How Does Parkinson’s Disease Affect Sleep?

Some symptoms of Parkinson’s disease, like sleep problems, aren’t visible to others. But they have a big impact on a person’s quality of life. Sleep problems are among the most common symptoms of Parkinson’s. They can even occur before other more obvious symptoms appear. On top of that, poor sleep also worsens other aspects of Parkinson’s disease. So attention to sleep quality is an important part of treatment. 

How does Parkinson’s disease affect sleep?

Parkinson’s disease results from damage to nerve cells in certain parts of the brain. These nerve cells then can’t make enough dopamine and norepinephrine. These chemicals serve as important messengers throughout the nervous system. Without them, symptoms of Parkinson’s develop.

Sleep is a complex process that involves many parts of the brain. The loss of nerve cells in Parkinson’s affects the normal sleep cycle. That can include:

• Not enough rapid eye movement (REM) sleep or deep sleep

• Troubles moving around in bed

• Changes in muscle tone that increase the risk for conditions like sleep apnea

• Vivid dreams and nightmares

What kinds of sleep problems are common in people with Parkinson’s disease?

Sleep problems affect more than 75% of people with Parkinson’s disease. Changes in sleep can even be an early sign of the condition. Let’s take a look at some of the ways that Parkinson’s can affect sleep. 

Insomnia 

Trouble falling asleep or staying asleep is the most common sleep concern for people with Parkinson’s. Insomnia tends to be worse the longer you have the condition. People who also have depression or anxiety often have more problems with insomnia.

Parkinson’s may affect areas of the brain that control normal sleep cycles. Good sleep may also be difficult because of:

• Pain or cramps

• Having to urinate often at night

• Medication effects on sleep

• Problems with muscle tone 

• Effects of depression or anxiety

EXPERT PICKS: WHAT TO READ NEXT

• Early signs of Parkinson’s disease: Some of the first symptoms of Parkinson's disease can be subtle. And they can start well before the classic tremor.

• Parkinson’s disease treatment: Parkinson’s cannot be cured. But there are many different types of treatments that can help with daily symptoms.

• Self-care tips: If you have Parkinson’s, small changes in your daily habits can make a big difference. Learn from the experts — people who are living with the condition offer their best tips.

Parkinson’s can also lead to excessive daytime sleepiness, which may impact sleep at night.

Dreams and nightmares

Vivid, frightening, or emotional dreams are another common sleep disruption. One study found that more than 20% of people with Parkinson’s had nightmares or night terrors at least once a week. For people who have dementia caused by Parkinson’s, nightmares are even more common.

The cause of scary or disturbing dreams isn’t clear. Medications and stress may play a role. But the disease process itself is a big factor. There are even some unique themes. People with Parkinson’s disease are more likely to have dreams that include animals, or nightmares that are aggressive or violent.

REM sleep behavior disorder 

Dreams happen during REM sleep. Usually, the brain sends signals to your muscles so you don’t move during dreams. But some people with Parkinson’s disease have a condition called rapid eye movement sleep behavior disorder (RBD). The normal shutoff signal to the muscles gets disrupted. So people may start to act out what’s happening in their dreams.

People with RBD may kick, shout, or move around while they’re sleeping. They may even act out violent behaviors. 

Not everyone with RBD has or will have Parkinson’s disease. But if RBD develops after the age of 50 years, the risk of Parkinson’s is higher. In one study, 73% of people with RBD had Parkinson’s within 12 years. 

Restless legs 

Restless legs syndrome affects around 15% of people with Parkinson’s. It can start before or after Parkinson’s is diagnosed. But it’s more common as Parkinson’s progresses. 

People with restless legs syndrome feel an uncomfortable urge to move their legs around, especially at night. That makes it harder to sleep, which affects mood, energy, and thinking. It also makes restless legs symptoms worse.

Obstructive sleep apnea

Parkinson’s disease increases the risk for obstructive sleep apnea. Likely because of changes in the brain that affect breathing, sleep cycles, and muscle tone.

Having sleep apnea is also a risk factor for Parkinson’s disease. And if you have Parkinson’s, it’s a risk factor for the faster progression of symptoms. Sleep apnea affects oxygen delivery to the brain. And broken sleep cycles impair the body’s ability to prevent damage to nerve cells.   

How can sleep disturbances be treated in Parkinson’s?

Diagnosing most sleep disorders begins with a sleep study. That helps to tailor treatments that are more likely to help.

Medications

Some sleep disorders in Parkinson’s are best treated with medications. All have possible side effects. And treatments for sleep and Parkinson’s may interact. When they’re needed, common medications include the following (ordered by the sleep problem they help treat):

• Excessive daytime sleepiness: caffeine, methylphenidate, or modafinil

• REM sleep behavior disorder: melatonin or clonazepam

• Insomnia: zolpidem or eszopiclone. Over-the-counter (OTC) sleep aids are not recommended. 

• Restless legs syndrome: dopamine agonists such as pramipexole or rotigotine

Therapies and devices

Besides medication, there are devices and therapies that also work for Parkinson’s sleep problems: 

• Continuous positive airway pressure (CPAP): CPAP helps treat sleep apnea by improving brain oxygen and sleep quality.

• Cognitive behavioral therapy (CBT): A first-line strategy, CBT helps improve behaviors, thoughts, and feelings about sleep. 

• Light therapy: Exposure to bright light at certain times of the day may improve sleep quality. That can reduce daytime sleepiness. In some studies, light therapy even helped the motor symptoms of Parkinson’s disease. 

• Deep brain stimulation: This intervention mainly treats the motor symptoms of Parkinson’s disease — especially when medications are no longer working. But there’s some evidence that deep brain stimulation may also help to improve sleep problems.

Self-care and lifestyle

Treating Parkinson’s disease means more than medications. Self-care and healthy routines can help slow down symptoms and improve sleep:

• Sleep hygiene: Try for a consistent bedtime and wake-up time. Sleep in a cool, dark room without screens. Limit or avoid caffeine and alcohol, especially before bed.

• Let in the light: Light exposure helps to regulate sleep cycles. That can happen with a walk outside or sitting by a window. A light box may also be helpful.

• Stay active: Studies have shown that people with Parkinson’s who exercise 3 times a week or more also sleep better. That means less daytime sleepiness and better mood. Exercise also helps the motor symptoms of Parkinson’s.

• Food matters: What you eat can slow down or speed up the progression of Parkinson’s. Eating patterns like the Mediterranean diet or MIND diet help to protect brain cells. That can have a positive impact on sleep.

Frequently asked questions

Why trust our experts?

Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified family physician since 1999. She worked as a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Our editorial standards

Meet our experts