Sleep for Ageing & Parkinson's
- Matt Gable
- Apr 27, 2021
- 46 min read
Updated: Sep 28, 2023
The negative affect that Parkinson's has on sleep is often talked about. But what about the positive impact that sleep has on Parkinson's?
I am going to talk about how each and every symptom has some form of association with sleep deprivation. Improving sleep quality and quantity could lead to having a drastic improvement in quality of life for those with PD.
I have studied sleep for the last decade, due to finding that my epilepsy is mainly triggered by lack of sleep or too much sleep.
I cover the following:
Parkinson's Disease
Parkinson's disease is the fastest growing neurological condition in the world. It is estimated that around 145,000 people live with Parkinson's in the UK and more than 10 million worldwide [1, 2].
It's caused by the gradual breakdown of nerve cells in the part of your brain called Substantia Nigra. These nerve cells are in charge of producing the chemical called dopamine. Dopamine enables neurons in your brain to control movement. When one type of neuron steadily degenerates, the chemical imbalance causes physical symptoms. These include tremor, slowness, stiffness, and walking and balance problems. This is why it is called a movement disorder. Constipation, depression, memory problems and other non-movement symptoms also can be part of Parkinson’s [3].
It's still unknown as to what causes the nerve cells to break down, but scientists believe it to be a combination of genetic, environmental and lifestyle factors.
PD & Sleep
Sleep problems are incredibly common for PD patients and in some cases can be severe. This can be due to the Parkinson's medication causing daytime sleepiness or even a sudden onset of sleep. But just like anyone without PD, sleepiness during the day could be if you aren't sleeping well at night. In fact, 76% of people with Parkinson's disease suffer with excessive daytime sleepiness [4]. It's very important to get support from healthcare professionals if this happens [5].
The US National Sleep Foundation’s recommendations for nightly sleep are broken down into different age groups [6]. The guidelines for adults are as follows:
18-25 years old: 7-9 hours
26-64 years old: 7-9 hours
65 or more years old: 7-8 hours
You will notice that they trim an hour off of the guidelines for older adults. What is not mentioned in the average article is the reason as to why. It is not that you need less sleep as you get older, it is that your brain will start to lose the ability to generate the amount of sleep that it still needs. This is ageing in general so everyone has this to look forward to.
The part of the brain that starts to deteriorate the quickest and earliest is the Hypothalamus [7]. The Hypothalamus is one of the main control centres that plays a crucial role in many important functions. The functions that are sleep related:
Thermoregulation
Mood
Wakefulness
Sleep state
Circadian rhythm
Stress adaptation
Food cravings
Thyroid hormone release
Growth hormone
Much more
With this being said, 7-8 hours are still good numbers to aim for.
Sleep Apnoea
The Parkinson's Foundation state that sleep apnoea can be seen in up to 40% of PD patients [8]. A study published to the Brazilian Academy of Neurology states that obstructive sleep apnea (OSA) occurs in up to 66% of PD patients [9].
It's known to be the most common sleep related breathing disorder. The number of people suffering increases with age and it is known to cause mortality in the elderly. But older adults are less likely to complain about their sleep apnoea symptoms such as snoring, gasping, choking, and shortness of breath.
The main treatment for sleep apnoea is to use a continuous positive airway pressure (CPAP), which provides a continuous flow of air through the upper airways, preventing obstruction and improving oxygenation during sleep. A study published to the Journal of Clinical Sleep Medicine found that PAP therapies improved the overall non-motor symptoms of PD [10].
However, if the CPAP is not well maintained, there is a possibility that it could blow bacteria and viruses into the lungs. This could lead to just a simple cold developing into pneumonia [11]. This is why the CPAP must be cleaned on a regular basis.
Nocturia
Sleep apnoea can also cause Nocturia, another symptom of PD that has been reported by 60% of PD patients [13]. This makes it one of the most common non motor symptoms in Parkinson's. Nocturia is a condition in which you wake up during the night because you have to urinate. Urinary symptoms have been recognised by Parkinson's UK as one of the top 10 priority areas for research in PD [14].
The US National Sleep Foundation did a survey in 2003 that specifically assessed nocturia among older age groups who self-reported insomnia [15]. The results showed that 53% of respondents aged 55–84 years perceived nocturia as the cause of their disturbed sleep every night or the majority of nights.
Although nocturia is very common, there is no specific treatment for PD patients. The treatment is limited to the advice given for general management of urinary symptoms in neurological patients [16, 17, 18]. This could mean simply reducing fluid intake and large meals a few hours before going to bed and also making sure you go to the toilet just before.
Pneumonia
Parkinson's disease is NOT a death sentence and doesn't directly kill people who have PD. However, it can trigger other problems. The two major causes of death for those who have PD are pneumonia and falls. Pneumonia can affect anyone with a poor immune system. It accounts for 70% of deaths among PD patients making it the leading cause [19, 20].
There is a vaccine called Pneumococcal Polysaccharide Vaccine (PPV) and it is given to people aged 65 and over and people who have chronic illnesses [21].
The most effective way to prevent pneumonia naturally is to fortify your immune system. The immune system works by having natural killer (NK) cells that locate dangerous elements and kill them [22]. If we don't sleep enough then the numbers of our NK cells drop.
An experiment was done with people having their sleep restricted for just 4 hours on a single night. It was then looked at to see the percentage reduction in immune cell activity. There was a huge 70% drop in NK cell activity [23, 24]. This is why links are being found between short sleep duration and the risk of numerous forms of cancer. Currently the list includes cancer of the bowel, cancer of the prostate and cancer of the breast.
Falls
We all know that it's easy to lose concentration when we are sleep deprived and it doesn't take a healthcare professional to tell you that it will contribute to falls in older adults. Most people with Parkinson's experience falls as a result of the disease symptoms. It is estimated that 60.5% of patients with PD experience at least one fall and 39% have recurrent falls [25]. Despite the higher risk in Parkinson's patients, the reported incidence of falls have been based on small studies. Most of these studies don't describe the age, gender or the specific incidence of falls.
The US National Library of Medicine retracted data from the China Health and Retirement Longitudinal Study (CHARLS) [26]. In this study were 12,759 respondents who were aged 50 and older with no specific disease or disability. 2,172 respondents (17%) had falls within the last 2 years. It was found that both sleep duration and sleep disturbance was strongly associated with falls.
The participants who had a night time sleep duration of 5 hours were more likely to report falls than those who had a sleep duration of 6 hours. But there was no association between falls and a sleep duration of 8 hours.
Participants having sleep disturbances 1-2 days, 3-4 days, or 5-7 days per week were also more likely to report falls than those who had no sleep disturbances at all. The nap sleep duration was not significantly associated with falls.
REM Sleep Behaviour Disorder
"Any Parkinson's patient who falls out of bed whilst sleeping has REM sleep behaviour disorder until proven otherwise" - Dr Ron Postuma, Parkinson Canada [27]
So, what is REM?
Let me start this one by giving you an understanding of the different stages of sleep [28, 29]. We have two basic types of sleep, Non REM and REM (Rapid Eye Movement).
Non REM is subdivided into 4 stages:
Stage 1 is the transitionary stage of going from wake to sleep and it takes about 3-4% of the night.
Stage 2 takes 45-50% of the night which is the biggest stage you have.
Stage 3 and 4 are combined together and are your physical restoration. This is where the largest amount of growth hormone is emitted and is usually at the beginning of the night. The reason being is so that if you only get 3 hours sleep your body is still functional.
REM:
Rapid Eye Movement sleep is the later stage of the night which is usually known for being the stage of dreaming. REM sleep is your mental restoration and your brain is more active than any other stage. This is where you move information from your short term memory to your long term memory.
REM sleep behaviour disorder is a very common sleep disorder seen in people with PD, and affects up to 50% of patients [30]. It can cause people to act out their dreams without being aware. Their physical movements during sleep can be dangerous as they could translate to hitting the wall, bedside table or even their partner [31]. Those who suffer from REM sleep behaviour disorder usually remember their dreams and describe them as being vivid.
REM sleep behaviour disorder often begins years before Parkinson’s is diagnosed and therefore can be seen as a sign of the disease early on.
I talk about melatonin further down, but it is a great way to reduce REM sleep behaviour disorder and I often recommend it to anyone with sleep difficulties [32]. Here in the UK is has to be prescribed, but in the US it can be sold as a supplement.
In both the UK and US, a benzodiazepine called Clonazepam is widely used to manage RBD. It can reduce or fully treat the condition in 90% of cases [33]. But I recommend no form of benzodiazepine due to it being a sedative [34, 35]. Sedation is not sleep, again I talk about this in greater detail further down. It will also cause side effects such as falls and cognitive slowing in the PD patients.
Here are 4 tips for injury prevention of RBD:
Place padding on the floor beside the bed
Place your mattress on the floor. Note that it may be difficult to stand up if you have movement difficulties
Install padded bed rails
Sleep in a separate bed to your partner to prevent the risk of injuring them
Restless Leg Syndrome (RLS)
RLS is a sleep related condition that causes an uncontrollable urge to move your legs [36]. It is a common condition that can develop for anyone at any age, yet it's more common for middle age adults. Although RLS is not life threatening, it can however severely disrupt sleep causing insomnia [37].
Neurologists believe that the symptoms of RLS are due to how the body handles dopamine [38]. As Parkinson's is caused by the breakdown of the nerve cells in the brain that are in charge of producing dopamine, this would explain the association between RLS and Parkinson's. As dopamine is increased at times of stimulation, such as RLS, it can inhibit the production of the melatonin that makes us drowsy and helps us sleep [39].
RLS is sometimes caused by iron deficiencies [40] and therefore your doctor might suggest taking an iron supplement, or eating iron-rich foods such as:
Red meat, fish and shellfish
Dark green vegetables
Iron-enriched bread and breakfast cereals
Before you begin increasing your iron intake, I would suggest getting a blood test first to check if it could be iron deficiency.
Early Morning Off (EMO)
Early morning off is a symptom that anyone with Parkinson's can experience at any stage of the disease [41]. It's when those who are treated with oral levodopa, which is considered to be the best therapy for PD, gradually start to experience off periods. This is caused by the medication wearing off overnight, leaving people feeling stiff and slow in the early morning before the next dose is taken [42].
EMO can also affect urinary urgency, anxiety, pain and mood, which could impact the patients independence and ability to get out of bed and go to the toilet [43]. This shows that identifying and managing EMO is important for PD patients.
A QOL (Quality of life) questionnaire was sent to patients and carers of the Japan Parkinson's Disease Association to measure the appearance of EMO [44]. The analysis assessed the responses from 2,205 completed surveys. 79.8% of the patients felt as though they have experienced EMO, and 37.8% of the patients stated that they experience EMO on a daily basis.
Another Japanese study including 157 PD patients, found that increasing the quality of sleep was significantly related to an improvement in early morning mobility, which then contributes to a reduction in EMO periods [45, 46].
Gastrointestinal (GI) Problems
EMO periods can also be due to Gastrointestinal (GI) problems, which is also known to be common across all of the stages of PD [47]. Although this can be managed by having a Subcutaneous Apomorphine injection, it’s also clear that GI problems are associated with sleep abnormalities [48].
A study was done with 772 men and women, aged from 20 to 98 years old [49]. The participants who had insomnia reported more GI problems than those without (33.6% vs 9.2%). Inversely, the people with GI problems report insomnia more than those with healthy sleep patterns (55.4% vs 20%).
Parkinson's can disrupt the movement of the stomach, so that food or medications that are taken orally don’t flow naturally into the intestines [50]. The effect of oral levodopa relies on it being emptied from the stomach effectively and then reaching the small intestine where it is absorbed.
Constipation is another result of having a decreased bowel movement and is very common for those with Parkinson's. Studies show that that over 60% of PD patients suffer from moderate to severe constipation [51, 52]. Click here for my blog about constipation.
Insomnia
In general, insomnia is trouble getting to sleep and staying asleep [53]. The inability to slow down due to stress is a cause of insomnia. It is not a surrounding problem such as light exposure. It is usually a problem with something going on in your life.
An 8 year Parkinson's study with assessment data recorded in 1993,1997 and 2001 showed that insomnia was present in 54–60% of the patients at each of the three study visits [54].
In 2003, the SCOPA-PROPARK cohort study started, in which patients were evaluated annually with the SCOPA scale [55, 56, 57]. Out of 412 PD patients, 110 (27%) had insomnia. Of the remaining 302 patients, 99 (33%) developed insomnia at some point during the follow-up.
A third (31%) of the UK population say that they suffer from insomnia [58]. 22% of people in the UK struggle to fall asleep every single night and a further 15% struggle to fall asleep at least once a week [59]. Google search data [60]:
There are 9,900 searches per month in Google UK for “how to get to sleep”
There are 12,100 searches per month in Google UK for “how to fall asleep”
There are 5,400 searches per month in Google UK for “I can’t sleep”
Dr. Daniel Greer states that Cognitive Behavioural Therapy for insomnia (CBT-I) is the front line treatment [61]. It has the same effectiveness as medication, but access to the treatment is unfortunately harder to get.
Here is a brief insight into what CBT looks like for insomnia patients [62].
The physical stage of the therapy is to schedule the sleep with restrictions. If they usually go to bed at 2300 but don't get to sleep until 0100 then instead they will be scheduled to go to bed at 0100 instead. Building up the natural sleep deprivation on purpose will help to fall asleep and stay asleep.
The mental stage of the therapy is to ask them questions about their sleep, followed by giving them facts. Educating people on the positive effects of sleep and negative effects of sleep deprivation.
Depression
Your moods can change a few times throughout the day. These changes are not necessarily a sign of depression, but might be related to changes in your medications [63]. However, It has to be accepted that depression is common for people who have Parkinson's. It's important to be open about how you feel, and to let your family and friends know what they can do to help.
Sleep problems that are associated with depression include insomnia, hypersomnia, and obstructive sleep apnoea. The majority of people with depression may alternate between insomnia and hypersomnia during one period of depression [64].
Sleep disruptions can affect the body’s stress system and disrupt circadian rhythms, making you more vulnerable to depression. Fortunately, people who are treated for major depression often report that their quality of sleep has increased. Overall, having healthy sleep reduces the risk of initially developing depression and the risk of relapse in people who have successfully been treated for depression.
I attended a seminar in 2017, where I met Olympic Team GB Psychologist, Katie Warriner. She said about exercising your brain just as much as your body in order to keep it healthy. Here is what she recommends to do before sleeping [65]:
"Did you know we have approximately 150,000 thoughts per day? Before you sleep tonight, think about three things you are grateful for or 3 things you did well. It's been shown to be as effective at changing our mood as taking antidepressants, and it only takes 2 minutes." - Katie Warriner
Anxiety
It is understandable to feel worried after being diagnosed with PD. But having constant feelings of nervousness and worry could be a sign of anxiety and would need to be addressed with your doctor.
A study reported a depressive disorder in 92% of Parkinson's patients diagnosed with an anxiety disorder, and an anxiety disorder was present in 67% of depressed PD patients [66]. In addition to this, other studies show that 30-40% of PD patients experience social phobias and panic disorders [67, 68].
Researchers have found that people who are prone to anxiety are more sensitive to the effects of insufficient sleep, which then provokes the symptoms of anxiety [69].
A recent study at the university of California showed that a sleepless night may increase levels of anxiety by up to 30%, but getting a full night's sleep resets an anxious brain and calms you down [70, 71].
For some people, even after falling asleep, they may wake up with anxiety in the middle of the night and struggle to get back to sleep. Fortunately, anxiety is one of the most treatable mental health conditions [72]. That's not saying it is easy, but there are so many ways to treat it.
Interestingly, you could try scheduling times to actively worry [73]. This could then stop you from worrying before going to bed.
Rigidity
When it comes to PD, rigidity means having stiff or inflexible muscles [74].
There was a study done with 12 PD patients who had a single night of total sleep deprivation [75]. This showed an improvement of rigidity, bradykinesia (slowness of movement), posture disturbances and functional disability that remained for 2 weeks. But, the same study also showed that the sleep deprivation had a significant negative impact with depression which lasted for 1 week. The overall benefit of this study was that the possible change of dopamine receptors that were induced by sleep deprivation, could explain the improvement.
Another study showed that the dysfunction of the brainstem systems that control muscle tone during REM sleep may contribute to increased rigidity during the wakefulness of PD patients [76].
The treatments and management for rigidity are physiotherapy, occupational therapy and speech therapy. Here are the ways in which you can help yourself at home with or without your partner:
Each of these treatments and recommendations need to be followed by rest.
Looking at this from a personal training perspective, the flexibility/mobility plan is the one that stands out to me. It is not only exercise in it's own way but also an 'active rest'. Active rest is what to do between training sessions. It restores blood flow to the muscles that have been worked, activates nerves and is intended to allow your joints to move without being impinged. When you use specific, repetitive movement patterns, your body will close in around those patterns and become unbalanced. I highly recommend an easy to use, low intensity plan.
Bradykinesia
Bradykinesia means slowness of movement [81]. It is one of the earliest signs of Parkinson's and is reported in up to 98% of PD patients [82].
Although levodopa is the main drug treatment for Parkinson's, for some people it doesn't control all of their motor symptoms [83]. Deep Brain Stimulation (DBS) is the main surgery for Parkinson's and is used to improve the movement symptoms.
A study was done using DBS of the Subthalamic Nucleus (STN) [84]. The primary function of the subthalamic nucleus is movement regulation [85]. The study found that the DBS increased total sleep time and reduced patient reported sleep problems and early morning dystonia for up to 24 months post treatment. These changes in sleep were related to improvements in functioning, specifically those affected by bradykinesia.
Male Hormones
Men are affected by Parkinson's more than women, with the gender ratio of about two to one [86, 87]. Although this sparks questions about the gender difference, there is still no certain answer as to why. Researchers believe that it may be due to the male sex hormone testosterone [88]. If somebody's testosterone levels drop drastically due to stress or a sudden turn of other life events, then they are more vulnerable to PD [89, 90].
Testosterone deficiency is frequently reported with male PD patients [91]. Researchers at the University of North Texas Health Science Center did a rat study that indicates that testosterone may enhance the damage and death in dopamine neurons induced by oxidative stress [92, 93]. This would explain the sex difference ratio.
Dr. Kalipada Pahan, professor of neurology at the Rush University Health Center says "Preservation of testosterone in males may be an important step to become resistant to Parkinson's disease" [94].
Journal of the American Medical Association (JAMA) published a study where researchers compared testosterone levels in a group of 10 healthy young men [95]. In the first week of the study, the participants slept for 8 hours each night at their home. Then they had three nights of 10 hours sleep followed by eight nights of 5 hours sleep at the lab. The results showed that their testosterone levels decreased by up to 15% after just one week of sleep loss compared to the 8-10 hours worth.
Another study with 531 men, found that the patients who slept 4 hours or less had half as much testosterone as those who sleep 8 hours or more [96]. Matthew Walker, director of the Center of Human Sleep Science says that men who routinely sleep 4-5 hours a night will have a level of testosterone of someone 10 years older [97]. He also says that men who sleep 5 hours or less have significantly smaller testicles than those who sleep 7 hours or more [98].
Female Hormones
Numerous studies have evaluated the impact of sleep on female sex hormones [99, 100, 101, 102]. Research shows that women who suffer from insomnia are four times more likely to struggle with fertility compared to women who are well rested [103].
When it comes to getting pregnant, one of the most important female hormones is follicle-stimulating hormone (FSH). It's role is to prepare the ovaries for the release of an egg. One study found that women who routinely slept 6 hours or less a night have 20% less FSH than women who got a full 8 hours [104].
Dr. Rachel Saunders-Pullman, a clinical researcher who specialises in Parkinson's, analysed the records from the Women's Health Initiative Observational Study to find if the length of fertility for women may be a factor in risk for Parkinson's disease [105, 106].
In this study there were 74,000 women who had natural menopause and about 7,800 who had surgical menopause. They divided both the natural menopause women and surgical menopause women into three separate groups each, depending on the length of the woman's fertility. They relied on self reported data to determine the number of cases of diagnosed PD.
It was found that women who had natural menopause and a fertile life span of more than 39 years had about a 25% reduced risk of getting the disease compared to women fertile for 33 years or less before having natural menopause. The women who had surgical menopause and had used hormone therapy in the past had almost twice the risk of getting the disease compared to those who never used hormone therapy. Current users of hormone therapy had no increased risk compared to those who had never used.
Sexual Concerns
Having a reduction of sexual desire and/or experiencing sexual dysfunction is another non-motor symptom of Parkinson's [107].
It's obvious that if the person with Parkinson's is bloated due to constipation, regularly feels the need to urinate, or just not being able to stand up out of their chair, then the last thing that they will have on their mind is being romantically engaged with their partner.
The research about PD and sexual dysfunction is very limited, but one study using a Quality of Sexual Life Questionnaire (QoSL-Q) shows that the satisfaction from the patients sex life decreases with ageing and progression of Parkinson's disease [108]. Couples with the man as the Parkinson's patient have shown to be more dysfunctional [109].
Male SD:
The most studied sexual dysfunction is erectile dysfunction in men. Men with Parkinson's have an increased rate of ED than men without. One study shows that erectile dysfunction affects 60% of men with Parkinson's disease compared to an age matched group of men without PD who's prevalence was 37.5% [110]. Another study shows that 70% of men with PD experience erectile dysfunction [111].
Erectile dysfunction, lower urinary tract symptoms, and hypogonadal symptoms all have a relationship with poor sleep, and the less sleep, the worse these symptoms become [112]. This is particularly those with obstructive sleep apnoea (OSA), a symptom that affects up to 40% of patients with Parkinson's. Numerous studies show that using CPAP treatment for OSA whilst sleeping can improve sexual satisfaction and erectile dysfunction [113, 114, 115]. The conclusion of one of the CPAP studies states that ED is very frequent in men with severe OSA and can at least partly be reversed by long-term CPAP therapy in most seriously affected patients.
Female SD:
Sexual dysfunction affects over 40% of women [116, 117]. This can be caused by different biological, psychological and social factors [118]. Having a low sex drive, nocturia, or fear of incontinence during sexual activity seems to be the particular concerns for female Parkinson's patients, and each symptom increases with age [119, 120].
A study with 171 women examined the influence of both sleep quantity and quality, and the effect it would have towards female sexual response and activity [121]. The results of the study showed that sleeping longer can promote a healthier sexual desire. It also showed that women who up their sleep by just 1 hour increase the odds of engaging in partnered sexual activity by 14%.
A 1 year study investigated female patients undergoing CPAP treatment for OSA [122]. The aim was to look into the effect that the CPAP had on female sexual dysfunction. At the end of the study, the results showed a significantly positive change as women reported a vast reduction of sexual dysfunction. Also, daytime sleepiness significantly decreased after 1 year.
Melanoma
People with Parkinson's are 4 times more likely to get melanoma than those without. Inversely, people with melanoma are 4 times more likely to get Parkinson's than those without [123]. The association between both has been researched for decades, and two of the common clinical features they share are vitamin D deficiency and sleep difficulties, sleep apnoea in particular [124, 125, 126].
Studies show that Parkinson's patients have a significantly lower vitamin D concentration than age matched people without PD [127]. Long term vitamin D deficiency itself could lead to chronic loss of dopamine neurons in the central nervous system which could then increase the risk of developing Parkinson's disease [128]. Sleep studies have shown that VDD is associated with poor sleep quality and quantity, and that patients who have VDD are at a significantly higher risk of sleep disorders [129, 130]. Vitamin D is also correlated with postural stability as well as better verbal fluency and memory [131, 132].
Many recent worldwide studies suggest that vitamin D plays a protective role against numerous types of cancer [133, 134, 135, 136]. One study found that higher vitamin D3 levels are associated with both thinner tumours and better survival from melanoma [137]. Due to there being many studies showing conflicting results, it can't yet be proven that vitamin D protects against cancer [138, 139, 140].
Freezing of Gait (FOG)
Freezing is having the sudden inability to move your feet despite trying to move forward [141]. These episodes could last anything from a few seconds to a few minutes. They occur less often when walking on a straight, unobstructed path. Any deviation from that can interfere, and one study showed that even the width of a doorway can induce FOG [142].
A very recent study published in the Journal of Clinical Sleep Studies showed that Parkinson's patients who experience FOG have significantly worse sleep than those who don't. The results of this study indicate that sleep could be the key to prevention or at least delay of freezing [143]. Another study concluded that poor sleep is associated with freezing regardless of the severity of PD [144].
Memory Problems
A Parkinson's study was performed on zebrafish. Some of the zebrafish were given a pesticide called Rotenone to mimic the effects of PD [145]. They were then sleep deprived for 4 whole weeks by being in an aquarium that had 24 hour lighting. It was found that after sleep deprivation, the learning and memory of the fish was impaired. It also caused anxiety and depressive behaviour and a reduced exercise capacity. The scientists concluded by saying "Our findings suggest that zebrafish treated with rotenone may have a more severe damage of memory and emotional function after sleep deprivation, which may be related to the changes in the dopamine systems".
A second Parkinson's study had 54 PD patients undergoing a 48 hour memory test [146]. The results showed that the participants who were having a good night's sleep performed significantly better than those who didn't. This study was questioned as many elderly people have a decline in how much deep sleep they have and how that might contribute to having memory difficulties. Separate to this, researchers are now exploring options for improving deep stages of sleep in older age groups.
Dr. Matthew Walker conducted a study that found that adults over the age of 60 had a 70% loss of deep sleep compared to younger adults between 18 to 25 [147]. Older adults had a harder time remembering things the next day, and memory impairment was linked to reductions in deep sleep.
A separate study by Dr. Walker had two groups of volunteers [148]. One group was getting a full 8 hours of sleep, whilst the other was deprived by being kept up in the laboratory, under full supervision with no naps or caffeine. The following day, the volunteers were placed in an MRI scanner with a list of facts to learn as the MRI was taking snapshots of brain activity. When the scan finished, they were tested to see just how effective their learning has been. The results showed a significant 40% deficit in the brain's ability to make new memories without sleep.
Postural Instability (PI)
Alongside rigidity and bradykinesia, postural instability is one of the primary motor symptoms of Parkinson's and often appears at the later stages of the disease [149].
A Parkinson's study was performed at the Institute of Health Sciences in Turkey [150]. 56 Parkinson’s patients and 58 healthy subjects were involved. The aim of the study was to see if postural stability affects the physical activity of the PD patients. The Parkinson’s group with postural instability not only had reduced physical activity, but also a shorter sleep duration than the healthy subjects.
A Brazilian study looking into impaired posture control found that the loss of sleep quality results in a loss of performance in posture control [151].
At the University of Health Sciences in Switzerland, 158 subjects underwent a single night sleep study by being placed on a posturographic platform [152]. The study concluded that sleep disordered breathing (SDB) is largely associated with daytime postural instability.
Although it's not a cure, deep brain stimulation (DBS) may be an option. The surgery is only known to give a moderate benefit to postural stability. But, like what I said about bradykinesia, a study showed that the DBS increased total sleep time and reduced patient reported sleep problems and early morning dystonia for up to 24 months post treatment [153].
Sense of Smell (Olfactory)
A loss of smell (anosmia) or reduced sensitivity to odours (hyposmia) can be experienced years before the Parkinson's motor symptoms emerge, and can be present in up to 90% of early stage PD cases [154].
Many studies have looked into the association between olfactory, sleep and Parkinson's disease [155, 156, 157, 158, 159]. A study from the Korea University Guro Hospital concluded that olfactory dysfunction and REM sleep behaviour disorder might relate to prognosis in patients with Parkinson's [160].
The Walter Reed Army Institute of Research found that just one night of wakefulness significantly decreased the subjects ability to identify odours correctly [161]. A similar study at the same institute suggests that 24 hours of continuous wakefulness is associated with a decrease in functional brain activity within the prefrontal cortex, particularly the orbitofrontal cortex [162].
The orbitofrontal cortex is involved in odour identification and olfactory memory [163, 164, 165]. People with Parkinson's disease often show impairments on tasks that rely on this part of the brain [166].
Eye Issues
Eyes and eyesight problems are often experienced by Parkinson's patients. This can be due having a retinal dopamine depletion and a decreased dopaminergic supply to the visual cortex of the brain. Having difficulty moving the eyes, blurred vision, double vision, or involuntary closing of the eyelids are just some of the problems that can be brought on by PD [167].
A multicentre study was performed on 848 PD patients and 250 healthy age-matched control [168]. The goal of the study was to find the difference in the ophthalmologic symptoms of patients with Parkinson's, compared to controls. They each completed the Visual Impairment Parkinson's Disease Questionnaire (VIPD-Q). Ophthalmologic symptoms were reported by 82% of the PD patients, compared with 48% of controls.
Dry Eye Disease (DED) is an eye condition that people with PD are more prone to get than those without [169, 170]. This can be due to multiple reasons, one being motor functions that affect the blinking. A study at the Mustafa Kemal University in Turkey found that the blink rate of PD patients was significantly less than the controls [171]. Multiple studies show that sleep is the influencing factor of DED [172, 173, 174, 175].
It's recommended to have an eye test at least once a year. Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged [176]. It's possible that the optromitists can find signs of sleep apnoea during a routine eye test [177]. The likelihood of developing the eye disease Glaucoma is higher for not only people with Parkinson's but also those who suffer with sleep apnoea [178, 179]. Restoring good quality vision will have a dramatic positive impact on the quality of life of the Parkinson's patients, and it's possible that the treatment of sleep apnoea could reverse the cause of some of the symptoms.
Skin Irritations
It's common for people with PD to develop dry, inflamed, oily and itchy skin, particularly on the face or scalp [180, 181,182]. Those who have previously undergone deep brain stimulation are at a greater risk of developing skin complications [183] . These skin irritations are mostly experienced in the late evening and during the night [184].
Dry and Inflamed:
Dry skin can be brought on by dehydration [185]. It's natural for us to lose more water during the night as we can't hydrate ourselves whilst we sleep. But, PD patients are advised to avoid drinking water before bedtime as it can cause the need to urinate during the night. Instead, using moisturiser before going to bed and using conditioner in the shower will help keep your skin hydrated [186]
When it comes to itchy skin, a study with 51 care home residents who were over 65 years of age, showed that scores of both a sleep quality questionnaire and itch questionnaire were strongly associated with each other [187].
Seborrheic Dermatitis:
Seborrheic Dermatitis (SD) is a skin condition that affects the scalp, hair, eyebrows, beard and moustache [188]. About 52-59% of PD patients suffer from Seborrheic Dermatitis, as opposed to 3% in the general population [189]. SD usually shows during times of stress and sleep deprivation [190]. Although there is not yet a full understanding of the cause of SD, improving your sleep is always advised as a lifestyle change, as chronic sleep can lead to it worsening [191].
A study at the Department of Dermatology of the Faculty of Medicine Hospital in Bangkok, looked at the quality of life of 166 patients with seborrheic dermatitis. 28.3% of the subjects reported sleep deprivation or emotional stress [192].
Fix Your Sleep Naturally
These tips are not only about getting to sleep, the majority of people with Parkinson's have trouble staying asleep. If you go to bed at 9pm and wake up at 3:30am then don't be surprised, as that is still 6.5 hours.
Pay off the Sleep Debt An example of sleep debt is when someone who needs 8 hours of sleep per night only gets 6 hours. That person will then be in 2 hours of sleep debt [141]. Sleep studies show that getting one or two long nights of sleep do not remove the effects of sleep deprivation and that just 1 hour of sleep deprivation will take up to 4 days to recover [142, 143].
Nightly Routine
Levodopa at night Sometimes underdosing or wearing-off of levodopa at night can lead to poorly controlled symptoms. Taking a nighttime dose of controlled- or extended-release carbidopa-levodopa (Sinemet CR or Rytary, respectively) may improve sleep. Several studies of dopamine agonists reported improvements in sleep quality - https://www.parkinson.org/sites/default/files/attachments/Sleep_web.pdf
Temperature Dropping your body temperature by about 1°c will help you to initiate sleep and stay asleep. That is why it is easier to fall asleep in a room that is too cold than too hot. Aim for a bedroom temperature of around 18°c. If you are someone with a thyroid disease, 15.5-19°c might be better as hypothyroidism can decrease your tolerance to the cold. Having a bath or shower before bed can also help with body temperature. Although you would think that it would be making you hotter, it is in fact doing the opposite. Your blood rushes to the surface but when you get out of the bath, the heat radiates out of your body so that your core temperature decreases.
Light Exposure Blue light, which is part of the spectrum of sunlight, is 450-480 nanometres. It hits a cell in the eye called the Melanopsin cell, which turns off the Melatonin Phosphate in your brain. On the positive side, that is a great way to help wake you up in the morning. However, If you have terrible night's sleep, and you wake up in the morning for work and it is still dark, the Melatonin Phosphate is still on. A study had people reading on an iPad for 1 hour before bed, and people doing the same with a book. The iPad delayed the release of the Melatonin by up to 3 hours and reduced it by 50%. Smart phones have a setting where you can schedule the blue light. I set mine to turn off 2.5 hours before my average bed time, and turn back on in the morning 15 minutes after I wake up. There are also light bulbs and glasses which are made with a filter inside them to filter out the blue light.
Noise White noise machine
Making the Bedroom Inviting Create a welcoming sleeping environment by making the bedroom dark, cool and comfortable.
Don't Stay Awake in Bed Do not stay in bed if you are awake. Your brain will learn the association of your bedroom being about wakefulness. Get out of bed and go to a different room. Keep the lights dim and participate in something peaceful and calming, such as reading a book (not an iPad).
Fluid Intake and Output Reduce your fluid intake a few hours before bedtime to avoid waking in the night with the urge to urinate. Also make sure you go to the toilet just before heading to bed in order to empty the bladder. I talked about Nocturia in greater detail further up. If you do need to go to the toilet, a great tactic is to place small motion sensor lights in the bedroom, hallway and bathroom. It saves you from reaching for each light switch and because they are dim it would make it easier for you to fall back to sleep. They are very cheap but make sure you get the warm/dim rather than bright LED.
Food The advice is simple; Don't go to bed too full, or too hungry.
Caffeine A study suggests that the consumption of caffeine in coffee or tea may lower risk of developing Parkinson's, but the time of which it is taken should be thought about. Caffeine is a class of drug called a psychoactive stimulant. Because it is a stimulant, it is more likely that you will have difficulty either falling asleep, or staying asleep. The duration of action is much longer than what most people would expect. Caffeine has a half life of 6 hours, but a quarter life of 12 hours. This means that if you have a coffee at 12pm, then a quarter of that coffee is still in your brain at 12am. This will also result in your deep sleep being blocked. Studies show that having anything between 150-200mg of caffeine in the evening can reduce your deep sleep by 20%. Caffeine can be used strategically in the morning by cutting it down 14 hours before bedtime. A study suggests that the consumption of caffeine in coffee or tea may lower risk of developing PD. If you feel very tired from the medication you are on, it might be okay for you to still have a coffee after midday.
Avoid Alcohol A largely misunderstood 'sleep aid'. Alcohol is a class of sedative drugs. It will knock out the cortex in the brain, sedating you and making you unconscious, but without going into naturalistic sleep. You will also wake up numerous times throughout the night. It also decreases the amount of REM sleep you have and can trigger REM sleep behaviour disorder that night.
Do Not Smoke Nicotine is a stimulant
Treat Stiff Muscles Having stiff muscles is something that comes free with ageing, but it could also be a symptom of PD. Stiff Muscles can contribute to your balance problems and sleep issues. Gentle stretching exercises and warm baths are a great start, but physical therapy might be a better option if it doesn't improve.
Technology Free Zone! Use your bedroom for sleep and sex only.
Bed Sheets 45% of PD patients complain about the difficulty they have with turning in bed. It's been suggested that silk bed sheets make it easier to roll over in the night. Although satin bed sheets can increase sweat so should be avoided if night sweats occur.
Sleep Position Because we move around during sleep, we can't necessarily choose the sleep position we wake up in. But, we can try to choose the one we fall asleep in...
Avoid Benzodiazepines! (sleeping tablets) Pharmaceutical sleep and natural sleep are two different things and as I mentioned with alcohol, sedation is not sleep. Benzodiazepines such as: Restoril, Xanax, Valium and other sleeping pills literally obliterate stage 3 and 4 of sleep (the physical restoration) and almost knock it out completely. They weaken the immune system giving a higher risk of infections. Sleeping pills are associated with Alzheimer's, pneumonia, cancer and death. It can also affect the treatment of Parkinson's disease after causing a decrease in the concentration of dopamine. https://pubmed.ncbi.nlm.nih.gov/11903102/
Safe Use of Antidepressants (if prescribed) Antidepressants are a motor stimulant which will contribute to REM sleep behaviour disorders and more. A potential harmful association was found between movement disorders and the use of numerous antidepressants [9].
Meditation & Relaxation Techniques Mayo clinic & Harvard
Tai Chi & Yoga
Sense of Smell https://www.sleepfoundation.org/bedroom-environment/how-smell-affects-your-sleep#:~:text=What%20Are%20the,up%20to%20sleep.
Worry Journal If you are someone who suffers from anxiety, depression or maybe just stress in general, try a worry journal. If there is anything on your mind, get it off your chest, write it down and come back to it the following day. I would suggest doing it a couple of hours before sleep but keep it by the bed for if there is anything else on your mind.
Sleep Diary If you keep a sleep diary beside the bed and jot down how you feel and on a scale of 1-10 as to how tired you are. In the morning when you wake up, review your sleep by talking about how many hours you slept, how many times you woke up, etc.
Consistency This one is obvious and I left this until the end because each of the tips about how to fix your sleep will help with consistency. ___
Breathing Technique 4-7-8
Avoid Looking at The Clock
Adjust Your Sleeping Position
Fix Your Daytime Fatigue
Exercise Regularly - (I don't mean run 10 miles) According to the Harvard Health News, exercise is the only proven way for adults to prolong deep sleep. Although exercising may be the last thing you feel like doing, exercising to your ability, especially in the morning, can be energising. This could mean walking around the garden, or just you hoovering around the house. It can also have a positive effect for reducing rigidity.
Review Your Medications (Take the at the right time) Talk to your doctor about which of your Parkinson's medications might be contributing to daytime fatigue the most. Perhaps a supplement you are taking is having an effect against the medication.
Take Short Naps (If necessary) Quick naps around late morning/early afternoon can give you a top up of energy. Try to have a nap no longer than 20 minutes. Our main focus should be night time sleep, but if you feel as though you need to have a nap, then take it. Just know that there is no such thing as a sleep bank. Therefore, what most people call "catch up on sleep", doesn't actually exist.
Supplements
I have looked into the safety of these 3 following supplements being taken alongside Parkinson's medication. Although they are all naturally produced in your body, it is always recommended for you to talk to your doctor before you begin taking a supplement or make any changes to your existing medication.
Melatonin It is common to have circadian rhythm disturbances with Parkinson's disease, but melatonin is a circadian rhythm regulator. It offers neuroprotection and has potential for treating cognitive disorders in PD. It also controls the production of other hormones, helps regulate the body’s internal temperature, and influences cognitive performance and mood. It's a naturally produced hormone that is released by the pineal gland at night, but is also available in supplement form. Here in the UK it has to be prescribed, but can be sold over the counter in the US. A study was done with a 2 week treatment period for 40 patients with PD (29 males and 11 females, aged between 43–76 years old). Melatonin was administered in doses ranging from 5 mg to 50 mg/day. It was taken 30 minutes before bedtime to avoid any possible circadian phase shift, as shifts can occur if melatonin is released at any other time. All subjects were taking stable doses of Parkinson's medications during the course of the study. Treatment with 50 mg of melatonin significantly increased night time sleep compared to placebo, as revealed by actigraphy. Subjective reports of overall sleep disturbance improved significantly on 5 mg of melatonin when compared to 50 mg or placebo. It was found that high doses of melatonin were well tolerated in this study. Two separate benefits of melatonin are that It’s also a potent fighter against the growth and spread of cancer cells and prevents the formation of two proteins that are key biological markers of Alzheimer’s disease. Melatonin is not suitable for long term use for women who are still fertile, as it is possible for it to suppress fertility.
Magnesium Magnesium deficiency is common for adults. It is an essential mineral that your body needs in high quantities. People with low magnesium often experience restless sleep and waking frequently throughout the night. Insomnia is a common symptom of magnesium deficiencies. Maintaining healthy magnesium levels often leads to deeper and better sleep. Because it is not produced in your system, you need to find it in foods and/or supplements. Foods that are rich in magnesium; nuts, meat, dairy, broccoli and leafy greens...and even chocolate. Supplemental magnesium is also quick and effective. It has been shown to have a stabilising effect on mood. It is effective in relieving symptoms of moderate anxiety and moderate depression. There are different types of magnesium and I recommend either Magnesium L-Threonate or Magnesium Glycinate. Magnesium citrate is usually the cheapest, but that is due to the poor quality and can also cause diarrhoea.
Taurine Taurine is an amino acid, but unlike other amino acids, it doesn't build protein. However, it supports the body in other ways such as hydration, mineral regulation and supporting sleep. A study suggests that It may help to increase the growth of brain cells, which would then decrease the side effects of Parkinson's disease. It also plays a positive role in calming the nerves - Perhaps this might have a benefit for Parkinson's tremors? This I don't know. Taurine decreases anxiety and has been used to help those with seizures. A good benefit about taurine is that it won’t make you sleepy if you take it during the day.
GABA
5-HTP
Alpha Lipoic Acid
Vitamin K2
Vitamin D3
Vitamin E
Parkinson's Helplines
It is very easy to find the right help and support for Parkinson's. Just contacting your doctor, your Parkinson's nurse or even calling a helpline for advice.
UK: 0808 800 0303
US: 1-800-473-4636
Canada: 1-800-565-3000
Australia: 1800 022 222
Zew Zealand: 0800 473 4636
Similar Articles
References
15-20 sleep studies come out each month. That's between 180-240 studies a year.
Parkinson's UK - Reporting on Parkinson’s: information for journalists
Parkinson's Foundation - US/Worldwide Parkinson's Statistics
US National Library of Medicine - Excessive Daytime Sleepiness and Unintended Sleep Episodes Associated with Parkinson’s Disease
Parkinson's UK - Sleep Problems & PD
Sleep Foundation - Recommended Hours of Sleep
Sleep Foundation - Deterioration in the function of the SCN
Parkinson's Foundation - Sleep Apnoea & PD
Manoel Alves Sobreira-Neto, Márcio Alexandre Pena-Pereira, Emmanuelle Silva Tavares Sobreira, Marcos Hortes Nisihara Chagas, Carlos Maurício Oliveira de Almeida, Regina Maria França Fernandes, Vitor Tumas, Alan Luiz Eckeli - Obstructive sleep apnea and Parkinson's disease: characteristics and associated factors
Journal of Clinical Sleep Medicine - CPAP Treatment of Obstructive Sleep Apnoea in PD
The CPAP Shop - How to Avoid Pneumonia While Using a CPAP Machine
CPAP.com - Ultimate How To Guide: Best Ways To Clean Your CPAP
Movement disorders Clinical Practice - Nocturia in Patients With Parkinson's Disease
Parkinson's UK - Nocturia, Top 10 Research Priorities
Sleep Foundation - Nocturia and Disturbed Sleep in the Elderly
The Neurourology Promotion Committee in The International Continence Society - A guideline for the management of bladder dysfunction in Parkinson's disease and other gait disorders
Panicker JN, Fowler CJ and Kessler TM - Lower urinary tract dysfunction in the neurological patient: clinical assessment and management
National Institute for Health and Clinical Excellence (NICE) . Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease
Mehanna, R. and Jankovic, J. - Respiratory problems in neurologic movement disorders
Kbar, U. et al. - Incidence and mortality trends of aspiration pneumonia in Parkinson’s disease in the United States
British Society of Immunology - Natural Killer Cells
Dr. James Brown - Are you awake to sleep deprivation? The Biochemist Blog
Dr. Matthew Walker - Lack of sleep decreases immune system effectiveness
Natalie E. Allen, Allison K. Schwarzel and Colleen G. Canning - Recurrent Falls in Parkinson’s Disease: A Systematic Review
Samuel Kwaku Essien, Cindy Xin Feng, Wenjie Sun, Marwa Farag, Longhai Li and Yongqing Gao - Sleep duration and sleep disturbances in association with falls among the middle-aged and older adults in China: a population-based nationwide study
Dr. Ron Postuma, Parkinson Canada - About REM Sleep Behaviour Disorder
Sarah Sarway (Nutritiouslife.com) and Dr. Michael Breus (@thesleepdoctor) - A Simple Guide to the Stages of Sleep (and Why They Matter)
Commune podcast by Jeff Krasno - Sleep better with Dr. Michael Breus
Rositsa Poryazova, Michael Oberholzer, Christian R. Baumann and Claudio L. Bassetti - REM Sleep Behavior Disorder in Parkinson's Disease: A Questionnaire-Based Survey
Mayo Clinic - REM sleep behaviour disorder
A Schuld, T Kraus, M Haack, D Hinze-Selch, T Pollmächer - Obstructive sleep apnea syndrome induced by clonazepam in a narcoleptic patient with REM-sleep-behavior disorder
Danielle Pacheco, Sleep Foundation - REM Sleep Disorder Treatment
D. A. M. C. Van De Vijver, R. A. C. Roos, P. A. F. Jansen, A. J. Porsius and A. De Boer - Influence of benzodiazepines on antiparkinsonian drug treatment in levodopa users
Mayo Clinic - Restless leg syndrome
Jan-Erik Broman, Lena Mallon and Jerker Hetta - Restless legs syndrome and its relationship with insomnia symptoms and daytime distress: epidemiological survey in Sweden
Dr. Peter McCormick, University of Barcelona - The role of dopamine in sleep regulation
Richard P Allen, Christopher J Earley - The role of iron in restless legs syndrome
Chao Han, Wei Mao, Jing An, Lifei Jiao and Piu Chan - Early morning off in patients with Parkinson’s disease: a Chinese nationwide study and a 7-question screening scale
Parkinson's Western Australia - Wearing Off
A Rizos, P Martinez-Martin, P Odin, A Antonini, B Kessel, T Klemencic Kozul, A Todorova, A Douiri, A Martin, F Stocchi, E Dietrichs, K Ray Chaudhuri, EUROPAR and the IPDMDS non-Motor PD Study Group - Characterizing motor and non-motor aspects of early-morning off periods in Parkinson's disease: an international multicenter study
Rieko Onozawa, Jun Tsugawa, Yoshio Tsuboi, Jiro Fukae, Takayasu Mishima and Shinsuke Fujioka - The impact of early morning off in Parkinson's disease on patient quality of life and caregiver burden
Keisuke Suzuki, Hiroaki Fujita, Madoka Okamura, Saro Kobayashi and Koichi Hirata - Does good sleep reduce early-morning off periods in patients with Parkinson’s disease?
Hiroshi Kataoka, Keigo Saeki, Yuki Yamagami, Kazuma Sugie and Kenji Obayashi - Quantitative associations between objective sleep measures and early-morning mobility in Parkinson’s disease: cross-sectional analysis of the PHASE study
K. Ray Chaudhuri - Rapid and reliable management of early-morning OFF periods in patients with Parkinson’s disease
Daniel J Taylor, Laurel J Mallory, Kenneth L Lichstein, H Heith Durrence, Brant W Riedel and Andrew J Bush - Comorbidity of chronic insomnia with medical problems
Akira Ueki, Mieko Otsuka - Life style risks of Parkinson's disease: association between decreased water intake and constipation
Dr. Cherian Karunapuzha (Podcast Recording) - Constipation and the gut in Parkinson's
Keisuke Suzuki, Masayuki Miyamoto, Tomoyuki Miyamoto, Masaoki Iwanami and Koichi Hirata - Sleep Disturbances Associated with Parkinson's Disease
M D Gjerstad, T Wentzel-Larsen, D Aarsland and J P Larsen - Insomnia in Parkinson's disease: frequency and progression over time
International Parkinson and Movement Disorder Society - Short Parkinson's Evaluation Scale (SPES)/Scales for Outcomes in Parkinson’s Disease – Motor Function (SPES/SCOPA – Motor)
Kangdi Zhu, Jacobus J van Hilten and Johan Marinus - The course of insomnia in Parkinson's disease
Jacobus J van Hilten - Phenoprofiling PD
Aviva - Sleepless cities revealed as one in three adults suffer from insomnia
Linenbundle - Insomnia - How Big a Deal is it?
Linenbundle - Insomnia - How Big a Deal is it? - Insomnia and Google
American Journal of Managed Care (AJMC) - Dr Daniel Greer on Emergence of CBT as First-line Treatment for Chronic Insomnia
Dr. Michael Breus (@thesleepdoctor) - Tom Bilyeu - These Sleep Experts Explain How to Get the BestRest | Health Theory
Parkinson's UK - Depression - Do I have depression
Rob Newsome, Sleep Fountain - Depression and Sleep
Katie Warriner - Three positive thoughts before going to bed (video available upon request)
M A Menza, D E Robertson-Hoffman and A S Bonapace - Parkinson's disease and anxiety: comorbidity with depression
A Nuti, R Ceravolo, A Piccinni, G Dell'Agnello, G Bellini, G Gambaccini, C Rossi, C Logi, L Dell'Osso and U Bonuccelli - Psychiatric comorbidity in a population of Parkinson's disease patients
I H Richard, R B Schiffer and R Kurlan - Anxiety and Parkinson's disease
Andrea N Goldstein, Stephanie M Greer, Jared M Saletin, Allison G Harvey, Jack B Nitschke and Matthew P Walker - Tired and apprehensive: anxiety amplifies the impact of sleep loss on aversive brain anticipation
Yasmin Anwar, UC Berkeley - Chronically anxious? Deep sleep may take the edge off
Eti Ben Simon, Aubrey Rossi, Allison G Harvey and Matthew P Walker - Overanxious and underslept
Julia D Buckner, Rebecca A Bernert, Kiara R Cromer, Thomas E Joiner and Norman B Schmidt - Social anxiety and insomnia: the mediating role of depressive symptoms
Kim Pratt, Healthypsych.com - Psychology Tools: Schedule "Worry Time"
Parkinson's UK - Rigidity
P H Bertolucci, L A Andrade, J G Lima and E A Carlini - Total sleep deprivation and Parkinson disease
Maria E Linn-Evans, Matthew N Petrucci, Sommer L Amundsen Huffmaster, Jae Woo Chung, Paul J Tuite, Michael J Howell, Aleksandar Videnovic and Colum D MacKinnon - REM sleep without atonia is associated with increased rigidity in patients with mild to moderate Parkinson's disease
Parkinson.org - Fitness Counts
Parkinson's UK - Exercising at home with Parkinson's: Your toolkit
Parkinson's NSW - Flexibility and Stretching Exercises Part 1
Parkinson's NSW - Flexibility and Stretching Exercises Part 2
Parkinson's Foundation - Bradykinesia (Slowness of Movement)
European Parkinson's Disease Association (EPDA) - Bradykinesia
Parkinson's UK - Deep Brain Stimulation
Kelly E Lyons and Rajesh Pahwa - Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease
Hayden Basinger and Joe Joseph - Neuroanatomy, Subthalamic Nucleus
Ivy N. Miller and Alice Cronin-Golomb - Gender Differences in Parkinson's Disease: Clinical Characteristics and Cognition
Stephen K Van Den Eeden, Caroline M Tanner, Allan L Bernstein, Robin D Fross, Amethyst Leimpeter, Daniel A Bloch and Lorene M Nelson - Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity
American Physiological Society (APS) - Male hormone testosterone cause of sex differences in Parkinson's disease risk, study suggests
Saurabh Khasnavis, Anamitra Ghosh, Avik Roy and Kalipada Pahan - Castration Induces Parkinson Disease Pathologies in Young Male Mice via Inducible Nitric-oxide Synthase*
M.Alam and W.JSchmidt - Mitochondrial complex I inhibition depletes plasma testosterone in the rotenone model of Parkinson's disease
E Mitchell, D Thomas and R Burnet - Testosterone improves motor function in Parkinson's disease
Shaletha Holmes, Meharvan Singh, Chang Su and Rebecca L. Cunningham - Effects of Oxidative Stress and Testosterone on Pro-Inflammatory Signaling in a Female Rat Dopaminergic Neuronal Cell Line
Rebecca L. Cunningham, Teresa Macheda, Lora Talley Watts, Ethan Poteet, Meharvan Singh, James L. Roberts and Andrea Giuffrida - Androgens exacerbate motor asymmetry in male rats with unilateral 6-hydroxydopamine lesion
Dr. Kalipada Pahan, Rush University Medical Center - Sudden decline in testosterone may cause Parkinson's disease symptoms in men
Rachel Leproult and Eve Van Cauter - Effect of 1 Week of Sleep Restriction on Testosterone Levels in Young Healthy Men
Victor H Goh and Terry Y Tong - Sleep, sex steroid hormones, sexual activities, and aging in Asian men
The Drive Podcast (Podcast Notes) - Dr. Matthew Walker on Sleep: Heart Disease, Cancer, Sexual Function, and the Causes of Sleep Disruption
University of California News - Lack of sleep shrinks men's testicles?
Isabela B Antunes, Monica L Andersen, Edmundo C Baracat and Sergio Tufik - The effects of paradoxical sleep deprivation on estrous cycles of the female rats
Susan Labyak, Susan Lava, Fred Turek and Phyllis Zee - Effects of shiftwork on sleep and menstrual function in nurses
A Baumgartner, M Dietzel, B Saletu, R Wolf, A Campos-Barros, K J Gräf, I Kürten and U Mannsmann - Influence of partial sleep deprivation on the secretion of thyrotropin, thyroid hormones, growth hormone, prolactin, luteinizing hormone, follicle stimulating hormone, and estradiol in healthy young women
Jacqueline D. Kloss, Michael Perlis, Jessica Zamzow, Elizabeth Culnan and Clarisa Graciac - Sleep, Sleep Disturbance and Fertility in Women
I-Duo Wang, Yung-Liang Liu, Chung-Kan Peng, Chi-Hsiang Chung, Shan-Yueh Chang, Chang-Huei Tsao and Wu-Chien Chien - Non-Apnea Sleep Disorder Increases the Risk of Subsequent Female Infertility—A Nationwide Population-Based Cohort Study
Sandrine Touzet, Muriel Rabilloud, Hans Boehringer, Enriqueta Barranco and René Ecochard - Relationship between sleep and secretion of gonadotropin and ovarian hormones in women with normal cycles
American Academy of Neurology - Reproductive factors may protect women from Parkinson's disease
Connie Marras and Rachel Saunders-Pullman - The Complexities of Hormonal Influences and Risk of Parkinson’s Disease
Claudia Marques Santa Rosa Malcher, Kleber Roberto da Silva Gonçalves Oliveira, Milena Coelho Fernandes Caldato, Bruno Lopes dos Santos Lobato, Janari da Silva Pedroso, and Marco de Tubino Scanavino - Sexual Disorders and Quality of Life in Parkinson's Disease
O Moore, T Gurevich, A D Korczyn, M Anca, H Shabtai and N Giladi - Quality of sexual life in Parkinson's disease
R G Brown, M Jahanshahi, N Quinn, and C D Marsden - Sexual function in patients with Parkinson's disease and their partners
Carlos Singer, 1William J. Weiner, 1Juan R. Sanchez-Ramos and Mark Ackerman - Sexual Dysfunction in Men with Parkinson’s Disease
Gila Bronner, Vladimir Royter, Amos D Korczyn and Nir Giladi - Sexual dysfunction in Parkinson's disease
Taylor P Kohn, Jaden R Kohn, Nora M Haney, Alexander W Pastuszak and Larry I Lipshultz - The effect of sleep on men's health
Kuan-Fei Chen, Shinn-Jye Liang, Cheng-Li Lin, Wei-Chih Liao and Chia-Hung Kao - Sleep disorders increase risk of subsequent erectile dysfunction in individuals without sleep apnea: a nationwide population-base cohort study
Kerri L Melehan, Camilla M Hoyos, Garun S Hamilton, Keith K Wong, Brendon J Yee, Robert I McLachlan, Shamus O'Meagher, David Celermajer, Martin K Ng, Ronald R Grunstein and Peter Y Liu - Randomized Trial of CPAP and Vardenafil on Erectile and Arterial Function in Men With Obstructive Sleep Apnea and Erectile Dysfunction
Richard Schulz, Fabian Bischof, Wolfgang Galetke, Henning Gall, Jörg Heitmann, Andrea Hetzenecker, Markus Laudenburg, Till Jonas Magnus, Georg Nilius, Christina Priegnitz, Winfried Randerath, Maik Schröder, Marcel Treml, Michael Arzt and German Sleep Apnea Research Network (GERSAN) - CPAP therapy improves erectile function in patients with severe obstructive sleep apnea
J R Berman - Physiology of female sexual function and dysfunction
E O Laumann, A Paik and R C Rosen - Sexual dysfunction in the United States: prevalence and predictors
Megan McCool-Myers, Melissa Theurich, Andrea Zuelke, Helge Knuettel, Christian Apfelbacher - Predictors of female sexual dysfunction: a systematic review and qualitative analysis through gender inequality paradigms
Gabriela Kołodyńska, Maciej Zalewski and Krystyna Rożek-Piechura - Urinary incontinence in postmenopausal women – causes, symptoms, treatment
The North American Menopause Society - Decreased Desire
David A Kalmbach, J Todd Arnedt, Vivek Pillai and Jeffrey A Ciesla - The impact of sleep on female sexual response and behavior: a pilot study
Marian Petersen, Ellids Kristensen, Søren Berg and Bengt Midgren - Long-term effects of continuous positive airway pressure treatment on sexuality in female patients with obstructive sleep apnea
Lauren A Dalvin, Gena M Damento, Barbara P Yawn, Barbara A Abbott, David O Hodge and Jose S Pulido - Parkinson Disease and Melanoma: Confirming and Reexamining an Association
Fiammetta Romano, Giovanna Muscogiuri, Elea Di Benedetto, Volha V Zhukouskaya, Luigi Barrea, Silvia Savastano, Annamaria Colao and Carolina Di Somma - Vitamin D and Sleep Regulation: Is there a Role for Vitamin D?
Qi Gao, Tingyan Kou, Bin Zhuang, Yangyang Ren, Xue Dong and Qiuzhen Wang - The Association between Vitamin D Deficiency and Sleep Disorders: A Systematic Review and Meta-Analysis
Qing Ye, Ya Wen, Nasser Al-Kuwari and Xiqun Chen - Association Between Parkinson's Disease and Melanoma: Putting the Pieces Together
Khanh Luong and Lan Nguyen - Role of Vitamin D in Parkinson's Disease
Paul Knekt, Annamari Kilkkinen and Harri Rissanen - Serum Vitamin D and the Risk of Parkinson Disease
Maryam Mosavat, Aisling Smyth, Diana Arabiat and Lisa Whitehead - Vitamin D and sleep duration: Is there a bidirectional relationship?
Qi Gao, Tingyan Kou, Bin Zhuang, Yangyang Ren, Xue Dong and Qiuzhen Wang - The Association between Vitamin D Deficiency and Sleep Disorders: A Systematic Review and Meta-Analysis
Amie L Peterson, Martina Mancini and Fay B Horak - The relationship between balance control and vitamin D in Parkinson's disease-a pilot study
Amie L Peterson, Charles Murchison, Cyrus Zabetian, James B Leverenz, G Stennis Watson, Thomas Montine, Natasha Carney, Gene L Bowman, Karen Edwards and Joseph F Quinn - Memory, mood, and vitamin D in persons with Parkinson's disease
Alison M Mondul, Stephanie J Weinstein, Tracy M Layne and Demetrius Albanes - Vitamin D and Cancer Risk and Mortality: State of the Science, Gaps, and Challenges
Elizabeth T Jacobs, Lindsay N Kohler, Andrew G Kunihiro and Peter W Jurutka - Vitamin D and Colorectal, Breast, and Prostate Cancers: A Review of the Epidemiological Evidence
Elena Tagliabue, Sara Raimondi and Sara Gandini - Chapter One - Vitamin D, Cancer Risk, and Mortality
Cheryl D Toner, Cindy D Davis and John A Milner - The vitamin D and cancer conundrum: aiming at a moving target
Julia A Newton-Bishop, Samantha Beswick, Juliette Randerson-Moor, Yu-Mei Chang, Paul Affleck, Faye Elliott, May Chan, Susan Leake, Birute Karpavicius, Sue Haynes, Kairen Kukalizch, Linda Whitaker, Sharon Jackson, Edwina Gerry, Clarissa Nolan, Chandra Bertram, Jerry Marsden, David E Elder, Jennifer H Barrett and D Timothy Bishop - Serum 25-hydroxyvitamin D3 levels are associated with breslow thickness at presentation and survival from melanoma
Gina P Kwon, Christina S Gamba, Marcia L Stefanick, JoAnn E Manson, Rowan T Chlebowski and Jean Y Tang - Association of 25-hydroxyvitamin D levels and cutaneous melanoma: A nested case-control study of the Women's Health Initiative Observation Study
Fie Juhl Vojdeman, Christian Medom Madsen, Kirsten Frederiksen, Darshana Durup, Anja Olsen, Louise Hansen, Anne-Marie Heegaard, Bent Lind, Anne Tjønneland, Henrik Løvendahl Jørgensen and Peter Schwarz - Vitamin D levels and cancer incidence in 217,244 individuals from primary health care in Denmark
Sang Min Park, Tricia Li, Shaowei Wu, Wen-Qing Li, Abrar A Qureshi and Eunyoung Cho - Vitamin D Intake and Risk of Skin Cancer in US Women and Men
Parkinson Foundation - Freezing
Q J Almeida and C A Lebold - Freezing of gait in Parkinson's disease: a perceptual cause for a motor impairment?
Xiaohui Tang, Lijia Yu, Jingyun Yang, Wenjing Guo, Ying Liu, Yaling Xu and Xijin Wang - Association of sleep disturbance and freezing of gait in Parkinson disease: prevention/delay implications
Filipe Oliveira de Almeida, Carlos Ugrinowitsch, Leandro C Brito, Angelo Milliato, Raquel Marquesini, Acácio Moreira-Neto, Egberto Reis Barbosa, Fay B Horak, Martina Mancini and Carla Silva-Batista - Poor sleep quality is associated with cognitive, mobility, and anxiety disability that underlie freezing of gait in Parkinson's disease
Dong-Jun Lv, Ling-Xi Li, Jing Chen, Shi-Zhuang Wei, Fen Wang, Hua Hu, An-Mu Xie and Chun-Feng Liu - Sleep deprivation caused a memory defects and emotional changes in a rotenone-based zebrafish model of Parkinson's disease
Michael K Scullin, Lynn Marie Trotti, Anthony G Wilson, Sophia A Greer and Donald L Bliwise - Nocturnal sleep enhances working memory training in Parkinson's disease but not Lewy body dementia
Bryce A. Mander, Joseph R. Winer, and Matthew P. Walker - Sleep and Human Aging
Dr. Matthew Walker - Sleep Dependent Memory Processing
Samuel D Kim, Natalie E Allen, Colleen G Canning and Victor S C Fung - Postural instability in patients with Parkinson's disease. Epidemiology, pathophysiology and management
Aktar, Burcina, Donmez Colakoglu, Berrilb, Balci, Birgulc - Does the postural stability of patients with Parkinson’s disease affect the physical activity?
Fabianne Furtado, Bruno da Silva B. Gonçalves, Isabela Lopes Laguardia Abranches, Ana Flávia Abrantes and Arturo Forner-Cordero - Chronic Low Quality Sleep Impairs Postural Control in Healthy Adults
Francis Degache, Yannick Goy, Sopharat Vat, José Haba Rubio, Olivier Contal, Raphaël Heinzer - Sleep-disordered breathing and daytime postural stability
Kelly E Lyons, Rajesh Pahwa - Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease
Richard L. Doty - Olfactory dysfunction in Parkinson disease
Alex Iranzo, Paula Marrero-González, Mónica Serradell, Carles Gaig, Joan Santamaria and Isabel Vilaseca - Significance of hyposmia in isolated REM sleep behaviour disorder
Heather Carlson, Joana Leitão, Sylvain Delplanque, Isabelle Cayeuxd, David Sander and Patrik Vuilleumier - Sustained effects of pleasant and unpleasant smells on resting state brain activity
Brown University - Smell sensitivity varies with circadian rhythm, study suggests
Yuanyuan Li, Wenyan Kang, Linyuan Zhang, Liche Zhou, Mengyue Niu, and Jun Liu - Hyposmia Is Associated with RBD for PD Patients with Variants of SNCA
E Buckley, A Siddique and A McNeill - Hyposmia, symptoms of REM sleep behavior disorder and Parkinsonian motor signs suggests prodromal neurodegeneration in 22q11 deletion syndrome
Sung Hoon Kang, Hye Mi Lee, Woo-Keun Seo, Ji Hyun Kim, Seong-Beom Koh - The combined effect of REM sleep behavior disorder and hyposmia on cognition and motor phenotype in Parkinson's disease
William D S Killgore, Sharon A McBride - Odor identification accuracy declines following 24 h of sleep deprivation
Maria Thomas, Helen Sing, Gregory Belenky, Henry Holcomb, Helen Mayberg, Robert Dannals, Henry Wagner JR., David Thorne, Kathryn Popp, Laura Rowland, Amy Welsh, Sharon Balwinski and Daniel Redmond - Neural basis of alertness and cognitive performance impairments during sleepiness. I. Effects of 24 h of sleep deprivation on waking human regional brain activity
David H Zald and José V Pardo - Emotion, olfaction, and the human amygdala: Amygdala activation during aversive olfactory stimulation
Wen Li, Leonardo Lopez, Jason Osher, James D. Howard, Todd B. Parrish and Jay A. Gottfried - Right Orbitofrontal Cortex Mediates Conscious Olfactory Perception
Keiko Watanabe, Yuri Masaoka, Mitsuru Kawamura, Masaki Yoshida, Nobuyoshi Koiwa, Akira Yoshikawa, Satomi Kubota, Masahiro Ida, Kenjiro Ono and Masahiko Izumizaki - Left Posterior Orbitofrontal Cortex Is Associated With Odor-Induced Autobiographical Memory: An fMRI Study
Lauren L. Drag, Linas A. Bieliauskas, Alfred W. Kaszniak, Nicolaas I. Bohnen and Elizabeth L. Glisky - Source memory and frontal functioning in Parkinson's disease
R. A. Armstrong - Visual Symptoms in Parkinson's Disease
Carlijn D.J.M. Borm, Femke Visser, Mario Werkmann, Debbie de Graaf, Diana Putz, Klaus Seppi, Werner Poewe, Annemarie M.M. Vlaar, Carel Hoyng, Bastiaan R. Bloem, Thomas Theelen and Nienke M. de Vries - Seeing ophthalmologic problems in Parkinson disease
V Biousse, B C Skibell, R L Watts, D N Loupe, C Drews-Botsch and N J Newman - Ophthalmologic features of Parkinson's disease
Barbara Nowacka, Wojciech Lubinski, Krystyna Honczarenko, Andrzej Potemkowski and Krzysztof Safranow - Ophthalmological features of Parkinson disease
Cengaver Tamer, Ismet M Melek, Taskin Duman and Hüseyin Oksüz - Tear film tests in Parkinson's disease patients
Masahiko Ayaki, Kazuo Tsubota, Motoko Kawashima, Taishiro Kishimoto, Masaru Mimura and Kazuno Negishi - Sleep Disorders are a Prevalent and Serious Comorbidity in Dry Eye
Anat Galor, Benjamin E Seiden and Douglas M. Wallace - The association of dry eye symptom severity and comorbid insomnia in US veterans
Wanhyung Lee, Sung-Shil Lim, Jong-Uk Won, Jaehoon Roh, June-Hee Lee, Hongdeok Seok and Jin-Ha Yoon - The association between sleep duration and dry eye syndrome among Korean adults
Motoko Kawashima, Miki Uchino and Kazuo Tsubota - The association of sleep quality with dry eye disease: the Osaka study
NHS UK - Glaucoma
Mountain View Eye Center - Sleep Apnea And Your Eyes
Jong Youn Moon, Hyung Jun Kim, Yoon Hyung Park, Tae Kwann Park, Eun-Cheol Park, Chan Yun Kim and Si Hyung Lee - Association between Open-Angle Glaucoma and the Risks of Alzheimer's and Parkinson's Diseases in South Korea: A 10-year Nationwide Cohort Study
Aditya Chaitanya, Vijaya H Pai, Aswini Kumar Mohapatra and Ramesh S Ve - Glaucoma and its association with obstructive sleep apnea: A narrative review
Maria A Sondrup, Cecilie Bjergen, Anne N Gaarskjær, Andrea Joseph, Rikke Lassen, Shiran Mamedov, Maria Poulsen, Tessa Radovanovic, Cathrine Schacksen, Maja Thaarup, Maria Andersen, Lorenz M Oppel and Parisa Gazerani - Investigation of itch in Parkinson disease
Stanford Parkinson's Community Research - Sweating and Temperature Regulation in PD
Parkinson's Foundation - Skin Changes
Friederike Sixel-Döring, Claudia Trenkwalder, Christoph Kappus and Dieter Hellwig - Skin complications in deep brain stimulation for Parkinson's disease: frequency, time course, and risk factors
Alexis B. Lyons, Lauren Moy, Ronald Moy and Rebecca Tung - Circadian Rhythm and the Skin: A Review of the Literature
Lídia Palma, Liliana Tavares Marques, Julia Bujan and Luís Monteiro Rodrigues - Dietary water affects human skin hydration and biomechanics
Francine Santoro and Sandrine Teissedre - A Novel Night Moisturizer Enhances Cutaneous Barrier Function in Dry Skin and Improves Dermatological Outcomes in Rosacea-prone Skin
Elisabeth Hahnel, Ulrike Blume‐Peytavi and Jan Kottner - Associations of dry skin, skin care habits, well‐being, sleep quality and itch in nursing home residents: Results of a multicentre, observational, cross‐sectional study
Mayoclinic - Seborrheic Dermatitis: Symptoms and Causes
Valentina S Arsic Arsenijevic, Danica Milobratovic, Aleksandra M Barac, Berislav Vekic, Jelena Marinkovic and Vladimir S Kostic - A laboratory-based study on patients with Parkinson’s disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production
Robert A. Schwartz, Christopher A. Janusz and Camila K. Janniger - Seborrheic Dermatitis: An Overview
National Eczema Association - Seborrheic Dermatitis: Causes, Symptoms and Treatments
Manapajon Araya, Kanokvalai Kulthanan and Sukhum Jiamton - Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country
-
Sleep Foundation - Sleep Debt and Catching up on Sleep
Christopher M Depner, Edward L Melanson, Robert H Eckel, Ellen R Stothard, Sarah J Morton and Kenneth P Wright Jr - Ad libitum Weekend Recovery Sleep Fails to Prevent Metabolic Dysregulation during a Repeating Pattern of Insufficient Sleep and Weekend Recovery Sleep
BioMed Central - Antidepressants and movement disorders: a postmarketing study in the world pharmacovigilance database
The content on this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
Comments