Re: Sleep disorders & fatigue in PD

[Bill Olson <WOLSON@xxxxxxxxxxx>]

----- Original Message -----
From: "Kelly Grant" <kglw@xxxxxxxxxxxxxxx>
To: <PARKINSN@xxxxxxxxxxxxxxxxxxxx>
Sent: Saturday, December 16, 2000 9:47 AM
Subject: Sleep disorders & fatigue in PD


> Howdy Folks
> This write-up goes with the list of "non-motor" PD smptoms.
>
> Sleep Disorders in PD
> We spend over one third of our lives in sleep. The daily time spent
sleeping
> decreases as we age. No one is exactly sure why we sleep, but it is felt
> that sleep is necessary to "recharge" the brain for the next day's
> activities. We have all had nights of little or no sleep and it is obvious
> that thinking and functioning the day after can be very difficult.
> Sleep disturbances are a prominent part of PD. Often times it is difficult
> to fall asleep and once asleep there are frequent awakenings. The need to
> frequently urinate (see below) may also disrupt what would be a good
night's
> sleep. Once awake, it becomes harder to fall back asleep. This
interference
> in the normal sleep patterns results in increased sleepiness or somnolence
> during the daytime hours. The sleep-wake cycle then becomes fragmented,
with
> poor sleep during the night and excessive sleep during the day.
> Treatments of these sleep disturbances include simple measure such as
> attending to good "sleep hygiene." This refers to avoiding such things as
> alcohol, caffeine, nicotine, and excessive fluid intake prior to bed.
Also,
> increasing activity during the day may lead to more restful sleep at
night.
> Occasionally, medications can be used during the day to decrease excessive
> daytime sleepiness. These medications are stimulants and although they can
> be helpful in some cases, they may have some serious adverse effects.
> Extremely vivid dreams can occur as a common side effect of medications
used
> to treat the motor symptoms of PD. These dreams may be so vivid and real
> that family members or caretakers may think that the patient is
> hallucinating, delusional, or demented. A patient who is not psychotic or
> demented will soon realize, after several episodes, that these are dreams.
> If these dreams become particularly bothersome, reducing the nighttime
dose
> of L-dopa or dopamine-agonist may alleviate this side effect. Otherwise,
> patients, family members, and caretakers should be assured that these
dreams
> are due to medication effects and are not a sign of dementia or psychosis.
> There are disorders of sleep that are closely associated with PD. One such
> disorder is called REM (rapid eye movement) behavior disorder. REM sleep
is
> that stage of sleep in which dreams occur. In normal people there is an
> inhibition of muscle tone, which functions as a protective mechanism
during
> REM sleep. In REM behavior disorder the inhibition of that tone is loss.
> This leads to the outward expression of behaviors such as laughing,
> screaming, kicking, punching, etc. Spouses may be at risk for bodily harm
> and may have to sleep in another bed or part of the house. Patients who
have
> this disorder will usually go on to develop some signs and symptoms of
> parkinsonism. Likewise, PD patients when studied in a special sleep
> laboratory may demonstrate features of REM behavior disorder too. REM
> behavior disorder can be effectively treated with low doses of a
medication
> called clonazepam.
> Yet another sleep disorder seen frequently in association with PD is
> restless leg syndrome (RLS). This is a peculiar disease in which there is
a
> feeling that one needs to move their legs. Movement of the legs typically
> alleviates the sensation of restlessness. The symptoms of RLS usually
> respond very well to treatment with L-dopa or the dopamine agonists, the
> same medications used to treat the symptoms of PD.
> An important point is that having PD does not exclude someone from having
> common problems of sleep disturbance, such as obstructive sleep apnea
(OSA).
> The word "apnea" means "no breath" and the obstruction is often times due
to
> structural abnormalities of airway or neck. OSA can be a complication of
> obesity. OSA is the most common cause of excessive daytime sleepiness. OSA
> is characterized by lapses in breathing for periods of time during the
> night. During these breathing lapses the brain is deprived of oxygen.
> Usually, following these episodes the patient is jolted out of sleep to
take
> a breath. This occurs frequently during the night and results in a severe
> disruption of normal sleep. OSA responds very well to devices that assist
in
> overcoming the obstruction to airflow, resulting in a great improvement in
> daytime wakefulness and alertness.
>
> Fatigue
> The feeling of fatigue is an extremely common symptom in PD. In some
studies
> fatigue occurs in almost one-half of all patients with PD and sometimes
> fatigue may be the first symptom of the disease. It is important to
separate
> fatigue from the depression frequently seen with PD. Fatigue may accompany
> depression, but also it may be present without any of the other signs or
> symptoms of depression. Additionally, fatigue may naturally arise from
> disruption of sleep. If fatigue a part of the spectrum of a depressive
> symptom, then treatment of the fatigue should focus on treatment of the
> underlying depression. If the fatigue is a result of sleep disturbance,
then
> treatment of the sleep disturbance should lead to an improvement in energy
> levels. Sometimes, it becomes necessary to use a class of medications
termed
> "pscychostimulants," like amphetamines, to treat the underlying fatigue.