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Parkinsonism

Description

Parkinsonism is a progressive nervous disease occurring most often after age 50. It is associated with the destruction of brain cells that produce dopamine and is characterized by muscular tremor, slowing of movement, partial face paralysis, weakness, and an odd gait and posture. Insomnia is the most common sleep-related symptom in patients with parkinsonism.

Diagnosis

Apart from insomnia, other sleep-related difficulties include the inability to get out of bed unaided, the need to arise to go to the bathroom, the inability to turn over in bed, painful leg cramps, vivid dreams and nightmares, back pain, limb jerks, and visual hallucinations. Sleep abnormalities include sleep fragmentation and total sleep-wake cycle reversal. The medications commonly used to treat parkinsonism can produce sleep disruptions, including increased numbers of arousals and awakenings and decreased amounts of REM sleep.

Treatment

Low doses of dopamine tend to improve sleep, whereas higher doses cause sleep disruption. The timing of the medication has a marked effect on sleep.

Source: Adapted from International Classification of Sleep Disorders Diagnostic & Coding Manual, American Academy of Sleep Medicine.