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Sleep / Fatigue

Generally, sleep is reported as the most troublesome non-motor symptom for people living with Parkinson's. Getting quality sleep regularly is critical to living well with Parkinson's.

As humans, we cycle through two different kinds of sleep, REM (rapid eye movement) sleep, and NREM (non-rapid eye movement). It's important to get a proper balance of both types of sleep cycles. REM sleep is important because it is restorative and provides positive emotional regulation.

For many with Parkinson's, they experience REM Sleep Behavior Disorder also known as RBD. RBD is characterized by people acting out vivid dreams, including talking, jumping out of bed, kicking, biting, etc. Even though the person is often unaware. About 50% of people with PD report RBD as one of their symptoms. 80% of people with RBD have been found to develop a neurodegenerative disorder within 10 years, making it a highly effective predictor. RBD issues are strong measures of conversion to movement disorders.

Other common sleep issues, include:

  • Insomnia - difficulty falling or staying asleep

  • Sleep fragmentation - frequent awakening or arousals

  • Excessive Daytime Sleepiness - Interrupted sleep at night

  • Nighttime sweating - Due to inability to regulate body temperature

  • Trouble Moving in Bed - Tremor, stiffness and rigidity impact ability to feel comfortable

  • Sleep apnea - Pauses in breathing or shallow breaths during sleep

  • Fatigue - Overwhelming tiredness, low energy, and lack of stamina due to lack of sleep

  • Restless Leg Syndrome - Unpleasant feelings in the legs when they are at rest

Discuss symptoms with your physician. Some medications may help, but often adaptations and modifications to beds and bedrooms can be even better - especially to enhance you and your partner's safety. Many couples living with PD discover the safest and most effective way to ensure both partners sleep safely and soundly is to sleep in separate beds.

If sleep problems persist, it may be worth consulting your physician for a referral to a sleep study.


Joseph H. Friedman, MD write about Fatigue in his book, "Making the Connection Between Brain and Behavior," stating: "Patients with fatigue do not suddenly develop fatigue. Fatigue settles in gradually. It comes an 'old friend," one that the doctor may not particularly be interested in hearing about, unlike tremors or freezing or drooling, which are objective problems that can be viewed in a technical manner."  He goes on to explain, "The truth is, fatigue can be an extremely amorphous concept, and the understanding of fatigue can vary tremendously depending on the type of patient and the background of the provider. The fact that there are so many concepts of fatigue makes it a difficult symptom to define, assess and treat." He also address fatigue as it is related to muscle fatigue for individuals who's muscles lose strength when they are no longer used. "When we talk about fatigue in PD, we are focusing on the general fatigue a person feels when out of energy, often due to exercise, mental, or physical, or depression."

There have been several studies of fatigue in PD. These have had relatively consistent results. About half of people with PD rate fatigue as one of the worst three symptoms of PD, including the typical motor aspects of PD such as tremor, slowness, gait dysfunction, and so on. About one-third of PD patients rate fatigue as their single worst symptom. In a drug study of newly diagnosed, very mildly affected PD patients, one-third considered fatigue as a significant problem.

Friedman adds, "motivation and fatigue are thought to be closely related. And motivation is a symptom of apathy. There is no known treatment for fatigue in PD. Obviously, the first thing to do is to carefully figure out what the patient means by the term. How much does sleep disturbance contribute? How much may be due to depression? How much may be apathy or frustration? How much exercise does the person do? How much is an excuse to avoid embarrassment in social interactions? Clearly, all of these factors need to be addressed as well as they can be. What is left is what I label as fatigue."

Sleep Treatments

Prior to taking any over the counter sleeping pills, you should consult with your doctor. People who stay on sleep medications long-term have been found to have higher infection rates, increased risk of grogginess the next day, high fall rates, and even higher rates of heart disease and strokes.

There are alternatives to prescribed sleep medications. Melatonin is available over the counter as a supplement and has provided some short-term benefits for sleep. Naturally occurring melatonin is a hormone that is closely linked to light; when your body experiences less light, your brain produces more melatonin making you feel less awake. The less melatonin your brain produces, the higher your risk of insomnia and other sleep problems. Melatonin supplements the natural neurotransmitters associated with sleep, signaling your body it's time to go to bed.

Melatonin may not be effective for everyone, or its effects may be short-lived. It may also be associated with some residual sleepiness and fatigue the following day. It is also not recommended for people living with depression. As with all supplements, be sure to talk to your physician about their possible use and what dose they recommend for you.

Additional recommendations to improve sleep:
  • Protect your bedroom - avoid blue light from TVs and other devices

  • Prepare your sleeping area - reduce light and noise, lower room temperature to around 65, consider a white noise machine

  • Develop a routine sleep schedule - keep consistent throughout week and weekend

  • Reduce or adjust daytime napping

  • Watch when and what you eat

  • Limit liquids before bedtime

  • Get daily exposure to sun

  • Exercise regularly

  • Clear a path to the bathroom

Lack of sleep causes fatigue, and fatigue is one of the most common and disabling PD symptoms leaving the person feeling weary, exhausted, and zapped of energy. Fatigue can:

  • Prevent you from being physically active

  • Get worse over time as PD progresses

  • Make depression worse

  • Make it difficult to focus and concentrate on important tasks

  • Make everything feel like an intense effort

  • Get in the way of connecting with others

  • Undermine countless daily activities

  • Make it much more difficult and exhausting to cope with PD


Davis Phinney Foundation for Parkinson's. Every Victory Counts, Your Go-To Resource of Essential Information for Living Well with Parkinson's. Page 93. "Manual." Sixth Edition. 2021

Friedman, MD. Joseph H. "Making the Connection Between Brain and Behavior: Coping with Parkinson's Disease." Chapter 3. Fatigue. Pages 19-36. Second Edition. DemosHealth 2013


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