If sleepiness during the day is due to an anti-parkinson medication,
it is possible to either adjust the dosage or change the medication
to reduce this side effect. Some patients who have persistent
daytime sleepiness despite medication adjustments
have benefited by the use of mild stimulants, such as caffeine or
modafinil (Thorpy and Adler 2005). It is of great importance to
recognize daytime sleepiness and to abstain from driving if
sleepiness is a problem as there is a
significant risk of falling asleep at the wheel that may lead to
serious accidents and injury.
In addition to the anti-parkinson medications, drugs administered
for medical indications, including somme anti-hypertensive drugs,
anti-anxiety drugs, and pain medications can cause daytime
sleepiness. Consultation with the primary physician and adjustments
in these drugs with the elimination overly sedating drugs may be
beneficial.
Some studies have suggested that sleepiness may be a part of the
Parkinson disease process in some individuals. The évidence in
support of this concept comes from several studies showing that some
patients are sleepy during the day despite havint sufficient hours
of nocturnal sleep and regardless of medications. It has been
hypothesized that in these patients, areas in the brain that control
sleep and wakefulness are affected .
In some patients, there is an association of sleep disorders with
hallucinations. In these patients, vivid hallucinations occur
against a background of daytime sleepiness and nighttime
wakefulness. The daytime hallucinations may correspond to the
intrusion of episodes of REM or dream sleep during wakefulness. The
atypical anti-psychotic medications, including quetiapine and
clozaril, when given in small doses in the evenings may improve both
the hallucinations and the nighttime sleep disturbance.
For PD patients and caregivers, the key to understanding and
improving sleep disturbances is an accurate reporting of symptoms to
the primary physician or neurologist. This will allow an appropriate
work-up and treatment. An additional approach that can be
implemented at home is the establishment of good sleep hygiene. .