Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson's disease

Neurology. 2004 Oct 26;63(8 Suppl 3):S35-8. doi: 10.1212/wnl.63.8_suppl_3.s35.

Abstract

Nocturnal disturbances are common in Parkinson's disease (PD) patients, with almost 70% of these patients reporting nocturnal disturbances. The etiology of sleep disturbances in patients with PD is still controversial. They might be dependent on dopaminergic drugs, on disease progression, or on a combination of these two factors. Nocturnal disturbances can be categorized in four groups: 1) PD-related motor symptoms, including nocturnal akinesia, early-morning dystonia, painful cramps, tremor, and difficulty turning in bed; 2) treatment-related nocturnal disturbances; 3) psychiatric symptoms, including hallucinations, vivid dreams, depression, dementia, insomnia, psychosis, and panic attacks; 4) other sleep disorders, including insomnia, REM behavioral disorder (RBD), restless legs syndrome (RLS), periodic leg movements (PLMS), and excessive daytime sleepiness (EDS). Specific treatment options are supplied for every group. A global evaluation of nocturnal disturbances would provide clinicians with a valuable tool to establish an optimal regimen that could positively influence all nocturnal disturbance categories and thus improve PD management on. However, it is important to consider that management of some nocturnal disturbances in a group may worsen nocturnal symptoms of another group or may increase EDS. PD-related symptoms can be treated with long-acting DA agonists to obtain continuous DA receptor stimulation during the night. Both treatment-related nocturnal disturbances and psychiatric symptoms may be related to drug treatment, and therefore, in both cases, drug reduction or discontinuance should be considered. Some sleep disorders, such as RLS and PLMS, may be controlled by DA agents, and others, such as insomnia and EDS, may be improved by reducing dopaminergic stimulation.

Publication types

  • Review

MeSH terms

  • Antiparkinson Agents / adverse effects
  • Antiparkinson Agents / therapeutic use
  • Catechol O-Methyltransferase Inhibitors
  • Cholinesterase Inhibitors / therapeutic use
  • Disorders of Excessive Somnolence / drug therapy
  • Disorders of Excessive Somnolence / etiology
  • Dopamine Agonists / therapeutic use
  • Dystonia / drug therapy
  • Dystonia / etiology
  • Hallucinations / drug therapy
  • Hallucinations / etiology
  • Humans
  • Muscle Cramp / drug therapy
  • Muscle Cramp / etiology
  • Narcotics / therapeutic use
  • Parkinson Disease / complications*
  • Parkinson Disease / drug therapy
  • Parkinson Disease / psychology
  • Psychotic Disorders / drug therapy
  • Psychotic Disorders / etiology
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Sleep Disorders, Intrinsic / drug therapy
  • Sleep Disorders, Intrinsic / etiology*

Substances

  • Antiparkinson Agents
  • Catechol O-Methyltransferase Inhibitors
  • Cholinesterase Inhibitors
  • Dopamine Agonists
  • Narcotics
  • Serotonin Uptake Inhibitors