Dear Patrick,

I didn’t sleep well last night and I noticed my balance is worse than normal today, is that my Parkinson’s or is it because I didn’t sleep well?
Sven M., Age 64. Sweden.

Hi Sven,

Thanks for your question. The answer is that both Parkinson’s and aging can affect balance.

I have had the good fortune of attending many appointments with my clients during the visit to their neurologist. Sleep hygiene, or quality of sleep is typically one of the first questions a doctor will ask their patient.

If the patient is not sleeping well, this can be seen as a contributing cause of the symptoms related to the Parkinson’s diagnosis. The Parkinson’s Disease and Research Center, at the University of California, San Francisco, reports:

In general, research seems to indicate that people with Parkinson’s disease have more sleep disruptions than similarly aged people without the disease. The most commonly reported sleep-related problems are the inability to sleep through the night and difficulty returning to sleep after awakening, generally referred to as maintenance insomnia. Unlike many older adults, patients with Parkinson’s disease often find that they have no trouble initiating sleep, but often wake up within a few hours and find sleeping through the rest of the night to be difficult.

Rather than prescribing more medicine, which can have side effects and can create other complications, often times managing the individuals quality of sleep is the best way to improve recently occurring symptomatic issues.

20983939_sAlong with sleep problems, people with Parkinson’s frequently experience sleepiness during the day. According to the Sleepfoundation.org:

“One study found daytime sleepiness in 76% of Parkinson’s patients. These sleep-related symptoms can have a major impact on quality of life for Parkinson’s patients and treatment for these problems should be integrated with their therapeutic regimens.”

The good news is if you’re struggling to sleep well and experiencing some new developments with your Parkinson’s, you don’t need to wait for an appointment with your neurologist to see if getting better sleep will help.

Recently, client of mine returned from a two-week hiatus. When he walked in I noticed a pronounced degradation of his posture. He confided with me he had noticed that his posture had become poor and also conceded that his balance seemed off. He was obviously concerned because the change had seems to have happened so quickly.

After a brief conversation it become clear that because of some logistical issues that were going on in his life, he had not slept well for the past two weeks. I reassured him that this was likely the cause of the balance and posture problems he was experiencing, and I encouraged him to commit to getting better rest.

After one week of getting better rest, his posture and balance return to his normal baseline.

Sleep deficit symptoms

Good sleep hygiene is incredibly important and can affect both motor and motor symptoms. Here’s a short list of issues that can be affected by a sleep deficit.

Non-motor symptoms

        • Anxiety
        • Depression
        • Stress
        • Fatigue and loss of energy
        • Sexual problems
        • Fluctuations in blood pressure (specifically orthostatic hypotension)
        • Dizziness

Motor symptoms

        • Posture
        • Strength
        • Balance
        • Functional coordination
        • Fine motor skill
        • Tremor
        • Slowness

All of the above can be severely impacted by lack of sleep, so if you notice a sudden change in any of the above, of course contact your neurologist, but in addition, make your sleep quality/pattern one of the first things you consider.

Chair Cardio for Parkinson’s

Next up is a great time to introduce a cardio segment. Follow the instructions on the video, and once again, cut back if you are tiring.

Suggested remedies

The Parkinson’s Disease and Research Center recommends the following steps for better sleep:

      • Regular rise time and bedtime—by doing this every day, you can help your internal clock by providing regular cues, thereby improving your sleep-wake cycle. This should help in getting to sleep faster and reduce the number of nighttime awakenings.
      • Get plenty of bright natural light exposure, preferably in the morning along with exercise. This will give your internal clock a strong cue to run on time.
      • Avoid stimulants, such as caffeine and nicotine. Avoid caffeine-containing drugs, drinks, and foods for eight hours before bedtime. Avoid tobacco in the evening. This will help with getting to sleep and staying asleep.
      • Avoid thoughts or discussions about topics that cause anxiety, anger, and frustration before bedtime. This will help with getting to sleep.
      • Institute and maintain a definite bedtime routine that is relaxing to help signal the body that sleep is to occur soon. Examples might include: a bath, brushing teeth, a small glass of warm milk (4-6 oz.), or a light snack. This will help with getting to sleep and will reduce the need to awaken due to hunger.
      • Reserve the bedroom and especially the bed for sleeping. Avoid activities like reading and watching television in bed. Your body needs cues to associate the bed with sleeping and not other activities.
      • If you nap, try to do so at the same time every day and for no more than 1 hour, and ending by 3pm.
      • Don’t spend more than 15 minutes trying to sleep—if you cannot sleep after 15 minutes get out of bed and engage in a quiet activity. Ideally, the activity should be in low light and sedentary, for example, listening to soft relaxing music or meditating, not reading with a bright light or watching television. Return to bed only when you are sleepy.

Suggested ways to stay asleep.

The Parkinson’s Disease and Research Center recommends the following steps for better sleep:

      • Minimize light and noise at bedtime and throughout the night. This will reduce stimulation and promote normal function of the body’s melatonin rhythm that helps to promote and maintain sleep. Ear plugs may be helpful if the environment is noisy. Avoid alcohol within 4-6 hours of bedtime. When taken at bedtime, alcohol may help induce sleep but disrupts sleep later in the night.
      • Avoid heavy exercise within 6 hours of bedtime. Exercise increases the body temperature. Sleep onset normally occurs as the core body temperature is decreasing. Artificially increasing body temperature can therefore give the wrong cue to the brain and contribute to sleep disruption.
      • Avoid heavy late night meals. They can interfere with the ability to fall and stay asleep. A light snack at bedtime, however, may promote sleep. Good bedtime snacks include dairy products and carbohydrates.
      • Assure the bedroom environment is right for sleep: comfortable bed, dark, quiet, and a cool temperature for sleeping.
      • Avoid looking at the bedroom clock if you awaken. If necessary, face the clock to the wall.

I hope this information helps. Please feel free to share your experiences with sleeping issues. I will gladly publish your story, and answer any questions I can about this important topic.

Disclaimer:

USE AT YOUR OWN RISK: Patrick LoSasso’s videos are for informational purposes only. Consult a physician before performing this or any exercise program. After consulting with your physician, it is your responsibility to evaluate your own medical and physical condition, and to independently determine whether to perform, use or adapt any of the information contained here. Any exercise program has an inherent risk of injury. By voluntarily undertaking any exercise displayed herein, you assume the risk of any resulting injury.


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