• Parkinsonian patients fear the night because it’s a time where anxiety, restless legs, rigidity and immobility, urinary urgency, insomnia and pain can occur. The patient is like a turtle on the back, waiting to be rescued by the drugs in the early part of the morning.
•The fear of being left on his own at night is one of the reason, in my experience, for parkinsonian patients to refuse hospital admission.
•Unfortunately, after the patient falls asleep, the sleep can be disturbed by threatening vivid nightmares; the patient will shout, scream, fight back physically the threat ( a person, a snake, etc..) and wakes up terrified, remembering part of the story. During his fight, he can hurt his bed partner, hurt himself by falling from the bed for instance…it’s called REM Behaviour Disorder (RBD) as it occurs in the part of the sleep called REM (Rapid eye movement) where the dreams take place. It’s also source of visual hallucinations.
Treatment of Sleep Disorders
•Obviously sleep disorders are multi-factorial and their treatment requires a full review of each possible causes to be efficient.
•Dr Marion has an interest in sleep disorders in Parkinson’s disease for many years and had published on REM behavior disorders in Parkinson’s disease.
•Her systematic approach with the assessment of every possible causes of insomnia give a chance of the patient to improve.