Sleep Changes and Hallucinations Associated with Parkinson's

Almost 1 million people in the US live with Parkinson's disease (PD). Parkinson's is a progressive disorder affecting the nervous system with no known cure. Symptoms such as sleep disturbances may be early signs and begin several years before a Parkinson's diagnosis.

Key takeaways:
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    Any disruption in the four sleep stages can disturb healthy brain development, memory preservation, emotional processing, and tissue restoration.
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    REM sleep disorders are sometimes present years before in people later diagnosed with Parkinson's Disease.
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    Sleep-related hallucinations associated with Parkinson's Disease may occur in people with sleep fragmentation and REM Behavior Disorder.
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    Visual hallucinations are present in 75% of people with Parkinson's Disease.
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    Non-medicinal strategies may reduce the severity of a sleep disorder and related hallucinations.

In addition, sleep disorders that cause a lack of quality sleep may trigger hallucinations associated with PD. Medical treatments are available, so contacting your medical practitioner is necessary. Still, there are also non-medicinal strategies that could help improve the quality of your sleep.

Adults typically have four to six sleep cycles a night. Each cycle comprises four stages that vary in length. Each stage is vital for our everyday function and the rejuvenation of our brain and body.

Our physical, mental, and emotional health is adversely affected if we cannot move properly through the sleep stages. Understanding the normal sleep cycle can help you better appreciate the cause of sleep disorders.

Sleep stages

Stage 1

This is a "dozing off" stage when you first go to bed and move from wakefulness to sleep, ideally lasting 5-10 minutes. After that, your body still has muscle tone and a regular breathing pattern, and the brain begins to slow down. You can awaken quickly during this stage.

Stage 2

This is another light sleep stage that ideally lasts about 20 minutes when your muscles relax and your brain patterns slow. Your heart rate, temperature, and respiratory rate will decrease as you transition to deep sleep. People typically spend nearly half of their time asleep in this stage.

Stage 3

This is a stage of deep sleep when it may be difficult to wake you, and your brain waves are at their slowest. Heart and respiratory rates also decrease.

It is essential to have an adequate deep sleep in this restorative stage, where there is boosting of your immune system, and your muscles, bones, and tissues rebuild. Enhancement of creativity and insight occur in this stage. Deep sleep typically lasts 20-40 minutes.

Stage 4: REM (rapid eye movement)

This is the stage where your brain is as active as if you are awake, and dreams are vivid. Adults typically require up to two hours of REM sleep each night, which is vital for healthy brain development, memory preservation, and emotional processing.

In a normal REM sleep stage, outwardly, your body has temporary paralysis and remains immobile. The only movement you have is in the muscles that control breathing and the movement of your eyes. REM sleep is essential for cognitive function.

Sleep disturbances

Any disruption to the sleep stages can affect memory and concentration in most adults. In addition, sleep deprivation contributes to neurological dysfunction, such as mood changes and hallucinations.

People with PD and sleep disorders are five times more likely to suffer from psychotic symptoms such as hallucinations. Sleep disturbances common in Parkinson's Disease include the following:

Insomnia. Difficulty falling asleep and or staying asleep. People with insomnia may also wake up very early.

Hypersomnia. Excessive daytime sleepiness or prolonged sleep at night.

REM Behavior Disorder (RBD). Sleep disruption causes people with RBD to thrash their arms and legs and sometimes strike their partners in sleep. People with RBD yell or talk in their sleep and may look like they are hallucinating. They may have a diagnosis of RBD five to ten years before Parkinson's disease.

Sleep Fragmentation. Fragmented sleep is common in people with Parkinson's disease, sometimes caused by some of the prescribed medications. This disruption in the sleep-wake cycle can also cause fatigue and headaches.

Hallucinations

Hallucinations are unusual sensory perceptions, having no physical stimulus involving sight, sound, smell, touch, and taste. Typically, hallucinations occur when a person is awake, whereas sleep disorders happen when someone is asleep.

In addition, medications for Parkinson's activate dopamine which stimulate the brain and can increase hallucinations. Visual hallucinations are the most common and occur in up to 75% of people with Parkinson's throughout the disease; they may see animals or people in the room.

According to the American Academy of Sleep Medicine, sleep-related hallucinations most often occur as a person falls asleep (hypnagogic) or begins to wake up (hypnopompic). These hallucinations can be very intense and disturbing and are sometimes called "parasomnias".

In addition, studies have shown that hallucinations in people with PD, associated with sleep, tend to occur in those with depression, significant REM Behavior Disorder (RBD), or a more prolonged treatment duration for PD.

Medical treatment

Visit your medical practitioner if you or your loved one hallucinate or have sleep disturbances. A medical examination and lab tests are required to determine if these symptoms are due to delirium, which can originate from a treatable cause, such as a bladder infection.

Medications prescribed for Parkinson's Disease could be the underlying cause, and the dose may need adjusting. In addition, medications to treat sleep disorders may reduce incidents of sleep-related hallucinations if other strategies are ineffective. Please talk with your medical practitioner to determine the best course of treatment for you or your loved one.

Tips to optimize sleep: creating sleep hygiene

You can set the stage for optimal sleep quality by creating a “sleep hygiene routine” that works for you and your loved one. These are some general tips you can consider depending on your needs.

Avoid or eliminate caffeine from your diet. Also, avoid heavy evening meals.

Avoid alcohol, especially in the evening.

Establish a regular bedtime routine and wake up at the same time each day.

Make sure you get some exercise, especially outdoors, throughout the day. Try to avoid exercising too close to bedtime. Meditation or relaxation techniques are recommended.

Avoid using "screens" (electronic devices or television) 1-2 hours before bed.

Keep your bedroom for sleep or sexual activity only—no reading or watching television.

Have your bedroom cool, dark, and quiet to promote rest.

Try not to drink fluids 1-2 hours before bedtime, and make sure you use the bathroom right before retiring.

A good night’s sleep

Disturbances to the normal sleep stages are common in Parkinson's disease and can cause or aggravate sensory hallucinations but most often affect the visual sense. Medical treatment and therapies are available to improve sleep quality and possibly reduce hallucinations.

In addition, practicing good sleep hygiene is something you and your loved one can do to optimize sleep and possibly reduce the incidence of hallucinations.

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