CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Parkinson's disease - Management
How do I manage sleep disturbance in people with Parkinson's disease?
- Take a full sleep history and advise good sleep hygiene, which includes:
- Avoidance of stimulants (for example coffee, tea, caffeine) in the evening.
- Establishment of a regular pattern of sleep.
- Comfortable bedding and temperature.
- Provision of assistive devices, such as a bed lever or rails to aid with moving and turning, allowing the person to get more comfortable.
- Restriction of daytime naps.
- Advice about taking regular and appropriate exercise to induce better sleep.
- Reviewing medication, trying to avoid any drugs that may affect sleep or alertness, or that may interact with other medication (for example, selegiline, antihistamines, H2-receptor antagonists, antipsychotics, and sedatives).
- Identify whether any of the following may be present and manage them appropriately, usually by requesting an interim referral or advice from the person's Parkinson's disease specialist team:
- Conditions related to Parkinson's disease:
- Restless legs syndrome.
- Periodic leg movements of sleep.
- Rapid eye movement (REM) sleep behaviour disorder.
- Nocturnal akinesia (inability to turn over in bed).
- Nocturia (see Urinary dysfunction).
- Conditions that may be caused by anti-parkinsonian medication (such as selegiline and dopamine agonists):
- Vivid dreams or nightmares.
- Hallucinations.
- See the CKS topic on Insomnia.
Clarification / Additional information
- Criteria for the diagnosis of restless legs syndrome are:
- A desire to move the extremities, usually associated with discomfort or disagreeable sensations in the extremities.
- Motor restlessness — people move to relieve the discomfort (such as walking about or rubbing the legs).
- Symptoms which are worse at rest, with at least temporary relief on activity.
- Symptoms which are worse later in the day or at night.
- Suspect REM sleep behaviour disorder if hallucinations occur, or vivid dreams or nightmares occur which are acted out (with jerking and sometimes violent limb or body movements).
- Clonazepam may be used (off-licence use).
- Modified-release levodopa preparations may be used for nocturnal akinesia in people with Parkinson's disease.
- See Mental health problems for background details on sleep disturbance in people with Parkinson's disease.
Basis for recommendation
These recommendations are based a guideline produced by the National Institute for Health and Clinical Excellence (NICE), Parkinson's disease: national clinical guideline for diagnosis and management in primary and secondary care [National Collaborating Centre for Chronic Conditions, 2006].
© NHS Institute for Innovation and Improvement