Treatment Of Parkinson's Sleep Disorders

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Most patients with Parkinson's disease have varying degrees of sleep disorders. In studies from different countries, the cumulative incidence of various types of sleep disorders in Parkinson's patients is as high as 75-98%. In some patients, sleep problems even appear earlier than motor symptoms, becoming an early warning indicator of Parkinson's disease. Doctors and patients tend to pay more attention to motor symptoms when visiting a doctor, but more and more studies have found that non-motor symptoms such as sleep disturbance, constipation, and depression also have a serious impact on the quality of life of patients.

How to treat sleep disorders in Parkinson's disease patients?

1. Non-drug treatment:

1) Exercise therapy: Studies have shown that regular exercise in the elderly can improve sleep quality, shorten sleep latency, and improve sleep efficiency.

2) Light therapy: Light therapy is a common intervention method for the treatment of circadian rhythm disorders, and it has recently been applied to the treatment of PD sleep disorders.

3) Cognitive-behavioral therapy: Cognitive-behavioral therapy has been successfully used in the treatment of insomnia in PD patients, which can enable patients to change their unhealthy behaviors and thinking patterns and help improve sleep disorders. Further research is needed on sleep disturbances in PD patients.

2. Drug treatment:

Adjust the dosage and administration time of Parkinson's disease drugs. For some medicines that can cause insomnia when taken too close to sleep time, it is best to change to take the medicine in the morning or reduce the dose. For patients with insomnia caused by difficulty turning over and painful convulsions, additional small doses of dopamine before going to bed can improve sleep coherence. Daytime somnolence or sleep onset requires careful adjustment of the dose of dopamine agonist.

Parkinson's drugs should avoid sudden withdrawal or withdrawal, and deny that there will be fluctuations in motor and non-motor symptoms. Adding new drugs should also gradually increase the dose from a small amount so that the neurotransmitters in the brain have an adaptation process.

1) Dopaminergic drugs: Dopaminergic drugs can improve sleep by improving nighttime motor symptoms and appropriately increasing blood dopamine concentration. Dopamine receptor agonists have a good effect on restless legs syndrome.

2) Benzodiazepines and non-benzodiazepines: They have the effect of improving difficulty in falling asleep and maintaining sleep, and are recommended to be used in small amounts in the short term.

3) Wake-promoting drugs: methylphenidate and modafinil are mainly used for the treatment of primary hypersomnias, which can improve the daytime subjective sleepiness symptoms in Parkinson's Disease patients.

4) Antipsychotics: Most antipsychotics are not recommended in the treatment of PD, but quetiapine and clozapine for the treatment of PD psychosis have the highest level of evidence support among antipsychotics.

5) Anti-anxiety and depressive drugs: A considerable number of PD patients have co-morbid anxiety and depression. Anti-anxiety and antidepressant drugs can improve the negative emotions of patients and improve the sleep of PD patients.

6) Melatonin: Similar to the mechanism of light therapy, melatonin can be tried to be applied to PD patients with circadian rhythm disorders.

According to different causes of sleep disorders, the drug treatment plan can be adjusted under the guidance of a doctor.

◎Selegiline and other drugs that may cause insomnia should be avoided in the evening or at night

◎For poor control of nocturnal motor symptoms, periodic leg movement, or restless legs during sleep, supplementation with dopaminergic drugs before going to bed can be used to treat

◎Clonazepam and other drugs can be used for REM sleep behavior disorder

◎For depression-related early awakening, antidepressants can be supplemented, etc.

◎When treating sleep disorders, it is necessary to pay attention to prevent excessive treatment to avoid other discomforts. Giving Parkinson's patients a good night's sleep is as important as improving motor symptoms.

Adjust your lifestyle

(1) Do not take drugs or food containing caffeine or nicotine, especially 4-6 hours before going to bed, which means that if you want to have a good sleep, it is best not to drink coffee or strong tea in the second half of the day, and not after dinner smoking. When you have a cold, choose your medicine carefully, and take the cold medicine that is suitable for taking at night;

(2) Avoid strenuous exercise before going to bed. Regular exercise during the day is beneficial to sleep, but exercise before bed can interfere with sleep;

(3) Avoid over-satiation, high-fat protein diet, and drinking too much water before going to bed;

(4) Don’t drink alcohol at night. Although alcohol can help nervous people fall asleep, it will make people wake up easily in the second half of the night;

(5) Sleep to avoid emotional agitation and overuse of the brain;

(6) Take regular breaks and go to bed on time. No matter when you fall asleep the night before, you must get up on time the next day. The purpose is to reshape the rhythm of the biological clock because the time to get up is very important to the biological clock;

(7) The temperature of the bedroom is appropriate, quiet, and the light is as dim as possible.

Food for sleep

(1) Drink a cup of hot milk before going to bed: Milk contains tryptophan, a biochemical substance that makes people feel tired. People who often insomnia drink a cup of hot milk before going to bed can often fall asleep quickly, and the hypnotic effect of milk is gradually strengthened, often making the second half of the night sleep more sweetly.

(2) Eating bread can make people fall asleep: When people eat bread, the pancreas will secrete insulin to metabolize the amino acids contained in the bread, and there is an amino acid metabolite of serotonin, which can calm and hypnotize.

(3) Eating apples or smelling the smell of apples before going to bed: The elements such as phosphorus and iron contained in apples are easily absorbed by the intestinal wall, and have the functions of nourishing the brain, nourishing blood, calming the mind, and sleeping. In addition, the aroma of apples has a great impact on people's psychology. Studies have found that the aroma components of apples contain 92% alcohol and 6% carbonyl compounds. Its rich aroma has a strong sedative effect on human nerves, causing People are relaxed and can induce sleep, so people who often suffer from insomnia and can't sleep, might as well put an apple with a strong fruity fragrance on the bedside, maybe you can sit back and relax tonight.

(4) Eating bananas before going to bed: Bananas are called "sleeping pills with peels". Insomniacs can easily fall asleep if they eat some bananas before going to bed. Because bananas are high in sugar, carbohydrates can increase the chemical composition of serotonin in the brain. Vitality can induce sleep. Note: Diabetic patients are not suitable for this article, and remember to brush your teeth before going to bed.

(5) Drink oatmeal before going to bed: Oatmeal can remove the acidic substances in the body that affect sleep, relax the nerves, and have a gentle sleeping effect. Oatmeal also prompts the body to secrete a type of insulin that helps tryptophan signal to the brain that it's time for sleep. And oats release glucose at a constant rate during sleep, which can prevent low blood sugar from causing nightmares.

Relaxation therapy

It aims to reduce the hypermetabolism of glucose in the patient's brain, reduce the level of physical and psychological arousal, effectively reduce the activity of autonomic nerves and skeletal muscle tone, and relieve anxiety. The main relaxation techniques of this therapy are abdominal breathing training, operation points: breathing should be deep, long, and slow; breathing through the nose instead of the mouth; exhaling and inhaling in about 15s, that is, deep inhalation (bulging belly) for 3-5s, hold your breath for 1s, then slowly exhale (retract your stomach) for 3-5s, hold your breath for 1s.

Music to sleep

The amplitude of music has a harmonious frequency, which is transmitted to the auditory center of the brain through the auditory nerve, causing people to associate with beautiful things, at the same time coordinating muscle tension and blood flow speed, and even the emotions of the whole body, reducing the mental tension and anxiety of insomnia patients.

Wink hypnosis

When people want to sleep, they can't lift their eyelids first, as the saying goes, "eyelid fights". This is because the upper eyelid is dominated by the sleep center in the cerebral cortex, and the eyelids are closed first when sleeping. Experience has shown that this mechanism can be used to regulate sleep. When the lights are turned off at night, lie on your back, staring at the ceiling, look back as much as possible, and start to open and close the eyelids repeatedly until the eyelids are sore and tired, forming a state of artificial eye muscle fatigue, and the eyes will naturally close and fall asleep peacefully. If persisted for a long time, this exercise can also prevent and reduce droopy eyelids in the elderly and delay the aging process.

Sleep disorder is actually a relatively common medical problem, but the incidence of PD patients is relatively high. If PD patients have sleep disorders and seriously affect sleep quality and quality of life, it is necessary to improve their sleep through medical means. In addition, having a good night's sleep also has a good effect on disease control.