The Other Signs of Parkinson’s Disease

Quincy AdamParkinsons Learn

Parkinson’s Disease is a chronic, progressive, nervous system disease that affects movement and other neurologic functions. Parkinson’s can affect other important functions, especially over time.

In addition to changes in thinking, Parkinson’s can also affect mood and sleep.  One way that Parkinson’s affects sleep is by causing excessive daytime sleeping, resulting in falling asleep during the day, when it is unplanned and unintended – sometimes putting the person with Parkinson’s safety at risk or the safety of others.

Factors Leading to Excessive Daytime Sleepiness

Approximately 30 – 50% of people with Parkinson’s Disease struggle with excessive daytime sleepiness. 1  The term “excessive” describes persistent and overwhelming sleepiness during the day where the person falls asleep without any warning during normal activities.

Researchers are still evaluating the causes of excessive daytime sleepiness2:

  • Parkinson’s Disease: Excessive daytime sleepiness may be the result of the same changes in the brain that lead to Parkinson’s motor symptoms. These changes can also affect mood, thinking and the sleep-wake cycle. The key brain areas for excessive daytime sleepiness are the brainstem and the hypothalamus.
  • Medications to treat Parkinson’s: Medications such as L-dopa or levodopa have been linked with the development of sleepiness in clinical studies. Antipsychotics and antidepressants can also contribute to sleepiness.
  • Poor sleep and sleep disorders: Parkinson’s disease can disrupt nighttime sleep patterns from tremors, leaving the person tired and sleep deprived during the day.  Or someone with Parkinson’s may have an undiagnosed sleep disorder such as restless leg syndrome or sleep apnea that may cause insomnia. Or their sleep may be disturbed by nocturia (excessive urination during the night).
  • Other mental health disorders: Depression has been associated with insomnia and early morning awakenings that may result in poor alertness during the day.2

Concerns about Parkinson’s and Excessive Sleepiness

While many people who are retired and aging may enjoy a daytime nap here and there, the sleepiness associated with Parkinson’s is a behavior that may affect the person’s safety, and interfere with necessary daytime activities such as appointments, meetings, conversations and planned social events.  Sometimes falling asleep when not intended could affect the safety of others. For example, the person with Parkinson’s and excessive daytime sleepiness may be watching a young grandchild and falls asleep leaving the baby or child unattended. Perhaps someone had something cooking on the stovetop and it boiled over, ran out of water or burned while the person was dozing.  Or of even greater concern, what if someone was operating anything mechanical – especially a car – and falls asleep at the wheel!

Even though the person with Parkinson’s may still be independent, falling asleep during the day when not intended can definitely affect the lives of spouses and other family members, friends and those who are engaged in conversations and care for someone with Parkinson’s.

Diagnosis and Treatment of Parkinson’s and Excessive Daytime Sleepiness

A physician will evaluate someone with Parkinson’s who reports daytime drowsiness using several different questionnaires such as the Epworth Sleepiness Scale3, and possible a sleep laboratory test such as the Parkinson’s Disease Sleep Scale.4

Researchers are currently evaluating medications that may help Parkinson’s patients who struggle with excessive daytime sleepiness.  For now, physicians may adjust, reduce or replace the Parkinson’s medication.  If daytime sleepiness does not respond to these measures, “wake promoting” medications may be considered such as bupropion, methylphenidate or modafinil.  Some others suggest light therapy or evaluation in a sleep laboratory to determine if snoring or some other nighttime activity is disrupting sleep.


  1. Parkinson’s Foundation. Understanding Parkinson’s: Sleep Disorders. http://www.parkinson.org/Understanding-Parkinsons/Symptoms/Non-Movement-Symptoms/Sleep-Disorders. Accessed on February 21, 2018.
  2. Parkinson’s Foundation. Aleksandra Videnovic, M.D. Sleep. A Mind Guide to Parkinson’s Disease. Downloaded from http://www.parkinson.org/pd-library?keys=sleep&tid=All&tid_1=18 on February 21, 2018.
  3. The Epworth Sleepiness Scale. http://epworthsleepinessscale.com/about-the-ess/. Accessed on February 21, 2018.
  4. K R Chaudhuri, S Pal, A DiMarco, C Whately-Smith, K Bridgman, R Mathew, F R Pezzela, A Forbes, B Högl, C Trenkwalder. The Parkinson’s disease sleep scale: a new instrument for assessing sleep and nocturnal disability in Parkinson’s disease. http://jnnp.bmj.com/content/73/6/629. Accessed on February 21, 2018.