Sleep disorders : Insomniac… Me never!!

We will briefly recall the four stages of sleep :
  • stage I : falling asleep ;
  • stage II : slow sleep ;
  • stage III : deep sleep / slow waves EEG delta with minimal consciousness activity ;
  • REM sleep stage : dream stage with the presence of rapid eye movements and absence of voluntary motor activity.
Sleep disorders are common in Parkinson’s disease (more than one in two patients present) and can be related to multiple causes (anxiety and anxiety-depressive disorders, motor fluctuations with painful nocturnal “de-off” phases, episodes of dystonia, overactive bladder with nocturia fragmenting sleep, restless legs syndrome with sometimes periodic leg movements during sleep….). One of the most classic is related to the involvement of neurons of the locus coeruleus, neurons involved in motor inhibition during REM sleep, explaining the occurrence of REM sleep motor disorders (TCMSP) of the parkinsonian, who somehow lives his waking dreams with sometimes aberrant and violent motor behaviors with sometimes in patients at an advanced stage of the disease a return to a motor state “on more” rarely found during the day before. These TCMSP are sometimes of early onset in the disease that can appear several years before the motor signs. The exploration of sleep disorders can involve ventilatory polygraphy or even polysomnography (with motor study on the anterior hamstring muscles) as in the general population. Actimetry (measurement of motor activity by a wrist bracelet) may also be useful in patients complaining of poor sleep to document nocturnal agitation, incessant rises, TCMSP. The treatments first go through the rules of hygiene of life applicable in all cases: physical activity during the day, no exposure to screens in the evening, light diet in the evening without taking alcohol …). Simple treatments such as Melatonin (sometimes increasing the dose to at least 4 mg) or even simple hypnotics can be proposed. Clozapine used in behavioral disorders of the disease sometimes brings an improvement in sleep (even if insomnia does not represent an indication of its use), the administration of Apomorphine at night by subcutaneous pump in fluctuating and painful patients may also be of interest and is being evaluated in a protocol (Apomorpheus).