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Parkinson's: When the Visuals and Voices Affect Sleep

Reviewed by Jennifer Robinson, MD on May 08, 2020

As your Parkinson’s disease progresses, you may one day “see” an animal in the room that isn’t really there, or a long-deceased friend at your kitchen table. Those are hallucinations, a feature of Parkinson’s psychosis. Lack of sleep plays a central role.

Many people with Parkinson’s disease have trouble sleeping and extreme daytime sleepiness. These aren’t just frustrating issues. People with Parkinson’s disease and sleep problems may be five times more likely to have psychotic symptoms.

Lack of sleep isn’t the only thing that triggers hallucinations, but it’s one with a lot of treatment options. That’s because, with Parkinsons, there are many things that can keep you up at night.  Fortunately, there are also lots of ways for doctors to treat them.

Fragmented Sleep

Sleep, wake, repeat: For many people with Parkinson’s, it happens all night. This broken sleep pattern is called sleep fragmentation.

Fragmented sleep is one of the most common sleep complaints among people with Parkinson’s disease. Parkinson’s symptoms and medications can disrupt your sleep throughout the night. Hallucinations may play a role in to fragmented sleep, too.

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Your doctor should be aware of your sleep-problem specifics in order to tailor a treatment strategy know about the details of your sleep problems to make a treatment for you. It could include:

Medication to help you sleep better. Clonazepam (Klonopin), a long-acting sedative, may help you sleep more normally.

Medication to reduce daytime sleepiness. Extreme daytime sleepiness can cause restless nights. Drugs called stimulants can help fight daytime fatigue and drowsiness in Parkinson’s disease. These include:

  • Modafinil (Provigil), a drug used for narcolepsy
  • Methylphenidate (Ritalin), a true stimulant medication

Changes to your Parkinson’s medications. Some can cause daytime drowsiness or affect your sleep at night. The doctor might adjust your Parkinson’s medications to address these problems.

Other drugs can also improve your sleep, including pimavanserin (Nuplazid), an antipsychotic drug that treats Parkinson’s disease hallucinations.

Hallucinations

It can’t be easy to get a restful night’s sleep after watching an animal scamper across the room -- especially when you know it’s a hallucination. (This is called retaining insight.) And you know a restless night will only make another hallucination more likely. So tell your doctor right away if you have a hallucination. That way, you can start attacking the problem from all possible angles.

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Your doctor may:

  • Rule out non-Parkinson’s causes, like infections
  • Review your prescriptions to ensure you’re taking the right dose of the right drug
  • Prescribe drugs to improve your sleep or your ability to manage if you can’t sleep well
  • Prescribe an antipsychotic drug to treat hallucinations, such as pimavanserin or clozapine (Clozaril)

 

REM Behavior Disorder (RBD)

If you have Parkinson’s disease, you may develop this problem with your REM (rapid eye movement) sleep stage. It can cause you to thrash, talk, or yell during sleep. Someone watching might think you’re hallucinating, but you aren’t awake. You’re physically acting out vivid dreams or nightmares. 

REM sleep is typically when you dream. You also don’t move due to a normal, short-term paralysis in the arms and legs called atonia.

When you have REM behavior disorder, you don’t experience normal sleep paralysis. As a result, you could kick, punch, flail your arms, and jump from bed. You may talk, laugh, shout, or scream.  Some drugs can improve these symptoms:

  • The sedative clonazepam, which improves RBD in most people
  • Certain antidepressants, including bupropion and sertraline
  • Parkinson’s medications (dopaminergic drugs), if you’re just beginning treatment

Simple Tips to Sleep Better

Medications can manage your hallucinations so you can sleep better -- and vice versa. But don’t forget that sleep hygiene matters, too. These simple tips should help anyone with sleep problems:

  • Sleep only as much as you need to feel refreshed.
  • Wake up at the same time every day.
  • Exercise daily -- but not close to bedtime.
  • Keep your bedroom cool.
  • Avoid tobacco and alcohol.
  • Limit fluid and avoid caffeine in the evening.
  • If you’re hungry before bed, have a light snack.
  • Get out of bed if you feel angry or frustrated.

 

WebMD Medical Reference

Sources

Parkinson’s Foundation: “Hallucinations and Delusions in Parkinson’s Disease,” “Hallucinations/Delusions.”

Clinical Neuropharmacology: “Nighttime Sleep and Daytime Sleepiness Improved With Pimavanserin During Treatment of Parkinson’s Disease Psychosis.”

Current Treatment Options in Neurology: “Sleep Dysfunction and its Management in Parkinson’s Disease.”

American Parkinson Disease Association: “Sleep Problems.”

Mayo Clinic: “REM sleep behavior disorder.”

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