Sleep Issues

Sleep problems can precede Parkinson’s diagnosis.

Sleep-related problems specific to Parkinson’s may occur early and even predate the diagnosis of the disease. These problems can seriously compromise your quality of life and lead to impaired functioning in daily activities.

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 disease. 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).

The impact on quality of life

Sleep disturbances can significantly affect the quality of life for individuals with Parkinson’s. These issues often result in impaired functioning during daily activities, as well as increased fatigue and cognitive difficulties. This, in turn, can lead to emotional and psychological stress, further compounding the challenges faced by people with Parkinson’s.

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.

Key Statistics

Approximately 50% to 80% of individuals with REM Sleep Behavior Disorder (RBD) go on to develop neurodegenerative disorders, specifically synucleinopathies like Parkinson’s disease (3).
Excessive Daytime Sleepiness (EDS) is a common prodromal symptom in Parkinson’s disease, affecting a significant proportion of individuals before the onset of motor symptoms but can be treated (4, 5).
Insomnia and obstructive sleep apnea are also considered potential prodromal features of Parkinson’s disease, although the evidence is less robust compared to RBD (4).
Sleep disturbances in the early prodromal stage of Parkinson’s disease are linked to neuroanatomical changes, particularly in the brainstem neurotransmitter systems (4).

Seeking medical advice

Given the strong correlation between sleep problems and Parkinson’s disease, it is essential for individuals experiencing persistent sleep disturbances to seek medical advice. Early diagnosis and intervention can significantly improve outcomes and quality of life.

Treatment and management of sleep problems in Parkinson’s patients should be approached holistically. This includes considering lifestyle changes, such as maintaining a regular sleep schedule, engaging in physical activity, and managing stress levels. Additionally, medical treatments and therapies, such as medications and cognitive-behavioral therapy for insomnia (CBT-I), can be effective in managing sleep-related issues.

Infosheet under review

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. https://doi.org/10.1111/jsr.14453

(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. https://doi.org/10.3389/fneur.2020.00610

(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. https://doi.org/10.1007/s11940-017-0458-1

(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. https://doi.org/10.1002/mds.10390