Pharmacological and non-pharmacological management of sleep disturbances in Parkinson's disease: if when and how.
Study Goal
The researchers aimed to evaluate the safety and efficacy of pharmacological strategies, including Melatonin, for managing sleep disturbances in Parkinson's disease.
Results Summary
Melatonin was identified as a commonly used therapy for REM sleep behavior disorder (RBD) and insomnia in PD patients, though further confirmatory evidence is needed for general recommendation.
Population
Patients with Parkinson's disease experiencing sleep disturbances.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Melatonin | no change | REM sleep behavior disorder (RBD) | Parkinson's disease patients | - | most commonly used therapy | #1 |
Clonazepam | no change | REM sleep behavior disorder (RBD) | Parkinson's disease patients | - | most commonly used therapy | #2 |
Modafinil | no change | excessive daytime sleepiness (EDS) | Parkinson's disease patients | - | most used pharmacological wake-promoting agent | #3 |
Caffeine | no change | excessive daytime sleepiness (EDS) | Parkinson's disease patients | - | most used pharmacological wake-promoting agent | #4 |
Proper sleep hygiene | increase | nocturnal sleep quality | Parkinson's disease patients | - | recommended | #5 |
Optimization of dopaminergic treatment during nighttime | decrease | insomnia | Parkinson's disease patients | - | highly recommended | #6 |
Eszopiclone | decrease | insomnia | Parkinson's disease patients | - | further intervention | #7 |
Melatonin | decrease | insomnia | Parkinson's disease patients | - | further intervention | #8 |
Calcium channel alpha-2-delta ligands | decrease | restless legs syndrome (RLS) | Parkinson's disease patients | - | therapeutic option | #9 |
Low-dose dopamine agonists (DA) | decrease | restless legs syndrome (RLS) | Parkinson's disease patients | - | therapeutic option | #10 |
INTRODUCTION: Sleep dysfunction occurs in various forms and is a bothersome and intrusive non-motor symptom of Parkinson's disease (PD). Frequently undiagnosed, their poor management can have a great impact on the quality of life of PD patients and their caregivers. AREAS COVERED: This article covers the safety and efficacy of pharmacological strategies for the management of the most frequent sleep disturbances in Parkinson's disease. Non-pharmacological aspects are also discussed, but these are not the main focus. Literature searches using electronic databases (Medline, Cochrane Library) and systematic checking of references from review articles/other reports were performed. EXPERT OPINION: Melatonin and clonazepam are the most commonly used therapies for the management of REM sleep behavior disorder (RBD). The most used pharmacological wake-promoting agents in the treatment of excessive daytime sleepiness (EDS) are modafinil and caffeine. Poor nocturnal sleep quality is usually linked to EDS, thus proper sleep hygiene is recommended. As nocturnal motor symptoms are commonly associated with sleep fragmentation and early morning off, optimization of dopaminergic treatment during nighttime is highly recommended for the proper management of insomnia. Further interventions include eszopiclone and melatonin for the management of insomnia. Therapeutic options for restless legs syndrome (RLS) include calcium channel alpha-2-delta ligands and low-dose dopamine agonists (DA). Further confirmatory evidence is needed before the general recommendation of these treatments.