Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Current possibilities of therapy for sleep disorders in Parkinson’s disease

Full Text:


The paper presents the specific features of the clinical presentation and pathophysiology of sleep and awakening disorders in patients with Parkinson's disease (PD). It covers the current views of the role of chronobiological mechanisms in the regulation of sleep and awakening in PD. The results of a follow-up of 20 patients (aged 58.56+8.24 years) diagnosed with PD without dementia with subjective nocturnal sleep disorders (disease history was 4.44+3.46 years; PD stage, 2.5+0.47) are given. In addition to antiparkinsonian drugs, melatonin was given in a dose of 3 mg/day. The efficiency of the therapy was evaluated by clinical assessment procedures before and 4—8 weeks after administration of the drug. The therapy outcome was better sleep characteristics in 17 (85%) patients, as evidenced by specialized questionnaires. The positive therapeutic effect as judged by the changes in Parkinson's disease sleep scale scores was shown by improvement of subjective sleep quality, reductions in awakening difficulties, in the total number of nocturnal awakening, in the degree of restlessness in bed, which mimics akathisia, and in the frequency of awakenings that were associated by the patients with urges to urinate (p<0.05).

About the Author

Marina Romanovna Nodel

Department of Nervous System Diseases


1. <div><p>Нодель М.Р., Яхно Н.Н. Нервно-психические нарушения при болезни Паркинсона. Неврол нейропсихиатр психосом 2009;2:3-8.</p><p>Нодель М.Р., Русакова И.М., Яхно Н.Н. Клиническая оценка нарушений сна и бодрствования при болезни Паркинсона. Неврол журн 2010;2:19-25.</p><p>Shulman L.M., Taback R.L., Rabinstein A.A., Weiner W.J. Non-recognition of depression and other non-motor symptoms in Parkinson's disease. Parkinson Relat Dis 2002;8(3):193-7.</p><p>Gallagher D.A., Lees A.J., Shrag A. What are the most important non-motor symptoms in patients with Parkinsons disease and are we missing them? Mov Disord 2011;25(15):2493—500.</p><p>Tandberg E., Larsen J.P, Karlsen K. Excessive daytime sleepiness and sleep benefit in Parkinson's disease: a community-based study. Mov Disord 1999;14(6):922—6.</p><p>Rye D.B., Bliwise D.L. Movement disorders specific to sleep and nocturnal manifestations of movement disorders. In: Movement disorders: neurologic principles and practice. R.L. Watts, W.C. Koller (eds). New York: McGraw-Hill, 2004;855-90.</p><p>Comella C. Sleep disorders in Parkinsons disease: an overview. Mov Disord 2007;22(Suppl 17):367-73.</p><p>Larsen J.P. Sleep disorders in Parkinsons disease. Adv Neurol 2003;91:324-9.</p><p>Factor S.A., McAlarney T., Sanchez-Ramos J.R., Wiener W.J. Sleep disorders and sleep effect in Parkinson's disease. Mov Disord 1990;5:280-5.</p><p>Saper C.B., Lu J., Chou T.C. et al. The hypothalamic integrator for circadian rhythms. Trends Neurosci 2005;28:152-7.</p><p>Srinivasan V., Cardinali D.P., Srinivasan U.S. et al. Therapeutic potential of melatonin and its analogs in Parkinsons disease: focus on sleep and neuroprotection. Ther Аdv Neurol Dis 2011;4(5):297—317.</p><p>Braak H., Del Tredici K., Rub U. et al. Staging of brain pathology related to sporadic Parkinsons disease. Neurol Aging 2003;24:197-210.</p><p>Beine B. Neurophysiologic basis of sleep and walkefulness. In: Fundamentals of sleep technology. N. Butkov, T. Lee-Choing (eds). Philadelphia: LWW, 2007;11-7.</p><p>Bordet R., Devos D., Brique S. et al. Study of circadian melatonine secretion pattern at different stages of Parkinsons disease. Clin Neuropharmacol 2003;26(2):65-72.</p><p>Fertl E., Auff E., Doppelbauer A., Waldhauser F. Circadian secretion pattern of melatonin in de novo parkinsonian patients: evidence for phase-shifting properties of l-dopa. J Neural Transm Park Dis Dement Sect 1993;5(3):227-34.</p><p>Adi N., Mash D.C., Ali E. et al. Melatonin MT1 and MT2 receptors expression in Parkinsons disease. Med Sci Monit 2010;61—7.</p><p>Zesiewich T.A., Sullivan K.L., Arnulf I. et al. Practice parameter: treatment of nonmotor symptoms of Parkinsons disease. Neurology 2010;74:924-31.</p><p>Chaudhuri K.R., Pal S., DiMarco A. et al. The Parkinson's disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson's disease. J Neurol Neurosurg Psychiatry 2002;73(6):629-35.</p><p>Johns M.W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-45.</p><p>Brown R.G., Dittner A., Findley L. et al. The Parkinson fatigue scale. Park Relat Dis 2005;11:49-55.</p><p>Peto V., Jenkinson C., Fitzpatrick R. PDQ-39: A review of the development, validation and application of a Parkinson's disease quality of life questionnaire and its associated measures. Neurol 1998;245(Suppl 1):10-4.</p><p>Arnulf I., Konofal E., Merino-Andreu M. et al. Parkinson's disease and sleepiness: an integral part of PD. Neurology 2002;58(7):1019—24.</p><p>М.Р. Нодель. Утомляемость при болезни Паркинсона. Журн неврол психиатр 2009;9:23-6.</p><p>Brzezinski A., Vangel M.G., Wurtmanc R.J. Effects of exogenous melatonin on sleep: a meta-analysis. Sleep Med Rev 2005;9:41-50.</p><p>Haimov N., Lavie P., Laudon M. et al. Melatonin replacement therapy of elderly insomniacs. Sleep 1995;18(7):598—603.</p><p>Kunz D., Bes F. Melatonin as a therapy in REM sleep behavior disorder patients: an open-labeled pilot study on the possible influence of melatonin on REM-sleep regulation. Mov Disord 1999;14:507-11.</p><p>Dowling G., Mastick J., Colling E. et al. Melatonin for sleep disturbances in PD. Sleep Med 2005;6:459-66.</p><p>Medeiros C.A., Carvalhedo de Bruin P.F., Lopes L.A. et al. Effect of exogenous melatonin on sleep and motor dysfunction in PD. A randomized, double blind, placebo controlled study. J Neurol 2007;254(4):459-69.</p><p>Федорова Н.В., Никитина А.В., Губанова Е.В. Роль мелатонина в терапии первичных нарушений сна у пациентов с болезнью Паркинсона. Cons med Неврол Ревматол 2012;2:2-7.</p><p>Литвиненко И.В., Красаков И.В., Тихомирова О.В. Расстройства сна при неосложненной деменцией болезни Паркинсона: результаты контролируемого сравнительного исследования применения мелатонина и клоназепама. Журн неврол и психиатр 2012;12:26-30.</p><p>Нодель М.Р. Нарушения сна и бодрствования при болезни Паркинсона: комплексный подход к терапии. Неврол нейропсихиатр психосом 2012;1:43-8.</p></div><br />

For citation:

Nodel M.R. Current possibilities of therapy for sleep disorders in Parkinson’s disease. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(2):29-34. (In Russ.)

Views: 622

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)