Losing Sleep Over Parkinson's

Much of what we understand about Parkinson's disease usually revolves around the three S’s: slowness, stiffness and shakiness.

But there are more than 30 nonmotor problems associated with the disease that can have just as much effect on a person's quality of life.

Nonmovement symptoms range from autonomic problems—such as high blood pressure, constipation and trouble sleeping—to sensory issues—such as unpleasant sensations in the leg or loss of smell and taste.

"These are not hidden symptoms of the disease, but rather they are part of the disease," said Michele Tagliati, MD, director of the Cedars-Sinai Movement Disorders Program. "And what we have come to realize is that they are as important, if not more important, than the obvious symptoms that everybody is familiar with."


Recognizing Parkinson's Disease

More than 10 million people live with the disease, struggling to control body movements. By the end of the year, 60,000 more will be diagnosed. Parkinson’s typically begins relatively late in life, but in some cases, the brain disease develops in those younger than 50.

Most people with the disease first notice a tremor somewhere on their body. Muscles of the legs, face, neck or other body parts may become unusually stiff or rigid. Another common early sign of the disease is a reduced swing of the arm on one side when a person is walking.

The Fourth "S": Sleeplessness

One of the most common nonmotor problems associated with Parkinson's disease is the REM behavior disorder. This is when a person acts out a dream through walking, talking, kicking and punching, which can result in bodily harm the person or their loved ones.

"Many patients with this disease are sleep-deprived," Tagliati said. "As far as I’m concerned, sleep is the most important act the brain can do. Not sleeping, even though it may not be the patient’s only problem, definitely aggravates all the problems."

Those problems could include difficulty balancing, hunched posture, weakness of face and throat muscles that causes difficulty in talking and swallowing, or the sudden inability to move.

For many older patients with Parkinson’s, getting a good night’s rest is their biggest issue. Many wake up several times a night, thinking they have to go to the bathroom, but this symptom is a form of sleep fragmentation, and that’s part of the disease’s culture.

"They also tend to think, because they are older, they shouldn’t sleep as much, which is not true," said Tagliati, the nation's leading research and treatment specialist in Parkinson's disease and other movement disorders. "You’re supposed to sleep, even if you are 80 years old."

Taglaiti said the disease is not what we think it is. The entire brain is affected in different stages and in different ways, which is why many patients have sleeping consultations to help manage their irregular behavior.

"It's important we are always asking patients the right questions and providing them with an individualized holistic approach to their diagnosis and therapy," Tagliati said. "This means knowing the patient and what is bothering them, acknowledging the issues and treating them to the best of our ability."