the Healing Sleep thread -

[lou_lou]

interesting links

http://www.humangivens.com/hgi/archive/sleepanddream1.htm

http://research.yale.edu/ysm/article.jsp?articleID=457

[hannahbanana]

Wow Tena, those are really excellent links.

Very fascinating reading about sleep. Thanks! I plan on sharing them with some friends if it's ok with you.

Thanks Tena,

Hannah

[kariner]

Hello,

Yes, very interresting links. But the bit about everyone needing 8 hours sleep has been found to be a belief. There are naturally short sleepers, long sleepers, and, of course, average sleepers. If you sleep 4 hours a night and feel that you are in your usual condition 'fit and alert' then there is no need to force yourself to get more or for the person who shares your life to worry. Of course I am talking about persons without neurological disorders.

Regards
Karine

[lou_lou]

Wow Tena, those are really excellent links.

Very fascinating reading about sleep. Thanks! I plan on sharing them with some friends if it's ok with you.

Thanks Tena,

Hannah

dear hannabanana,
I am sooooo glad they helped you!
peace to your heart...

[lou_lou]

Hello,

Yes, very interresting links. But the bit about everyone needing 8 hours sleep has been found to be a belief. There are naturally short sleepers, long sleepers, and, of course, average sleepers. If you sleep 4 hours a night and feel that you are in your usual condition 'fit and alert' then there is no need to force yourself to get more or for the person who shares your life to worry. Of course I am talking about persons without neurological disorders.

Regards
Karine

yes - you are correct,
here is a link to the sleep dictionary

http://www.talkaboutsleep.com/sleep-basics/dictionaries.htm

[kariner]

Hello,

Since Tena opened this thread about sleep, I thought I could try to help a bit with no pretention to be complete, since it is my field (but I am only studying to be a sleep technologist, no doctor or medical student). Now, society feels more and more concerned about sleep quality and sleep disorders, becauseit is involved in accidents, at work, on the road, in economy, in many ways.

And in PD, there is a large range of sleep disorders as the Locus Coeruleus, which function is, among others, to control wakefulness, is touched, and that is not the only reason. (It is also the reason why people with depression, anxiety etc suffer of sleep disorders, mostly either of insomnia or hypersomnia (tendancy to sleep "too much")

Here is one more site on sleep disorders, with audio resources etc :

http://www.docguide.com/news/content.nsf/channel?OpenForm&dt=g&id=48DDE4A73E09A969852568880078C249&c=Sleep%20Disorders

AND, scrolling through the list of channels I just found that there was one dedicated to PD :

http://www.docguide.com/news/content.nsf/channel?OpenForm&dt=g&id=48DDE4A73E09A969852568880078C249&c=Parkinson%27s


RBD (Rapid-Eye-Movement Sleep Behavior Disorder

Is a very hard to live with sleep disorder. It consists in acting one's dream. Example : a man dreams that someone wants to harm his wife, he wants to protect her and starts to hit the agressor. Unfortunately, in real life, he hits his wife sleeping beside him. Other example, one wants to run aways, but runs into a door and hurts himself. Bruises and broken bones can be caused by that. It responds well to treatment, so there is no need to cope with it.

It happens because while, normally, in REM sleep, the muscles' tonus is inhibited, but not in that disorder.

http://www.sleepdisorderchannel.com/rem/

INSOMNIA (we can discuss several types of insomnia)

Insomnia is a part of PD. But I would distinguish

- Sleep onset trouble

(Not to mention those who don't go to sleep but fall asleep as soon as they do, that is mainly a question of decision, and everyone "weighs" his reasons to stay up or get rest for himself)

http://www.sleepeducation.com/Disorder.aspx?id=62

Delayed sleep phase syndrome (a circadian rythm abnormality which is not, I suppose, especially a part of PD more than in the general population but that has to be verified, which consists in not being able to fall asleep before two in the morning. People with that condition go to bed late and get up late, because their whole endogenous circadian rythms, melatonin, temperature, alertness etc are delayed compared to other people. Treatment is phototherapy. Advanced or delayed phase syndrome can be idiopathic or caused by depression, a.o.)

Advanced sleep phase syndrome is just the opposite. One goes to sleep early or very early, and wakes up early or very early. The discomfort of those two syndromes are mainly social, because people who suffer of them are not synchronized with their family's rythms and can't help it. As a reminder, you have to types of rythms, endogenous, and clues from the outside, social clues, daylight...

Hard time getting to sleep. I suppose that PwP's sometimes experience either uncomfortable features when they lay down like tremor and so on but suppose, too, that drugs help (correct me wherever I am wrong, please)

Or a bad sleep hygiene (drinking coffee, tea before bedtime, it should be better to avoid exciting activities like sport...)

http://www.umm.edu/sleep/sleep_hyg.html

-Troubles maintining sleep.

Features like RLS - Restless legs syndrome

http://www.rls.org/NetCommunity/Page.aspx?&pid=184&srcid=178

DAYTIME SLEEPINESS (either as a feature of the disease itself or as an effect of dopamine agonists), or an effect of additional sleepdisorder like sleep apnoea

Daytime or excessive sleepiness? Possible causes

The most common cause of daytime sleepiness is simply a lack of sleep.

Some medications have that side-effect, among them, dopamine agonists, always read the warnings. But you know all that.

Daytime sleepiness intrinsic to PD - to investigate. Have any of you experienced daytime sleepiness before taking PD medication or being diagnosed? Have you experienced that you were sleepy during the day but not during the nigh (why? in your opinion?)

http://www.neurology.org/cgi/content/abstract/58/7/1019

Everything that can interrupt your sleep (periodic limb movements, pain that wakes you up, etc.)

Sleep Apnoea (central or obstructive, or even complex - a 'mix' of the two sleep apnoea

http://www.sleepapnea.org/info/index.html
http://www.stanford.edu/~dement/apnea.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16007620&dopt=Abstract

Melatonin (keep also in mind that Melatonin is ONLY produced in the dark, which means that, if you sleep during the day, you should feel concerned and so should your relatives that the room in which you sleep must be darkened) has been discussed.

More links : (there are a lot to be found, so... :-)

http://ageing.oxfordjournals.org/cgi/content/abstract/35/3/220


Greetings
Karine

[lou_lou]

Dear Karine,
I truly needed that info!
THANK YOU VERY MUCH!
Please tell me about the connection to PD to sleep Apnoea, as my Father
had Sleep Apnoea, and my brothers and myself.
Also
I read a medical journal article that shows most people that have epilepsy also have Sleep Apena.

[kariner]

Hello TenaLouise,

I did not answer yesterday to investigate more and try to answer properly today. I don't know and it seems that searchers are investigating on that too, some finding there is a prevalence of sleep apnea in PD, some finding there is not. There *might* be something, I personally believe there is. But I don't want to tell ********. I will study this today and try to find clues. Suggestions are welcome.

Greetings
Karine

[kariner]

Hi, here are a couple of articles on the subject that I found yesterday :

Neuroimaging of sleep and sleep disorders.
Nofzinger EA.
Sleep Neuroimaging Research Program, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. nofzingerea@upmc.edu

Herein are presented the results of research in the area of sleep neuroimaging over the past year. Significant work has been performed to clarify the basic mechanisms of sleep in humans. New studies also extend prior observations regarding altered brain activation in response to sleep deprivation by adding information regarding vulnerability to sleep deprivation and regarding the influence of task difficulty on aberrant responses. Studies in sleep disorder medicine have yielded significant findings in insomnia, depression, and restless legs syndrome. Extensive advances have been made in the area of sleep apnea where physiologic challenges have been used to probe brain activity in the pathophysiology of sleep apnea syndrome.

PMID: 16522269 [PubMed - indexed for MEDLINE]


Sleep apnea syndrome in Parkinson's disease. A case-control study in 49 patients.
Diederich NJ,
Vaillant M,
Leischen M,
Mancuso G,
Golinval S,
Nati R,
Schlesser M.
Department of Neuroscience, Centre Hospitalier de Luxembourg, Luxembourg. diederdn@pt.lu

In PD, the impact of nocturnal respiration on sleep continuity and architecture has not been systematically investigated by polysomnography (PSG). We performed a case-control study with retrospective analysis of PSG data of 49 PD patients. After classifying the PD patients according to their apnea/hypopnea index (AHI), they were matched with 49 controls in terms of age, gender, and AHI. There were 21 PD patients (43%) who had sleep apnea syndrome (SAS), classified as mild (AHI, 5-15) in 10 patients, moderate (AHI, >15-30) in 4 patients, and severe (AHI, > 30) in 7 patients. PD patients had more deep sleep (P = 0.02) and more nocturnal awakenings (P < 0.001) than the controls. Their body mass index (BMI) was lower (P = 0.04), and they maintained a more favorable respiratory profile, with higher mean and minimal oxygen saturation values (P = 0.006 and 0.01, respectively). These differences were preserved when only considering PD patients with AHI > 15. PD patients had less obstructive sleep apneas (P = 0.035), independently from the factor AHI. Only the respiratory changes of 4 PD patients with BMI > 27 and AHI > 15 (8%) approximated those seen in the controls. At an early or middle stage of the disease, non-obese PD patients frequently have AHI values suggesting SAS, however, without the oxygen desaturation profile of SAS. Longitudinal studies of patients with such "abortive" SAS are warranted to establish if this finding reflects benign nocturnal respiratory muscle dyskinesia or constitutes a precursor sign of dysautonomia in PD.

PMID: 16007620 [PubMed - indexed for MEDLINE]


Sleep breathing disorders in patients with idiopathic Parkinson's disease.
Maria B,
Sophia S,
Michalis M,
Charalampos L,
Andreas P,
John ME,
Nikolaos SM.
Department of Neurology, Medical School, University of Heraklion, Crete, Greece.

STUDY OBJECTIVES: to investigate the presence of sleep breathing disorders in patients with idiopathic Parkinson's disease (PD) and their correlation with the severity of the disease. PARTICIPANTS: Fifteen patients (mean age 63 +/- 4 years) with idiopathic PD (Group A) and 15 healthy matched controls (Group B) were studied. All patients were under treatment with L-Dopa/Carbidopa and classified according to the UPDRS motor scale: 8 had mild disease (UPDRS < 12), 6 moderate (UPDRS: 12-22) and 1 severe (UPDRS > 22). MEASUREMENTS AND RESULTS: All participants underwent full night polysomnography (PSG). The sleep-wake history was assessed. Spirometry, maximal respiratory pressures and arterial blood gases were also measured. Snoring was more common in Group A patients (73.3% vs. 33.3%, p = 0.002). Among the parameters studied apnea hypopnea index (AHI), mean O2 saturation, minimum O2 saturation, REM% sleep and Arousal Index (Arousal Index) were statistically different between the two groups. Furthermore, 9 PD patients fulfilled the criteria for obstructive sleep apnea-hypopnea syndrome (OSAHS) predominately mild, 1 for central sleep apnea hypopnea syndrome (CSAHS) and 5 were normal. In all patients a marked reduction in percentage REM sleep was observed. Among the patients with OSAHS 5 had mild PD, 3 moderate and 1 severe. The patient with CSAHS had moderate disease. Finally, 3 patients with mild and 2 with moderate PD had no evidence of sleep breathing disorders. Correlations between severity of disease and sleep parameters are provided. CONCLUSION: Our results suggest that sleep breathing disorders, predominantly obstructive, seem to be common in PD and those events correlate with the severity of the disease.

PMID: 14561023 [PubMed - indexed for MEDLINE]

[kariner]

Hello,

Again an article of yesterday's harvest :)

Greetings
Karine

1: Curr Neurol Neurosci Rep. 2006 Mar;6(2):169-76. Links
Excessive daytime sleepiness and unintended sleep in Parkinson's disease.
Rye DB.
Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, WMRB-Suite 6000, PO Drawer V, Atlanta, GA 30322, USA. drye@emory.edu

Patients with Parkinson's disease and parkinsonian syndromes (eg, dementia with Lewy body disease, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. This sleepiness is common and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, namely narcolepsy/cataplexy. Physicians need to be vigilant in assessing parkinsonian patients for sleepiness because treatment can dramatically enhance quality of life and prevent the significant morbidity and mortality that attends daytime sleepiness. Male patients with advanced disease, cognitive impairment, drug-induced psychosis, and orthostatic hypotension are most at risk for developing pathologic sleepiness. Because primary sleep disorders can coexist with parkinsonism (eg, sleep apnea, insufficient or interrupted sleep), these potential causes should be carefully assessed with polysomnography and treated appropriately. Dopaminomimetics exacerbate sleepiness in a small subset of patients in a dose-dependent fashion. Nonetheless, the primary pathologies involved in parkinsonism appear to be the greatest contributors to daytime sleepiness. Sleepiness in parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents such as bupropion, modafinil, or traditional psychostimulants.

PMID: 16522272 [PubMed - indexed for MEDLINE]

[lou_lou]

Hello,

Again an article of yesterday's harvest :)

Greetings
Karine

1: Curr Neurol Neurosci Rep. 2006 Mar;6(2):169-76. Links
Excessive daytime sleepiness and unintended sleep in Parkinson's disease.
Rye DB.
Department of Neurology, Emory University School of Medicine, 101 Woodruff Circle, WMRB-Suite 6000, PO Drawer V, Atlanta, GA 30322, USA. drye@emory.edu

Patients with Parkinson's disease and parkinsonian syndromes (eg, dementia with Lewy body disease, multisystem atrophy, and Shy-Drager syndrome) suffer from daytime sleepiness. This sleepiness is common and very real, often approaching levels observed in the prototypical disorder of sudden-onset sleep, namely narcolepsy/cataplexy. Physicians need to be vigilant in assessing parkinsonian patients for sleepiness because treatment can dramatically enhance quality of life and prevent the significant morbidity and mortality that attends daytime sleepiness. Male patients with advanced disease, cognitive impairment, drug-induced psychosis, and orthostatic hypotension are most at risk for developing pathologic sleepiness. Because primary sleep disorders can coexist with parkinsonism (eg, sleep apnea, insufficient or interrupted sleep), these potential causes should be carefully assessed with polysomnography and treated appropriately. Dopaminomimetics exacerbate sleepiness in a small subset of patients in a dose-dependent fashion. Nonetheless, the primary pathologies involved in parkinsonism appear to be the greatest contributors to daytime sleepiness. Sleepiness in parkinsonism, especially a narcolepsy-like phenotype, may necessitate treatment with wake-promoting agents such as bupropion, modafinil, or traditional psychostimulants.

PMID: 16522272 [PubMed - indexed for MEDLINE]

Dear Karine,
Thank you for all your research, I have had PD for over 10 years dxd,
I am 43 years old - and when I awake,sometimes its very hard to breath
and I have insta -panic! :confused:
I did not mean to put you to work, but I am very grateful for the great info!
in 2000
We made a film - called "In Search of A Champion" -
Congressman Evans and Greg Gerhardt and I gave a copy to then
President Clinton at the White House.
Congressman Evans of Illinois - a 22 veteran of the Congress of the US,
has had to retire, unfortunately - and Dr. Greg Gerhardt has been fighting for the GDNF serum to continue -w/ Amgen as controller.
I am just a PD patient/advocate for cures, waiting impatiently?
if you have the time my friend periwinkle has put it online:
it won many awards ~ take care!
link -
www.pwnkle.com/champion.htm

[kariner]

Hello,

Thanks for the link! I will have Anne have a look at this (haven't seen the film yet, it is loading while I write). You are fighting for exactly the same cause!!! I felt I had to tell you right away. It is one of the subjects she often writes about, young-onset PD (and, even, very young, sometimes...)

Don't worry to put me to work, it is for my own formation, you know.

See you (I'll give you my impression if I manage to see the film)
Karine

[kariner]

PS

"Don't worry to put me to work, it is for my own formation, you know." You didn't - I volunteered.

Karine

[kariner]

Hello,

I have seen the films. I am not yet familiar with Mozilla Firefox settings so I watched it with IE - a clue for those who can't open it with Mozilla Firefox.
Well done!

When do your waking up in panic with a choking feeling occur? May I ask you to describe it? Don't though take anything I say for set in stone - but you know that. Of course the only way to know if you have apnea is to undergo a polysomnography - or have someone tell you if you stop breathing, but there, too, the necessary next step will be to check in for proper examination.

See you
Karine

[kariner]

Hi again,

I found this (see attached file) on the Net : the Handbook of sleep and PD. Interresting! It was a PDF but too big so I put it into word and zipped it.

SLEEP DIFFICULTIES.zip

See you
Karine

[kariner]

Prevalence of Sleep Disturbances Varies According to Parkinson's Disease Subtype: Presented at ENS

By Norra MacReady

LAUSANNE, SWITZERLAND -- June 1, 2006 -- People with the akinetic-rigid subtype Parkinson's disease (PD) have an especially high risk of sleep disturbances, according to preliminary findings from a study presented here at the 16th Annual Meeting of the European Neurological Society (ENS).

Sleep disorders are commonly associated with PD, said Natasa Klepac, MD, professor of neurology, University of Zagreb Medical School, Zagreb, Croatia. In these patients, sleep disorders have several causes, including neurodegenerative changes that affect sleep centers in the brain, and the persistence of PD symptoms at night that make sleeping difficult, she said during a poster session on May 31st.

Dr. Klepac and her colleague, Maja Relaj, MD, professor of neurology, University of Zagreb Medical School, conducted a study to determine whether there is a difference in the incidence and type of sleep problems according to PD subtype.

They studied a consecutive series of 44 women and 39 men with idiopathic PD. The cohort's mean age was 61 years, they had a mean PD duration of 5 years, and a mean Hoehn & Yahr disease stage of 2, which is indicative of bilateral symptoms and affected gait and posture, but minimal disability.

Patients' motor performance was evaluated using the motor section of the Unified Parkinson's Disease Rating Scale, which gives a score according to tremor to bradykinesia ratio (TBR). This score was then used to classify patients as akinetic-rigid or tremor-dominant. Tremor-dominant patients were defined as those with TBR of 0.5 or more, while the akinetic-rigid types had a TBR less than 0.5.

Insomnia severity over a 1-month was assessed using patient self-reports on the Pittsburgh Sleep Quality Index (PSQI), which uses a higher score to denote poorer quality of sleep. Daytime sleepiness was measured with the Epworth Sleepiness Scale (ESS). An ESS score a score of 10 or more suggests that the person may not be getting enough sleep, and a score of 18 or more is considered very sleepy.

Results showed that 54 (65%) of the patients had the akinetic-rigid subtype and 29 (35%) had tremor-dominant PD. The mean PSQI score among the akinetic-rigid patients was 14, and among the tremor-dominant patients it was 9 (P <.05). The akinetic-rigid patients had worse scores in the quality, duration, and latency of sleep, as well as sleep disturbances. There was no significant difference between the groups on the ESS scores.

Nocturnal immobility among patients with the akinetic-rigid subtype of PD may interfere with normal sleep patterns, Dr. Klepac said. She suggested that clinicians maintain a particularly high index of suspicion for sleep disturbances among patients with this form of Parkinson's disease.


[Presentation title: Sleep and Parkinson's Disease: Preliminary Results. Poster 557]

Source
http://www.docguide.com/news/content.nsf/news/852571020057CCF685257180006BCF6D