Howdy Folks
This write-up goes with the list of "non-motor" PD smptoms.

Sleep Disorders in PD
We spend over one third of our lives in sleep. The daily time spent sleeping
decreases as we age. No one is exactly sure why we sleep, but it is felt
that sleep is necessary to "recharge" the brain for the next day's
activities. We have all had nights of little or no sleep and it is obvious
that thinking and functioning the day after can be very difficult.
Sleep disturbances are a prominent part of PD. Often times it is difficult
to fall asleep and once asleep there are frequent awakenings. The need to
frequently urinate (see below) may also disrupt what would be a good night's
sleep. Once awake, it becomes harder to fall back asleep. This interference
in the normal sleep patterns results in increased sleepiness or somnolence
during the daytime hours. The sleep-wake cycle then becomes fragmented, with
poor sleep during the night and excessive sleep during the day.
Treatments of these sleep disturbances include simple measure such as
attending to good "sleep hygiene." This refers to avoiding such things as
alcohol, caffeine, nicotine, and excessive fluid intake prior to bed. Also,
increasing activity during the day may lead to more restful sleep at night.
Occasionally, medications can be used during the day to decrease excessive
daytime sleepiness. These medications are stimulants and although they can
be helpful in some cases, they may have some serious adverse effects.
Extremely vivid dreams can occur as a common side effect of medications used
to treat the motor symptoms of PD. These dreams may be so vivid and real
that family members or caretakers may think that the patient is
hallucinating, delusional, or demented. A patient who is not psychotic or
demented will soon realize, after several episodes, that these are dreams.
If these dreams become particularly bothersome, reducing the nighttime dose
of L-dopa or dopamine-agonist may alleviate this side effect. Otherwise,
patients, family members, and caretakers should be assured that these dreams
are due to medication effects and are not a sign of dementia or psychosis.
There are disorders of sleep that are closely associated with PD. One such
disorder is called REM (rapid eye movement) behavior disorder. REM sleep is
that stage of sleep in which dreams occur. In normal people there is an
inhibition of muscle tone, which functions as a protective mechanism during
REM sleep. In REM behavior disorder the inhibition of that tone is loss.
This leads to the outward expression of behaviors such as laughing,
screaming, kicking, punching, etc. Spouses may be at risk for bodily harm
and may have to sleep in another bed or part of the house. Patients who have
this disorder will usually go on to develop some signs and symptoms of
parkinsonism. Likewise, PD patients when studied in a special sleep
laboratory may demonstrate features of REM behavior disorder too. REM
behavior disorder can be effectively treated with low doses of a medication
called clonazepam.
Yet another sleep disorder seen frequently in association with PD is
restless leg syndrome (RLS). This is a peculiar disease in which there is a
feeling that one needs to move their legs. Movement of the legs typically
alleviates the sensation of restlessness. The symptoms of RLS usually
respond very well to treatment with L-dopa or the dopamine agonists, the
same medications used to treat the symptoms of PD.
An important point is that having PD does not exclude someone from having
common problems of sleep disturbance, such as obstructive sleep apnea (OSA).
The word "apnea" means "no breath" and the obstruction is often times due to
structural abnormalities of airway or neck. OSA can be a complication of
obesity. OSA is the most common cause of excessive daytime sleepiness. OSA
is characterized by lapses in breathing for periods of time during the
night. During these breathing lapses the brain is deprived of oxygen.
Usually, following these episodes the patient is jolted out of sleep to take
a breath. This occurs frequently during the night and results in a severe
disruption of normal sleep. OSA responds very well to devices that assist in
overcoming the obstruction to airflow, resulting in a great improvement in
daytime wakefulness and alertness.

Fatigue
The feeling of fatigue is an extremely common symptom in PD. In some studies
fatigue occurs in almost one-half of all patients with PD and sometimes
fatigue may be the first symptom of the disease. It is important to separate
fatigue from the depression frequently seen with PD. Fatigue may accompany
depression, but also it may be present without any of the other signs or
symptoms of depression. Additionally, fatigue may naturally arise from
disruption of sleep. If fatigue a part of the spectrum of a depressive
symptom, then treatment of the fatigue should focus on treatment of the
underlying depression. If the fatigue is a result of sleep disturbance, then
treatment of the sleep disturbance should lead to an improvement in energy
levels. Sometimes, it becomes necessary to use a class of medications termed
"pscychostimulants," like amphetamines, to treat the underlying fatigue.