Sleep problems can precede Parkinson’s diagnosis.
Recognising and addressing sleep problems early gives you the power to improve your rest, boost your energy, and take control of your daily wellbeing. With the right support and strategies, better sleep is possible, and it can make a big difference in how you feel each day.
What are common sleep issues that occur prior to movement symptoms in Parkinson’s?
Understanding the early indicators
Sleep problems are more than just an inconvenience, they can be early indicators of underlying health issues, including Parkinson’s. Research indicates that specific sleep-related problems can manifest before a Parkinson’s diagnosis, providing crucial early warning signs (1). This finding underscores the importance of paying attention to sleep disturbances and seeking timely medical advice. Sleep problems are common in PD, with ~84% of respondents with PD reporting difficulty falling or staying asleep (2).
Sleep disturbances are often mentioned as early Parkinson’s symptoms, but the specific disorder, REM sleep behaviour disorder, is frequently overlooked. Unlike insomnia or sleep maintenance issues, RBD involves vivid dreaming accompanied by physical movements, such as shouting, punching, or kicking during sleep, often affecting the sleep partner. It occurs in about 0.5%-1% of the general population, rising to 5% in people older than 60. It is considered red flag for Parkinson’s, in that around 80% of those affected may go on to develop the condition within 15 years.
The impact on wellbeing
Sleep disturbances can significantly affect the wellbeing of people with Parkinson’s. Less sleep can make it harder to do everyday tasks. It can also cause people to feel more tired and have trouble thinking clearly. This can lead to stress and emotional struggles, making life even more difficult.
Common sleep-related problems in Parkinson’s
Several sleep-related problems are commonly associated with Parkinson’s:
- Insomnia or difficulty falling asleep or staying asleep.
- REM Sleep Behaviour Disorder (RBD) is when you are acting out dreams, sometimes violently, during REM sleep.
- Restless Legs Syndrome (RLS) is an uncomfortable sensation in the legs that creates an urge to move them, often disrupting sleep.
- Excessive Daytime Sleepiness, or feeling excessively sleepy during the day, despite having enough sleep at night.
- Nocturia, or waking frequently to urinate overnight.
- Obstructive sleep apnea (OSA) has been identified as a potential early non-motor symptom of Parkinson’s, possibly due to neurodegenerative changes in brainstem regions that regulate sleep and breathing.
Managing sleep issues in Parkinson’s
Given the strong connection between sleep disturbances and Parkinson’s, it is crucial for people experiencing persistent sleep issues, especially when accompanied by other early signs like reduced smell, constipation, or mood changes, to seek medical advice. Sleep problems such as insomnia, REM sleep behaviour disorder (RBD), and excessive daytime sleepiness (EDS) can appear years before a formal diagnosis, making them important early indicators of neurodegenerative changes.
Early diagnosis and intervention not only help manage symptoms more effectively but can also improve long-term outcomes and enhance daily functioning and emotional wellbeing. Addressing sleep issues early may even slow the progression of certain non-motor symptoms.
Treatment and management of sleep disturbances in Parkinson’s should be approached holistically. This includes:
- Lifestyle changes such as maintaining a consistent sleep schedule, engaging in regular physical activity, and reducing stress through mindfulness or relaxation techniques.
- Medical interventions, including medications tailored to specific sleep disorders (e.g., melatonin for RBD or dopaminergic agents for restless legs).
- Cognitive-behavioural therapy for insomnia (CBT-I), which has shown effectiveness in improving sleep quality in people with Parkinson’s.
- Complementary therapies, such as acupuncture, have also demonstrated benefits in improving sleep quality and reducing non-motor symptoms in Parkinson’s.
By taking a proactive and comprehensive approach to sleep health, people with Parkinson’s can significantly improve their quality of life and overall wellbeing.
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References:
(1) Dhawan, V., Healy, D. G., Pal, S., & Chaudhuri, K. R. (2006). Sleep-related problems of Parkinson’s disease. Age and Ageing, 35(3), 220-228
(2) Asadpoordezaki, Z., Henley, B. M., & Coogan, A. N. (2025). Prevalence and associations of self-reported sleep problems in a large sample of patients with Parkinson’s disease. Journal of Sleep Research.
(3) Roguski, A., Rayment, D., Whone, A. L., & Jones, M. W. (2020). A Neurologist’s Guide to REM Sleep Behavior Disorder. Frontiers in Neurology, 11, 610.
(4) Iranzo, A., Fereshtehnejad, S. M., & Postuma, R. B. (2017). Sleep disturbances in the prodromal stage of Parkinson disease. Current Treatment Options in Neurology, 19(5), 22.
(5) Adler, C. H., McDonnell, M. D., & Elton, R. (2000). Randomized trial of modafinil for treating subjective daytime sleepiness in patients with Parkinson’s disease: A double-blind, placebo-controlled study. Movement Disorders, 15(5), 819-825.
(6) Zhou, J., Camacho, M., Tang, X., Kushida, C. A., & Li, L. (2021). Association between obstructive sleep apnea and Parkinson’s disease: A systematic review and meta-analysis. Sleep Medicine Reviews, 55, 101381.
(7) Poryazova, R., Waldvogel, D., & Bassetti, C. L. (2007). Sleepwalking in patients with Parkinson disease. Archives of Neurology, 64 (10), 1524–1527.
(8) Li, F., Zhang, Y., Wang, Y., Wang, Y., & Zhang, X. (2024). Efficacy of acupuncture for patients with Parkinson disease who have poor sleep quality: A randomized clinical trial. JAMA Network Open, 7(3), e2820371. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820371
