A Guide to Healing Troubled Sleep from Parkinson’s Disease

Sometimes it’s hard to know why you’re not sleeping well. Is it because you’re nervous for tomorrow’s meeting, or from that impulsive 2PM cup of coffee?
For people with Parkinson’s, it might be one of the first signs of the progressive movement disease. Long before developing the disease’s more characteristic shaking and impaired motor skills, Parkinson’s patients tend to experience impaired sleep in addition to other non-motor symptoms, including smell loss and constipation.
 
Though common, problems with sleep are taxing on people of any health. It’s particularly important for Parkinson’s patients to regulate this symptom because poor rest exacerbates a myriad of other symptoms including anxiety, increased urination, body discomfort or cramps, and treatment side effects.
 
As reported in Parkinson’s News Today, doctors came together in the online webinar, “Night Fight with Parkinson’s: Acting Out Dreams, Insomnia and Other Sleep Issues,” hosted by the Michael J. Fox Foundation, to discuss how sleep issues manifest in Parkinson’s patients and how best to avoid them.
There are old tricks, but they explained, good sleep hygiene comes before counting sheep. A lot of good tricks and tips can build a good nights rest, and some supplements might do the rest. Early exercise, cannabis, melatonin, and pillow forts are among suggestions.

Parkinson’s Disease + Sleep

Parkinson’s disease is a rare neurological disorder, characterized by the progressive loss of control of movement. The disease progressively impedes on the central nervous system, causing patient’s to lose control of their mobility over time. Starting with light tremors and rigidity, patients notice rigid muscles, slowed movement, changes in speech, a loss of balance, and eventually, difficulty walking, talking, and in severe cases, hallucinations and delusions. The disease develops late in life, with most patients over age 50. While there are symptomatic treatments, there is no cure.
Bad sleep comes in many shapes and sizes. While some Parkinson’s patients experience excessive sleepiness, others develop insomnia. Some report sleep apnea, restless leg syndrome, and notably, around 90% of Parkinson’s patients report at some point experiencing REM sleep behavior disorder (RBD), a condition causing people to physically act our their dreams in real life.

Bedtime Routine

While we’re probably all used to some mindless late night scrolling, a thoughtful night-time routine can have a powerful effect on the quality of rest. That means spending the last hour before bed without looking at blue light—the harsh bright light emitted by phones, computers, and TV screens, interrupting the circadian rhythm. Changing your routine doesn’t mean skipping the before-bed episode of “Queen’s Gambit” that you were looking forward to most, but pushing favorites earlier, and skipping the mindless shows to veg out to. If you can’t help but send those last texts at bedtime, do yourself a favor and program the settings on your phone and computer to automatically turn off the blue light at nighttime, switching to a more mellowed yellow tone.
Okay, you’re thinking, it sounds nice to avoid the screen, but also tedious and unrealistic. You might just find though it’s not such a loss to skip skimming Netflix for a show to put you to sleep. While it might be hard to implement finishing the day with a chapter of your book, podcast, or journal entry, the benefit is self evidence. It feel good because it is good. Practicing evoking wellness and calmness from within us is a way to gain a tool of sustainable wellness of the body and mind.
“All of these things together form what we neurologist or sleep physicians call ‘sleep hygiene,’ and it’s really an important part of managing any sleep problem that a person with Parkinson’s will experience,” said Michele Hu, PhD, a professor of clinical neuroscience and consultant neurologist at Oxford University.

Sleep Hygiene: —Good Habits, Well Timed

Exercising, sticking to a nutritious diet, and limiting alcohol are pretty much always good ideas if you want to improve your health and wellbeing, and sleep is no exception. Manifesting good sleep means accepting a host of other healthy choices.
Doctor’s explain though, those healthy habits need to be considerate of sleep. Sometimes activities that make you feel you deserve a pat on the back aren’t unambiguous sleep aids. Exercise is good. Exercise at night, not always so good.  Movement disorder neurologist at the University of Arizona, Dr. Marie Cristinia Ospina explained, “Just like you have a well-balanced diet, you want a well-balanced exercise program.”
 This means maintaining a balanced exercise routine,  incorporating aerobics, resistance, and other exercises, and trying to squeeze that in early. While exercise in the A.M. aids quality sleep, a nighttime jog might keep you up.

A Balanced Diet, Hydration, and Late Night no-no’s

What we put into our body throughout the day has a big impact on how we rest. That doesn’t mean you need to follow the keto diet to get a good snooze, but a balance of proteins, carbs, and fats, and an effort to incorporate fresh fruits and vegetables, goes a long way.
Staying hydrated is important too, and if frequent urination plagues the patient, sticking to watery plant life like celery, strawberries, or watermelon might be a better solution. Having a glass of water by the bed can be a good reminder at night and upon wakeup to keep drinking in the routine.
While alcohol, sugar, and caffeine may add life in the moment, your sleep pays the price big time, meaning limiting them is vital. While they might keep you alert through your emails, they might also keep you alert through the night, preventing deep sleep. To get a good night cleanse, make sure to keep any vices earlier: coffee before noon, a midday sweet’s break, and finishing your glass of wine with an hour left before bed all go a long way. It’s also a good idea to only digest dense proteins and spicy foods earlier in the day to optimize your mind’s ease.

Meditation and Mindfulness

A calm mind is important to reach the deepest REM sleep, vital for cleansing the brain of any build up of waste. Doctors contend practices like meditation and mindfulness which exercise control and calmness of the mind facilitate the deepest sleep, as well as instilling techniques to assist returning to sleep when feeling restless. Ospina explained, “Anything that helps you with the rigidity of Parkinson’s disease, like massage, tai chi, yoga, acupuncture, helps relax the body so that it can fall asleep.”

A Peaceful Sleep Environment

Creating a calm and comfortable environment is crucial to reach uninterrupted rest. That means low light and noise, and if necessary, using an eye mask and ear plugs even when it’s already dark and quiet. Many Parkinson’s patients experience RBD [REM sleep behavior disorder], causing them to move around in their sleep. Some report the benefit of moving the bed closer to the ground and creating a type of pillow fort around the body to limit movement at night. Others suggest using sleeping bags or weighted blankets. For loved ones, they suggest only waking a patient of they are thrashing around and seem at risk for hurting themselves or others. If so, they recommend waking them to interrupt the RBD episode and letting them go back to bed after.

 Sleep Aids: Cannabis, Melatonin, Benzodiazepines

As careful as we can try to be, the burden to cure bad sleep is not all on the patient. Poor sleep is a symptom, and often that requires medicines and treatment to help the body with what it struggles to reach itself.
 
 Some patients find solace in supplements like melatonin, the natural hormone that regulates sleep, also available as a popular over-the counter supplements. Others use benzodiazepines, a tranquilizer also used to treat anxiety and panic attacks. Some have reported the benefit of using light therapies to maintain a healthy circadian rhythm, and one expert recommended the app Sleepio, a sleep-inducing cognitive behavioral therapy that inspires a mindfulness that helps those with insomnia get some rest.

CBD

Doctors noted that many Parkinson’s patients have anecdotally reported using cannabidiol (CBD), the non-psychoactive part of the cannabis plant, to both improve sleep and lessen pain. CBD is increasingly available commercially in an array of methods— with the possibilities of taking drops of an oil, smoking it in a cigarette, or eating a CBD-filled gummy bear.  However, verifiable research is only beginning to emerge as the popular street drug has increasingly become legalized in parts of the U.S. and makes its way to the lab.
A lack of CDC guidelines and spatter legal guidelines mean most Parkinson’s patients figure out their use for themselves rather than receiving a standardized treatment recommendation. Still, the doctors caution that the interaction between CBD and other treatments isn’t widely studied, so to take caution while testing the waters. They suggest speaking with healthcare providers first, starting with a low dose and taking it slow.
 
 One piece of advice—stick to CBD, the non-psychoactive strain of cannabis. Its for your own good, Ospina explained.
“In Parkinson’s patients, you usually want to stay away from the THC because you’re already on psychoactive medications,” Ospina said, referring to the common use of levodopa and domaine agonists by Parkinson’s patients. “We don’t want to add one more thing that can cause you to be confused and hallucinate.”
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The doctor’s said it: healthy habits build healthy sleep–but we know it’s not that easy. We’re definitely not judging that late night ice cream and movie night combo, but running on Parkinson’s-invoked sleepless nights isn’t easy either. That’s why we want to arm with some tools. So start slow— turn off your phone’s blue-light, put a book on your bedside table, and don’t forget an extra glass of water if you can’t forgo the night’s glass of wine.

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