tension leave your body.

Relax your facial muscles and allow your jaw to open slightly. Let your shoulders drop. Let your arms fall to your sides. Allow your hands to loosen so there are spaces between your fingers. Uncross your legs or ankles. Feel your thighs sink into your chair, letting your legs fall comfortably apart. Feel your shins and calves become heavier and your feet grow roots into the floor. Now, breathe in slowly and breathe out slowly.

Observe your abdomen rising and falling with each breath. Inhale and press your navel toward the spine then tense your abdomen. Feel the tension build and hold it. Take in a deep breath. As you exhale say “relax,” and let the tension leave you.

Here’s a PDF with more relaxation techniques from the University of Michigan.

The NIH recognizes the relaxation response as having broad health benefits including the reduction of pain and restoration of sleep. In addition, research on the relaxation response has shown that this simple technique can increase energy and decrease fatigue. It can increase motivation, productivity, and improve decision-making ability, too. The relaxation response lowers stress hormone levels and lowers blood pressure.

The relaxation response is your personal ability to make your body release chemicals and brain signals that make your muscles and organs slow down and increase blood flow to the brain. We hope these stress relieving solutions help you find a relaxation routine that suits you so that you will continue to practice it each day.


Rest and sleep

Parkinson’s disease creates many challenges to getting a good night’s rest. Try these tips to help you get enough rest and sleep, which is an important component of overall health and quality of life.

Getting a Good Night’s Rest

  • Make a regular, relaxing bedtime routine a habit.
  • Maintain a regular sleep schedule: get up and go to sleep at the same time every day.
  • Get plenty of bright light exposure during the day, particularly natural daytime light.
  • Decrease fluids several hours before bedtime, and go to the bathroom before getting into bed to sleep.
  • Avoid strenuous exercise, alcohol, nicotine and caffeine within 4 hours of your bedtime.
  • Use your bed only for sleeping and intimacy with your partner.
  • Banish animals from the bed!
  • Customize your sleep environment: invest in a good mattress and pillows.
  • Set the bedroom temperature at a cool, comfortable level.
  • Limit daytime napping to a 40-minute NASA nap (yes, tested by astronauts!).
  • Lie down to sleep only when sleepy. Learn to tell the difference between fatigue and sleepiness.
  • If you are unable to sleep after 15 minutes, get out of bed and engage in a relaxing activity like listening to music, meditation or reading until you are sleepy.
  • Turn off the TV. If weaning yourself of a TV habit is difficult, try a relaxation or nature recording.
  • Keep lighting and noise at low levels when trying to sleep.
  • Eliminate the common but bad habit of “checking the clock” throughout the night.
  • Limit prescription sedatives to a 2-week period; instead, try over-the-counter alternatives such as Valerian root capsules.
  • Sleep as much as needed to feel refreshed, but avoid spending too much time in bed.

Getting into Bed

  • Approach the bed as you would a chair; feel the mattress behind both legs.
  • Slowly lower yourself to a seated position on the bed, using your arms to control your descent.
  • Lean on your forearm while you allow your body to lean down to the side.
  • As you body goes down, the legs will want to go up like a seesaw.
  • DO NOT put your knee up on the mattress first. In other words, don’t “crawl” into bed.

Rolling or Turning Over in Bed

  • Bend your knees up with feet flat.
  • Allow knees to fall to one side as you begin to roll.
  • Turn your head in the direction you are rolling and reach top arm across the body.
  • Some PD patients find that “silk sheets” help them move better in bed.

Scooting Over in Bed

  • Bend your knees up with feet flat.
  • Push into the bed with feet and hand to lift your hips up off the bed. Then shift hips in the desired direction.
  • Finish by repositioning feet in the direction your hips moved.

Getting Out of Bed

  • Bend knees up, feet flat on the bed.
  • Roll onto your side toward the edge of the bed by letting the knees fall to that side. Reach across with the top arm, and turn your head to look in the direction you are rolling.
  • Lower your feet from the bed as you push with your arms into a sitting position.


May 18, 2017 – Sleeping Well with Parkinson’s – on line discussion

Hear expert discussion, and ask questions in MJ Fox Foundation Third Thursdays Webinar series.

Sleep disturbances are a common non-motor symptom of Parkinson’s disease that may cause difficulty falling or staying asleep. In this webinar, we’ll discuss sleep disorders that can occur in Parkinson’s, how to manage them and current research on sleep and PD.

Title: Sleeping Well with Parkinson’s

Date: Thursday, May 18, 2017

Time: 12:00 PM Eastern Time

Duration: 1 hour