Tips to Manage Your Parkinson's Motor Fluctuations

Medically Reviewed by Carol DerSarkissian, MD on October 22, 2021

Lifestyle changes can help you manage Parkinson's motor fluctuations -- symptoms that return after you've been getting treatment for years. Exercise, stress relief, and healthy eating can all play a role in making you feel better.

Focus on Diet

An overall healthy eating plan will give you the nutrients you need to feel your best. Try to get a balance of fruits, veggies, whole grains, and other nutritious foods with each meal.

You need protein from foods like meat, eggs, beans, and cheese to keep your muscles strong. But protein can also make it harder for your body to absorb levodopa -- a common medicine for Parkinson's.

One solution is to eat all of your protein-rich foods at dinnertime. Stick to fruits, vegetables, and whole grains early in the day.

Take levodopa 30 to 60 minutes before meals, so your body has time to absorb the medicine. If the drug upsets your stomach, take it with some crackers or toast.


Your body needs time to rest and recover when you have Parkinson's.

A good night's sleep will help you feel refreshed. If you wake up during the night and have trouble falling back to sleep, there are steps you can take to help you get the best rest.

To help you sleep through the night, keep your room cool, dark, and quiet. Don't eat a heavy meal or drink alcohol or other fluids within 3 hours of bedtime. It's hard to sleep when your belly is full or you need to use the bathroom.

Switch out your regular sheets for satin ones. The silky fabric will let you move more easily and prevent some of the stiffness and pain that can disrupt your sleep.

Do something relaxing before bed. Meditate, practice deep breathing, or take a warm bath to calm your mind. If you try these tips and you still can't sleep through the night, see your doctor for advice.


Staying active is an important part of managing your Parkinson's disease. Exercise strengthens muscles, improves flexibility, and helps prevent falls. It also helps with symptoms like stiffness and slowed movements.

Before you start a new exercise program, check with your doctor to make sure it's safe for you. Try to walk, swim, lift light weights, or do other exercises for at least 2 1/2 hours each week. Work with a physical therapist to design a routine that fits your needs and honors your limits.

It may be hard for you to exercise during "off" periods -- times when your levodopa isn't working so well and you have symptoms. Try to time activities to your "on" periods when your medicine is working best.

Manage Stress

It's important to find ways to relax, since too much stress can make your tremors, stiffness, and other symptoms worse.

Try some relaxation techniques, like deep breathing, for a few minutes each day. To do this, sit somewhere quiet, breathe in slowly through your nose, and let your belly expand. Then breathe out, gently pulling your belly in.

You can also do yoga or tai chi, exercise programs that combine gentle movements with deep breathing. They can help you relax while improving your balance and flexibility.

Music is another stress-buster. Listen to your favorite songs or find a soothing melody to calm your mind.

Adjust Your Medicine

If you’re taking levodopa, your doctor likely has told you it raises dopamine levels in your brain to prevent symptoms like stiffness and tremor. Early in the disease, levodopa should keep your dopamine levels steady from one dose to the next.

Once you've had Parkinson's for many years, your dopamine levels may start to drop between doses. When that happens, your symptoms could come back before it's time to take the next dose.

Your doctor can adjust when and how often you take levodopa to avoid these dips in dopamine levels. One strategy is to take smaller doses of levodopa more often during the day. Or you could take a higher dose of the drug the same number of times each day.

Switch to a New Drug Delivery Method

Another way to keep your dopamine levels steady is to try a long-acting form of levodopa that delivers a steady dose of the medicine. These include:

  • A patch that you wear on your skin
  • A capsule that slowly releases the drug into your body over several hours

Or you could take levodopa gel, which goes straight into your intestine through a needle and a tube called duopa. It works faster than a pill because your stomach doesn't have to break down the medicine first.

A new powder form of levodopa (INBRIJA) that you breathe into your lungs and helps relieve motor fluctuations faster than a pill has also been approved.

Add Another Drug

Your doctor may suggest a second medication to boost levodopa's effects in your body or make the medicine work longer. This could help you avoid "off" time, a period when your symptoms come back.

A few drugs make your body break down levodopa more slowly so that each dose lasts longer. These include:

Dopamine agonists like pramipexole (Mirapex) and ropinirole (Requip) act like dopamine in your brain. They can cut down on motor fluctuations, but they sometimes cause side effects like nausea, dizziness, and tiredness.

The drug apomorphine (Apokyn) is a type of dopamine agonist that acts as a "rescue" medicine. It helps bridge the gaps between levodopa doses and gives you quick relief when you get unexpected symptoms. You inject it under your skin, similar to the insulin shots people take to treat diabetes. Apomorphine starts working in just a few minutes, and its effects last for an hour or two.

Try Physical Therapy

A physical therapist can show you techniques that improve your balance and movement, and help you manage your motor fluctuations.

A physical therapy program can include:

  • Exercises to improve your strength and balance
  • Tips to prevent falls
  • Techniques to help you get up from a chair or bed and walk more easily
  • Advice on how to use canes or other mobility aids to help you get around safely

Get Occupational Therapy

An occupational therapist can teach you ways to manage motor fluctuations at work and home. You'll learn how to use tools like grabbers and long-handled shoe horns to do everyday tasks.

The therapist can also show you some changes to make to your home. For instance, you can get ideas such as adding stair rails or bathroom grab bars to prevent falls.


If medicine changes and other treatments don't stop your symptoms, surgery could be an option. Deep brain stimulation is a procedure that puts electrodes in your brain. They send out mild electrical impulses to help ease your Parkinson's symptoms.

Get Support

If motor fluctuations start to make you feel a little overwhelmed, reach out to others to get the emotional backing you need. Ask for support from your partner, family, friends, and medical team.

You can also join a support group for people with Parkinson's disease. Ask the doctor who treats you to recommend one in your area. Or find a group through an organization like the Parkinson's Foundation. When you join one, you'll meet people who understand just what you're going through and can offer advice.

Show Sources


Photo Credit: PaulMaguire / Getty Images

European Parkinson's Disease Association: "Complementary Therapies," "Motor Symptoms," "Therapists and Multidisciplinary Care."

Frontiers in Aging Neuroscience: "Protein-restricted diets for ameliorating motor fluctuations in Parkinson's disease."

Parkinson's Foundation: "Getting the Support You Need," "Managing PD Mid-Stride," "How Can I Cope With Anxiety and Stress?"

The Michael J. Fox Foundation for Parkinson's Research: "Diet and Parkinson's Disease," "Deep Brain Stimulation," "Inhaled Levodopa as a Treatment for Intermittent Motor Fluctuations in Parkinson's Disease."

University of California, San Francisco: "Sleep and Parkinson's Disease," "Catechol-O-methyl-transferase (COMT) Inhibitors," "Dopamine Agonists," "Monoamine Oxidase B (MAO-B) Inhibitors."

UF Health: "Stress Management Related to Parkinson's Disease."

American Parkinson Disease Association: "Motor Fluctuations in Parkinson's Disease: What You Need to Know."

Parkinson's UK: "Levodopa," "Wearing Off and Dyskinesia."

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