• Hua Hu
  • Chun-Feng LiuEmail author


We know that sleep problems often occur in patients with PD, such as difficulty in falling asleep, difficulty in maintaining sleep, etc. However, as a key indicator of sleep maintenance insomnia, sleep fragmentation is the most common complaint of sleep.

Risk factors for poor sleep include various physical diseases, female, poor sleep habits, life stress events, etc. Similarly, there are different sleep risk factors in Parkinson’s disease. In addition to the motor symptoms associated with PD, such as tremor, stiffness, leg spasm and dystonia, sleep disorders associated with PD are also very common, such as primary sleep disorders, psychophysiological insomnia (independent of the disease), RLS/PLMD, vivid dreams/nightmares and obstructive sleep apnoea (OSA).

Studies have confirmed that the insomnia of PD patients is related to many factors, among which the severe motor and non-motor symptoms are more closely related. Therefore, the quality of life of patients is obviously affected.

Existing evidence supports that the treatment of insomnia with PD is considered insufficient. Controlled-release carbidopa-levodopa, eszopiclone and melatonin 3–5 mg were considered acceptable risks without special monitoring. Although there is limited evidence to support the treatment of other psychiatric disorders that may lead to insomnia, the treatment of insomnia for specific psychiatric symptoms, such as anxiety, depression and hallucinations, is worth considering in clinical trials.


Insomnia Parkinson’s disease Risk factors Etiologic mechanisms Clinical manifestations Diagnostic criteria Diagnostic instruments Treatment 


  1. 1.
    Barone P, Antonini A, Colosimo C, et al. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson’s disease. Mov Disord. 2009;24:1641–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Abdulla AJJ, Pearce VR. The nighttime problems of Parkinson’s disease. Clin Neuropharmacol. 1988;11:512–9.CrossRefGoogle Scholar
  3. 3.
    Ylikoski A, Martikainen K, Partinen M. Parkinson’s disease and restless legs syndrome. Eur Neurol. 2015;73:212.PubMedCrossRefGoogle Scholar
  4. 4.
    Erro R, Santangelo G, Picillo M, et al. Link between non-motor symptoms and cognitive dysfunctions in de novo, drug-naive PD patients. J Neurol. 2012;259:1808–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Shafazand S, Wallace DM, Arheart KL, et al. Insomnia, sleep quality, and quality of life in mild to moderate Parkinson’s disease. Ann Am Thorac Soc. 2017;14:412–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Seockhoon C, Bohnen NI, Albin RL, Frey KA, Müller MLTM, Chervin RD. Insomnia and sleepiness in Parkinson disease: associations with symptoms and comorbidities. J Clin Sleep Med. 2013;9:1131–7.CrossRefGoogle Scholar
  7. 7.
    Chahine LM, Daley J, Horn S, et al. Association between dopaminergic medications and nocturnal sleep in early-stage Parkinson’s disease. Parkinsonism Relat Disord. 2013;19:859–63.PubMedCrossRefGoogle Scholar
  8. 8.
    Zhu K, van Hilten JJ, Marinus J. The course of insomnia in Parkinson’s disease. Parkinsonism Relat Disord. 2016;33:51–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Videnovic A, Willis GL. Circadian system—a novel diagnostic and therapeutic target in Parkinson’s disease? Mov Disord. 2016;31:260–9.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Sherif E, Valko PO, Overeem S, Baumann CR. Sleep benefit in Parkinson’s disease is associated with short sleep times. Parkinsonism Relat Disord. 2014;20:116–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Dhawan V, Healy DG, Pal S, Chaudhuri KR. Sleep-related problems of Parkinson’s disease. Age Ageing. 2006;35:220–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Duncan GW, Khoo TK, Yarnall AJ, et al. Health-related quality of life in early Parkinson’s disease: the impact of nonmotor symptoms. Mov Disord. 2014;29:195–202.PubMedCrossRefGoogle Scholar
  13. 13.
    Verbaan D, Van-Rooden SM, Visser M, Marinus J, Van-Hilten J. Nighttime sleep problems and daytime sleepiness in Parkinson’s disease. Mov Disord. 2010;23:35–41.CrossRefGoogle Scholar
  14. 14.
    Marinus J, Zhu K, Marras C, Aarsland D, van Hilten J. Risk factors for non-motor symptoms in Parkinson’s disease. Lancet Neurol. 2018;17:559–68.PubMedCrossRefGoogle Scholar
  15. 15.
    Schrempf W, Brandt MD, Storch A, Reichmann H. Sleep disorders in Parkinson’s disease. J Parkinsons Dis. 2014;4:211–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Rodrigues TM, Castro CA, Ferreira JJ. Pharmacological interventions for daytime sleepiness and sleep disorders in Parkinson’s disease: systematic review and meta-analysis. Parkinsonism Relat Disord. 2016;27:25–34.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    MD PM-MP, Fabrizio Stocchi MD, FRCP KSM, et al. Prevalence of nonmotor symptoms in Parkinson’s disease in an international setting; study using nonmotor symptoms questionnaire in 545 patients. Mov Disord. 2010;22:1623–9.Google Scholar
  18. 18.
    Rascol O, Perez-Lloret S, Ferreira JJ. New treatments for levodopa-induced motor complications. Mov Disord. 2015;30:1451–60.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Tekriwal A, Kern DS, Tsai J, et al. REM sleep behaviour disorder: prodromal and mechanistic insights for Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2016;88:445–51. Scholar
  20. 20.
    Iranzo A, Tolosa E, Gelpi E, et al. Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study. Lancet Neurol. 2013;12:443–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Abbott SM, Videnovic A. Chronic sleep disturbance and neural injury: links to neurodegenerative disease. Nat Sci Sleep. 2016;8:55.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Musiek ES, Holtzman DM. Mechanisms linking circadian clocks, sleep, and neurodegeneration. Science. 2016;354:1004–8.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Wallace DM, Shafazand S, Carvalho DZ, et al. Sleep-related falling out of bed in Parkinson’s disease. J Clin Neurol. 2012;8:51.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Garcia-Borreguero D, Larrosa O, Bravo M. Parkinson’s disease and sleep. Sleep Med Rev. 2003;7:115–29.PubMedCrossRefGoogle Scholar
  25. 25.
    Elise Tandberg MD, Larsen JP, Karen Karlsen MD. A community-based study of sleep disorders in patients with Parkinson’s disease. Mov Disord. 1998;13:895.CrossRefGoogle Scholar
  26. 26.
    Abel T, Havekes R, Saletin JM, Walker MP. Sleep, plasticity and memory from molecules to whole-brain networks. Curr Biol. 2013;23:R774–88.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Patti CL, Zanin KA, Sanday L, et al. Effects of sleep deprivation on memory in mice: role of state-dependent learning. Sleep. 2010;33:1669.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Yaffe K, Falvey CM, Hoang T. Connections between sleep and cognition in older adults. Lancet Neurol. 2014;13:1017–28.PubMedCrossRefGoogle Scholar
  29. 29.
    Van Someren EJ, Cirelli C, Dijk DJ, Van CE, Schwartz S, Chee MW. Disrupted sleep: from molecules to cognition. J Neurosci. 2015;35:13889–95.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Luik AI, Zuurbier LA, Direk N, Hofman A, Van Someren EJ, Tiemeier H. 24-hour activity rhythm and sleep disturbances in depression and anxiety: a population-based study of middle-aged and older persons. Depress Anxiety. 2015;32:684–92.PubMedCrossRefGoogle Scholar
  31. 31.
    Postuma RB, Aarsland D, Barone P, et al. Identifying prodromal Parkinson’s disease: pre-motor disorders in Parkinson’s disease. Mov Disord. 2012;27:617–26.PubMedCrossRefGoogle Scholar
  32. 32.
    Iranzo A, Valldeoriola F, Santamaría J, Tolosa E, Rumià J. Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry. 2002;72:661–4.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Menza M, Dobkin RD, Marin H, et al. A controlled trial of antidepressants in patients with Parkinson disease and depression. Curr Neurol Neurosci Rep. 2009;9:263.PubMedCrossRefGoogle Scholar
  34. 34.
    Martinez-Martin P, Visser MB, Rodriguez-Blazquez C, Marinus J, Chaudhuri K, Van-Hilten J. SCOPA-sleep and PDSS: two scales for assessment of sleep disorder in Parkinson’s disease. Mov Disord. 2010;23:1681–8.CrossRefGoogle Scholar
  35. 35.
    Shukla AW, Brown R, Heese K, et al. High rates of fatigue and sleep disturbances in dystonia. Int J Neurosci. 2015;126:928–35.CrossRefGoogle Scholar
  36. 36.
    Trenkwalder C, Kohnen R, Högl B, et al. Parkinson’s disease sleep scale—validation of the revised version PDSS-2. Mov Disord. 2011;26:644–52.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Marinus J, Visser M, van Hilten JJ, Lammers GJ, Stiggelbout AM. Assessment of sleep and sleepiness in Parkinson disease. Sleep. 2003;26:1049.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Lee CN, Kim M, Lee HM, Jang JW. The interrelationship between non-motor symptoms in atypical Parkinsonism. J Neurol Sci. 2013;327:15–21.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Soldatos CR, Dikeos DG, Paparrigopoulos TJ. The diagnostic validity of the Athens insomnia scale. J Psychosom Res. 2003;55:263–7.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540.PubMedCrossRefGoogle Scholar
  41. 41.
    Martino JT, Freelance CB, Willis GL. The effect of light exposure on insomnia and nocturnal movement in Parkinson’s disease: an open label, retrospective, longitudinal study. Sleep Med. 2018;44:24–31.PubMedCrossRefGoogle Scholar
  42. 42.
    Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson’s disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet. 2014;383:533–40.PubMedCrossRefGoogle Scholar
  43. 43.
    Ebersbach G, Hahn K, Lorrain M, Storch A. Tolcapone improves sleep in patients with advanced Parkinson’s disease (PD). Arch Gerontol Geriatr. 2010;51:e125–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Trosch RM, Friedman JH, Lannon MC, et al. Clozapine use in Parkinson’s disease: a retrospective analysis of a large multicentered clinical experience. Mov Disord. 1998;13:377–82.PubMedCrossRefGoogle Scholar
  45. 45.
    Khedr EM, Farweez HM, Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson’s disease patients. Eur J Neurol. 2015;10:567–72.CrossRefGoogle Scholar
  46. 46.
    van Dijk KD, Møst EI, Van Someren EJ, Berendse HW, Yd VDW. Beneficial effect of transcranial magnetic stimulation on sleep in Parkinson’s disease &dagger. Mov Disord. 2010;24:878–84.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  1. 1.Department of NeurologyThe Second Affiliated Hospital of Soochow UniversitySuzhouChina

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