By Mikal Williams, RPSGT, RST, BSBA
Summary: Sleep disturbances in dementia and Parkinson’s disease are both a symptom and a contributing factor to disease progression, as neurodegenerative changes disrupt circadian rhythms, melatonin production, and motor control, while poor sleep accelerates cognitive decline, neuroinflammation, and oxidative stress. Addressing sleep through consistent routines, environmental adjustments, physical activity, medication management, and behavioral therapies can improve patient well-being and potentially slow disease progression.
Key Takeaways:
- Brain degeneration (especially of the suprachiasmatic nucleus) disrupts circadian rhythms.
- Reduced melatonin production and behavioral symptoms (e.g., sundowning) contribute to sleep disturbances.
- Prioritizing sleep quality in dementia and Parkinson’s care can enhance patient well-being and potentially slow disease progression.
- Caregivers and healthcare providers play a key role in implementing sleep-supportive strategies.
Sleep is crucial for overall health and well-being, and for people with dementia or Parkinson’s, sleep disruptions are both a symptom and a contributor to the disease. Understanding how these conditions impact sleep and how poor sleep can lead to worsening neurodegenerative disease symptoms explains why sleep quality should be addressed when managing these neurological conditions.
How Dementia Impacts Sleep
Dementia, including Alzheimer’s, disrupts normal sleep patterns through a combination of brain changes and behavioral shifts.
One of the main culprits is the degeneration of the suprachiasmatic nucleus (SCN), the part of the brain that regulates the circadian rhythm. Without this internal clock working properly, people with dementia often experience fragmented sleep, and excessive daytime napping, as well as can present with “sundowning” where confusion and agitation get worse towards the end of the day.
Dementia also disrupts the brain’s production of melatonin, making it harder to maintain a consistent sleep-wake cycle.
As dementia progresses, physical discomfort, anxiety, and reduced mobility make initiating and staying asleep even harder.
How Parkinson’s Impacts Sleep
Parkinson’s disease, a movement disorder, also impacts sleep. Many people with Parkinson’s experience REM sleep behavior disorder (RBD) where the usual muscle paralysis during REM sleep does not occur and they act out their dreams with physical movements in bed that can cause injury to themselves or anyone else in the bed.
Parkinson’s is also associated with restless leg syndrome (RLS) and periodic limb movement disorder (PLMD) which makes falling asleep even harder.
Also, degeneration of dopaminergic neurons, which is one of the things that contributes to Parkinson’s, impacts brain regions that help regulate sleep.
How Poor Sleep Impacts Patients with Dementia and Parkinson’s
Dementia and Parkinson’s are known to disrupt sleep, but poor sleep can also speed up the progression of these diseases. In dementia, sleep disruption impairs the glymphatic system. This system is key to removing beta-amyloid, a toxic protein. When sleep is broken, beta-amyloid clearance slows down. In Parkinson’s, sleep disturbances worsen motor symptoms and fatigue. Sleep loss can also intensify the neuroinflammation and oxidative stress already present in Parkinson’s and accelerate neuronal degeneration.
Strategies for Sleep for Those with and for Those Who Care for Dementia and Parkinson’s Patients
A patient’s loved ones and caregivers can work on the below to help promote positive sleep behaviors and environment. Any patient plan should be reviewed and approved by their doctor first.
- Creating a Consistent Routine: Creating a timetable for sleep will help ground the circadian rhythm, even in people whose internal clocks are disrupted. Caregivers can help by ensuring consistent wake, meal, and nighttime routines. They can also help by ensuring their loved one is exposed to natural light in the morning (or potentially to at-home light therapy), which can help reinforce the body’s internal circadian clock and promote better sleep at night.
- Promoting Sleep-Friendly Environments: Caregivers can help make the sleeping space more comfortable and soothing by reducing noise, dimming lights, and keeping the temperature steady. Weighted blankets or white noise machines can be a source of additional comfort for those experiencing restlessness, anxiety, or RBD.
- Encouraging Physical Activity: Regular exercise is essential for an individual to be healthy, and it can also help improve sleep quality. Caregivers can help by encouraging walks, stretching, or other forms of exercise in accordance with their healthcare provider and the person’s physical abilities. In some cases, it may help RLS among Parkinson’s patients and the symptoms of other motor disorders as well.
- Managing Medications: If the patient is on medication, the caregiver can play a particular role in their administration, monitoring, and adherence. They can also work with the healthcare provider to adjust dosages or the timing, if the prescriptions interfere with good quality sleep.
- Addressing Underlying Sleep Disorders: Many people with dementia or Parkinson’s present with sleep disorders such as sleep apnea or RBD. Caregivers can advocate for the appropriate diagnosis of sleep issues and help with treatment plans such as ensuring continued adherence to CPAP therapy or assisting with pharmacological therapies.
- Accessing Behavioral and Cognitive Therapies: Cognitive behavioral therapy and relaxation techniques are usually most effective for insomnia. Caregivers themselves can help in developing mindfulness, meditation, or breathing exercises in their efforts for sustainable sleep treatment or scheduling time to work on these techniques together with the patient.
Conclusion
Recognizing the bidirectional relationship between sleep disturbances and neurodegenerative diseases is critical for improving positive patient outcomes by prioritizing sleep quality as a serious component of dementia and Parkinson’s care.
Healthcare providers, loved ones, and caregivers can not only improve patients’ quality of life but also potentially slow disease progression. When caregivers and family members help by assisting with putting these strategies into action, they can better help individuals with dementia or Parkinson’s achieve better sleep and feel better overall, which can lead to an improvement in the quality of life for all involved.
