Sleep disturbances are one of the most common — yet often under-recognized — non-motor symptoms of Parkinson’s disease (PD). While most people associate Parkinson’s with tremors and movement challenges, more than 80% of individuals with PD will experience a sleep problem during the course of the disease (Parkinson’s Foundation, 2024). These issues worsen with disease progression and are strongly linked to diminished quality of life (Iranzo et al., 2024).
Understanding how Parkinson’s disrupts sleep — and what can be done about it — is essential for patients, caregivers, and healthcare providers alike.
Why Sleep Matters in Parkinson’s
Quality sleep plays a critical role in regulating mood, cognition, immune response, and motor recovery — all of which are already impacted in PD. Unfortunately, PD often disrupts both the sleep-wake cycle (circadian rhythm) and sleep architecture. These disruptions are due to the neurodegenerative changes affecting brain regions that regulate sleep, including cortical and subcortical structures (Zahed et al., 2021).
In addition to these biological changes, common PD symptoms such as tremor, rigidity, and nocturia (frequent nighttime urination) can fragment sleep. Some medications used to manage PD, particularly dopaminergic therapies, may also contribute to either insomnia or excessive daytime sleepiness (Cleveland Clinic, 2021; Iranzo et al., 2024).
Common Sleep Disorders in Parkinson’s Disease
Sleep disturbances in PD are multifactorial. They may arise from the disease itself, side effects of treatment, or other co-occurring sleep disorders (Iranzo et al., 2024). Common sleep-related challenges include:
1. Insomnia and Fragmented Sleep
Many individuals with PD fall asleep easily but struggle to stay asleep. They may wake frequently due to symptoms like tremor, pain, or vivid dreams — sometimes triggered by levodopa-based treatments (Parkinson’s Foundation, 2024). Cortical electrophysiological studies have confirmed disrupted slow-wave and REM sleep in PD, which underlie poor restorative rest (Zahed et al., 2021).
2. Excessive Daytime Sleepiness (EDS)
EDS can emerge early in the disease and worsens over time. It may stem from insufficient nighttime sleep, medication side effects, or degeneration of wake-promoting brain regions (Medical News Today, 2023; Iranzo et al., 2024).
3. REM Sleep Behavior Disorder (RBD)
RBD causes individuals to physically act out vivid dreams due to a lack of muscle paralysis during REM sleep. Often preceding a Parkinson’s diagnosis by several years, RBD is increasingly recognized as a prodromal symptom and potential biomarker for neurodegeneration (Iranzo et al., 2024).
4. Restless Legs Syndrome (RLS)
RLS is characterized by uncomfortable leg sensations and a strong urge to move, especially at night. It may be linked to both PD pathology and dopaminergic treatments, complicating diagnosis and management.
5. Sleep Apnea
Obstructive sleep apnea (OSA) is more common in people with PD than previously thought. While classically associated with obesity, OSA in PD may stem from impaired brainstem control of airway muscles (Cleveland Clinic, 2021; Iranzo et al., 2024).
6. Circadian Rhythm Disorders
Degeneration of the suprachiasmatic nucleus and other circadian regulators in the brain can disrupt the natural sleep-wake cycle, leading to irregular sleep timing and daytime sleepiness (Zahed et al., 2021).
Strategies for Improving Sleep with Parkinson’s
Successful treatment requires identifying the root causes of sleep disturbance and tailoring interventions to each individual. A multimodal approach often yields the best outcomes.
Medical Management
- Medication Adjustments: Changing the timing or dosage of medications can reduce nocturnal symptoms and minimize daytime drowsiness (Parkinson’s Foundation, 2024).
- Targeted Therapies: Clonazepam or melatonin may help treat RBD, while gabapentin or dopamine agonists may relieve RLS — although careful monitoring is needed (Cleveland Clinic, 2021).
- Sleep Studies: Objective tests like polysomnography or actigraphy help confirm diagnoses such as RBD or sleep apnea and guide treatment (Iranzo et al., 2024).
Behavioral and Lifestyle Interventions (Sleep Hygiene)
Establishing good sleep habits is a cornerstone of PD sleep management:
- Go to bed and wake up at consistent times.
- Avoid stimulants like caffeine and alcohol late in the day.
- Limit screen time before bed and keep screens out of the bedroom.
- Keep the bedroom dark, cool, and quiet.
- Use satin sheets or pajamas to reduce friction when turning in bed (Sissons, 2023).
- Limit fluid intake in the evening to reduce nocturia. If nighttime urination is frequent, seek medical evaluation.
Cognitive Behavioral Therapy (CBT)
CBT for insomnia (CBT-I) can be effective for people with PD who have chronic difficulties initiating or maintaining sleep, particularly when sleep medications are contraindicated (Iranzo et al., 2024).
Light Therapy
Bright light therapy has shown promise in improving sleep quality, circadian alignment, and daytime alertness in PD when used consistently, especially in the morning (Chahine et al., 2017).
Future Possibilities: Neuromodulation and Electrophysiological Insights
Research into brain recordings during sleep in PD has revealed abnormal activity in both slow-wave and REM sleep stages. These disruptions may contribute not only to poor rest but also to symptom progression (Zahed et al., 2021). Deep brain stimulation (DBS) and other neuromodulation strategies are being explored to target these disturbances and improve sleep-related outcomes.
The Bidirectional Link Between Sleep and PD Progression
Mounting evidence suggests that sleep disturbances may accelerate neurodegeneration through increased oxidative stress and impaired waste clearance in the brain (Zahed et al., 2021). In fact, RBD has been proposed as a critical window for early intervention with neuroprotective strategies, even before motor symptoms appear (Iranzo et al., 2024).
When to Talk to a Healthcare Provider
Sleep problems in PD are not just inconveniences — they can significantly impair quality of life and may reflect underlying neurological changes. If sleep issues are frequent, disruptive, or dangerous (e.g., falling out of bed during dream enactment), it’s time to consult a sleep specialist or neurologist. Early, personalized treatment can ease symptoms and potentially modify disease progression.
At Somnology, we understand the complex role sleep plays in overall wellbeing. Our platform enables ongoing sleep monitoring, helps detect sleep disruptions early, and connects individuals with sleep specialists to create tailored care plans that support long-term health and wellbeing. Visit our website to learn more.
Sources:
- Chahine, L. M., Amara, A. W., & Videnovic, A. (2017). A systematic review of the literature on disorders of sleep and wakefulness in Parkinson’s disease from 2005 to 2015. Sleep medicine reviews, 35, 33–50. https://doi.org/10.1016/j.smrv.2016.08.001
- Cleveland Clinic. (2021, February 25). Sleep problems with Parkinson’s disease. Retrieved from https://my.clevelandclinic.org/health/diseases/14306-parkinsons-disease-and-sleep
- Iranzo, A., Cochen De Cock, V., Fantini, M. L., Pérez-Carbonell, L., & Trotti, L. M. (2024). Sleep and sleep disorders in people with Parkinson’s disease. The Lancet Neurology, 23(9), 925–937. https://doi.org/10.1016/S1474-4422(24)00170-4
- Sissons, B. (2023, September 20). Does advanced stage Parkinson’s disease cause people to sleep more? Medical News Today. https://www.medicalnewstoday.com/articles/parkinsons-sleep
- Zahed, H., Zuzuarregui, J. R. P., Gilron, R., Denison, T., Starr, P. A., & Little, S. (2021). The neurophysiology of sleep in Parkinson’s disease. Movement Disorders, 36(7), 1526–1542. https://doi.org/10.1002/mds.28562