Tips for Improving Sleep in Parkinson's

Lifestyle Therapy for Parkinson!

Who is the author Naoya Ogura, and what is lifestyle therapy?

Naoya Ogura has a doctorate in occupational therapy, with a special focus on lifestyle therapy. Lifestyle therapy is based on the idea that establishing healthy routines around sleep, exercise, stress management, and eating will be important in managing our physical and mental health.

This is especially true for Parkinson’s. Better sleep can improve movement; consistent exercise can potentially slow down the progression of the disease (animal model research); stress management can reduce anxiety or depression symptoms; and healthy eating can increase your energy.

Naoya received his doctoral occupational therapy degree in 2018 from University of Southern California and completed his residency at USC Occupational Therapy Faculty Practice. After graduation, he worked at Manakai O Malama, an integrative health clinic in Honolulu, Hawaii, and he currently is at Re+Active Physical Therapy and Wellness in Southern California. At Re+Active, he enjoys teaching sleep hygiene, mindfulness, and dance. He recently began teaching a 4-week online short course on sleep habits.

Dr Indu Subramanian and I had the pleasure of interviewing him for our #Parkinsonsecrets blog.

Why do I need sleep in the first place?

Dr. Indu Subramanian does live interviews of experts in Parkinson’s for the PMD Alliance

Sometimes people come to a session thinking that sleep is a passive process, almost like you’re shutting down your brain for the day. But in reality, sleep is a very active process that is crucial for physical and mental functioning.

Sleep occurs in 4 stages: N1, N2, N3, and REM (Rapid-Eye Movement) sleep. Each stage serves a different function, but the most important stages are N3, which is the deepest stage of sleep, and REM sleep, or the dreaming stage of sleep. N3 sleep is important for tissue growth, muscle repair, and immune system functioning. REM sleep is important for improving our mood and memory consolidation.

In addition to repairing our body and improving our mental functioning, getting enough sleep is important for managing Parkinson’s symptoms, and lack of sleep can make tremors, rigidity, and balance worse.

How does Parkinson’s impact sleep?

Some studies estimate that up to 50% to 81% of people with Parkinson’s struggle with sleep. Some of the common issues are frequent wakings at night, impaired REM sleep, and sleep fragmentation (or not getting consecutive hours of sleep).

One study compared people with Parkinson’s to a control group and found that people with Parkinson’s spent significantly less time in N3 and REM stages of sleep. This is partially due to sleep fragmentation — when your sleep is broken up, your brain stays in the lighter stages of sleep and does not get the benefits of high quality, consecutive hours of sleep. 

I can’t sleep well at night… What do I do?

There are three common types of sleep issues I see in the clinic: (1) People who have difficulty falling asleep at the beginning of the night, (2) People who wake up multiple times and have difficulty falling back asleep, and (3) People who fall asleep a lot during the day.

Each problem requires a slightly different approach, but sleep habit strategies are all about retraining your circadian rhythm. The circadian rhythm is like an internal clock that your brain uses to decide when to fall asleep and when to wake up. In some people this clock can malfunction, leading to dysregulated sleep patterns.

What do I do if I can’t fall asleep?

AARP has great information on insomnia!

An average adult should fall asleep within 15 minutes of getting into bed. If it takes longer than that to fall asleep, there are a few things I recommend.

The first thing to consider is, why do you think you’re not falling asleep? For some people, their mind is very active in bed. The brain is filled with worries or to-do lists for tomorrow, and it might have a hard time shutting down for the night. If you are like that, I recommend keeping a notebook by the bed to write down these thoughts. The act of writing things down has been shown to off-load the brain and help clear the mind.

Another common scenario I hear is this: you start dozing off on the couch, but the moment you get in bed you feel very awake. This suggests that your brain has learned to associate wakefulness with the bed, usually due to long-standing sleep problems. In this situation, I recommend practicing sleep induction meditations in the bedroom before getting into bed. Also, if you can’t fall asleep after approximately 20 minutes, try getting out of bed and return when you feel drowsier.

By jonny Acheson

What am I supposed to do if I wake up in the middle of the night?

This is called sleep fragmentation, and it’s a common problem in people with Parkinson’s. If you are unable to fall back asleep, the best thing to do is to safely get out of bed to sit in a comfortable chair or a couch. This is because the longer you spend in bed feeling frustrated about not falling asleep, the more your brain associates wakefulness with the bed, exacerbating your sleep problems.

Once out of bed, you’ll want to engage in a calming activity to occupy your mind. This might include listening to podcasts, stretching, or listening to music. The thing about calming activities is that what works for one person might not work for you! It will be a process of trial and error to figure out what works.

None of these things are working and it’s stressing me out! What can I do?

Research shows that being stressed about not sleeping makes the problem worse! This usually leads to a negative spiral, where poor sleep leads to worrying, and worrying leads to poor sleep.

If this sounds like you, I highly recommend practicing mindfulness. Start by noticing the kinds of thoughts you are having during these difficult nights. Common internal voices people report are, “I’m going to have such a rough day tomorrow,” or “Am I ever going to fall asleep?” While these thoughts are valid concerns, they can make the situation worse.

See if you can practice replacing these stressful thoughts with alternative thoughts like, “Yes, I’m not going to sleep well tonight but I’ll make it through. I’ve managed with less sleep before.” Sometimes being patient with yourself can reduce the pressure, and help you fall back asleep sooner.

I doze off a lot during the day when I’m watching TV or riding in the car. What should I do?

Napping isn’t necessarily a bad thing — it can be a good way to get a boost of energy, especially if you can’t sleep well due to restless leg syndrome or chronic pain.

But unplanned napping can perpetuate your sleep problem. If you are falling asleep multiple times, at different times during the day, you are confusing your biological clock even more. And if you happen to nap too close to bedtime, your sleep can become even more dysregulated.

To prevent this, I recommend scheduling nap time in the early afternoon and limiting it to 20 to 30 minutes if possible. To get the most out of the nap, start darkening your room 15 to 30 minutes before nap time, and try to fall asleep in your bed. Don’t forget to set an alarm clock! 

What can I do if I want more help?

The first step would be to talk to your doctor about your sleep problems if you haven’t already done so. They may refer you to a sleep specialist to work on some of these issues and even possibly recommend a sleep study.

If you are interested, Re+Active Physical Therapy is offering a 4-week short-course on sleep habits, where Email Dr. Ogura at info@re-activept.com for information on his course.

To read more books and articles by Michael S. Okun MD check Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #EndingPD #ParkinsonPACT #Parkinsonsecrets and https://www.tourettetreatment.com/

 Also listen to Dr. Subramanian interview experts at PMD Alliance where she hosts interactive reviews about Parkinson’s in a series called wholistic.