More than 75% of people with Parkinson’s are reported to have sleep problems — trouble falling asleep, acting dreams out with the body, or tossing and turning because their legs feel uncomfortable. These fall broadly into three groups.
Acting out dreams: REM sleep behavior disorder
REM sleep behavior disorder (RBD)A sleep disorder in which the muscles don't relax during sleep, so you speak or move as though acting out the content of a dream. Up to half of people with Parkinson's experience it, and it often appears 5 to 10 years before motor symptoms.Learn more is reported in up to half of people with Parkinson’s. Because the muscles don’t relax during sleep, you shout out or move your arms and legs, acting out exactly what is happening in the dream. What is striking is that this often shows up 5 to 10 years before motor symptoms do — in other words, it may have been there long before a Parkinson’s diagnosis. Medications such as clonazepam are reported to improve it by around 80% to 90%, so if it worries the person sleeping next to you, it is worth telling your care team.
Restless legs syndrome: when your legs won’t let you sleep
Restless legs syndrome (RLS)A syndrome in which an uncomfortable feeling in the legs comes with a strong urge to move them. It gets worse when you are still or lying down, and eases briefly when you move.Learn more is also common in people with Parkinson’s. You get an uncomfortable or tingling sensation deep in the legs along with an urge to keep moving them, and it gets noticeably worse when you are lying still, which makes falling asleep hard. If you suspect this, low iron may be behind it, so it is worth checking your iron levels with a blood test — if they are low, iron supplementation may improve the symptoms.
If you keep waking up to urinate
A large share of people with Parkinson’s experience nocturia, waking frequently at night to urinate. One of the main reasons is that autonomic function is affected as well, so too much urine is produced overnight. Cutting back on fluids, caffeine and alcohol for a few hours before bed, and spending some time during the day resting with your legs elevated, can help reduce how much urine is made at night.
If you snore heavily, check for sleep apnea
In Parkinson’s, movement of the neck and throat muscles is affected too, and sleep apnea is reported to be more common than in the general population. If you snore heavily, or you wake up feeling as though your breathing has stopped, it is worth getting checked with a sleep study.
Insomnia: when falling asleep is the problem
Some Parkinson’s medications, such as selegiline and amantadine, can actually interfere with sleep if taken late in the day, and simply moving the dose to earlier in the day is sometimes enough to improve things. Beyond that, the following help.
- Go to bed and get up at about the same time every day
- Get up and move for at least a few minutes every hour during the day
- Keep your phone and the TV out of bed
- Keep naps short, and avoid them after late afternoon
What you can do now
Rather than waiting for sleep problems to improve on their own, it matters to describe them specifically to your care team. The approach differs depending on the type of sleep problem — adjusting medication, testing iron levels, or a referral to a sleep specialist.
This article is not a substitute for medical diagnosis or treatment. If sleep problems persist, please talk with your care team.
