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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.