Hello Sheila Chaudoin:
You wrote that your 72 year old mother is having sleep
difficulties . . . . these tips are from two earlier postings:
Sleep disturbances are common in PD. Although doctors
report that approximately 75% of their PD patients
experience sleep disturbances the causes are unclear. Even
in healthy seniors, aging brings on sleep difficulties. Reasons
have ranged from pain, stiffness to frequent urination. Also,
PWP are disturbed by vivid dreams and the altered
sleep-awake cycle.
Sleep problems are placed into three categories- 1. sleep
start or continuance, 2. daytime sleepiness, and 3.
nightmares, vivid dreams, etc.
Although little research has been done in the field,
researchers have noticed that for PWP who awaken
spontaneously, stay awake because their PD symptoms
keep them from falling back to sleep.
This type of sleep disturbance is treated with an alteration
in meds. Using Sinemet CR at bedtime should reduce the
frequency of sleep disturbances and better quality sleep.
Age is the most important factor in determining sleep
needs. After age 35 sleep time generally falls to about 6 hrs
per night. Older adults usually have less problems falling
asleep, but complain of frequent awakenings. Parkinson's
patients tend to have worse problems with sleep than non-PD
seniors. Patients report the causes as reaction to or effects
of medications (L-dopa), PD symptoms such as stiffness or
a change in their sleep-awake cycle caused by the disease.
The most common PD reported sleep problem is
insomnia: the inability to fall asleep or stay asleep.
Treatment should begin with an evaluation of the patient's
day-night cycle and activities. A patient's anxiety or
depression, timing of meds, excessive alcohol, caffeine or
nicotine intake or even breathing problems (leading to sleep
apnea) should be considered.
If your mother's sleep-awake pattern is altered or
reversed a sedative at bedtime may work. Dalmane and
Valium are sometime used, but should be used sparingly
because they increase slowness of movement
(bradykinesia). This regimen must be supplemented with
activity during the awake phase: physical activities, caffeine
(not after lunch) and no naps.
Avoid alcohol or use of sleeping pills. Have a regular
bedtime and awaken time. Decrease fluid intake three hours
before bedtime, and use the bathroom before sleep.
Minimize light and noise and don't read or watch television in
bed.
There is also "Phototherapy." In a 1993 case study,
documented in Neurology , 1993, Dr. P. Mosbach and others
treated a 70 year old PWP who experienced sleep
disturbance, and major fatigue and drowsiness in the
afternoon, with a very bright light for 30 minutes before
dinner. This phototherapy resulted in her staying fully awake
for at least four more hours thereby resetting her sleep
pattern. This allowed her to sleep until the morning,
undisturbed. There were no reported side-effects or
complications.
General recommendations for behavior changes to
improve sleep:
1. Have a regular bedtime and arise time to reset the
internal clock.
2. Avoid excessive time in bed; it leads to light, shallow
sleep. Limit daytime naps.
3. Avoid alcohol, caffeine and nicotine . . . or at least
none after 2 p.m.
4. Regular daily exercise, not later than 6 p.m.
5. Keep the bedroom quiet and free of loud noises and
light and on the cooler side.
6. Decrease fluid intake after dinner.
7. Try special routines before bedtime, such as a warm
bath, 4 oz. of warm milk or a snack of cheese and crackers
(both high in the amino acid tryptophan).
8. Avoid prolonged use of sleep aid meds. Meds, such
as Doxepin or Trazodone (low-dose anti-depressants) are
sometimes used to help the patient through a limited crisis.
Two other recommended supplements to aid sleep are
the amino acid L-Tryptophan and the hormone Melatonin.
L-Tryptophan was thought to be a cause of the illness EMS
which leads to an elevated white blood cell count. But no
definitive evidence was ever established. Melatonin
maintains the sleep-awake cycle. It has proven effective in
inducing sleep in PD patients. Dosage is usually 3
milligrams 2 hours before bedtime. It should be used
sparingly.
I hope this information helps your mother. Good luck.
Stephan Schwartz 53/7
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