Sleep As Medicine: A Patient Guide for Managing Sleep in Neurological Conditions

For many, sleep problems stem from stress or poor sleep habits, but for patients living with neurological conditions, the disruption often runs much deeper. If you are managing a neurological condition, the lack of sleep can be one of the most frustrating parts of your day. Not because you are doing anything wrong, but because the condition itself may be working against your sleep every night.

Sleep and neurological health work in both directions. Neurological conditions can disrupt sleep, but poor sleep can also worsen symptoms, slow recovery, and make daily functioning more difficult.

The following neurological conditions are just a few that present symptoms that directly impact sleep quality:

Parkinson’s Disease

In Parkinson’s disease, the same brain changes that cause tremors and stiffness during the day are also active at night, disrupting deep sleep. About 90% of patients with Parkinson’s experience frequent waking throughout the night, including symptoms such as akinesia (the inability to move), and involuntary movements such as REM Sleep Behavior Disorder, where the body physically acts out during sleep, restless leg syndrome, and more.

Additionally, balancing frequent nighttime bathroom trips and the effects of medications on sleep timing can make getting a good night’s rest feel impossible.

Dr. Kandel’s Tip for Parkinson Patients

Sleep disruption in Parkinson’s disease is often related to nighttime movement difficulties, stiffness, and the need to get up during the night.

• Check with your doctor to ensure medications are not interfering with sleep. Some medications may increase nighttime awakenings or bathroom trips
• Use motion-detecting nightlights to help safely guide you to the bathroom
• Consider a bedside rail or bedside commode if getting to the bathroom at night is difficult
• Satin or silk sheets or pajamas may make it easier to turn in bed
• Work with your physician regarding appropriate use of medications, often an extra dose of dopamine medication can improve movement function throughout the night.

 Chronic Pain and Neuropathy

 Research shows that people living with chronic pain are nearly three times more likely to experience significant sleep disruption. Poor sleep can then increase pain sensitivity the following day. A lack of sleep will lower the pain threshold, making it easier to experience, not only pain, but also suffering, which is the emotional component connected to chronic pain.

In patients with chronic pain and neuropathy, symptoms can feel like a car alarm that keeps going off. During sleep, the brain cannot fully transition into deep restorative sleep because the same burning, tingling, and aching sensations keep the nervous system in a constant state of low-level alertness throughout the night.

Dr. Kandel’s Tip for Chronic Pain Patients

 Here are a few ways to address the pain signals that can keep your nervous system alert at night.

• Use supportive pillows or positioning to reduce pressure on painful areas. An adjustable bed can often be very effective.
• Maintain a consistent bedtime routine to help the brain transition into sleep.
• Gentle stretching, heat therapy, or relaxation techniques before bed may help calm the nervous system.
• Speak with your doctor about nighttime pain management if symptoms frequently wake you.

 Post-Stroke

 In stroke survivors, sleep is one of the lesser-known areas affected by changes in the brain, yet good sleep is essential for recovery. Poor sleep may also slow neurological recovery and increase fatigue throughout the day.

As the impact of stroke can throw off the brain’s internal clock, nearly one in three stroke survivors live with insomnia post stroke.  It is also common to have what is known as a sleep-wake cycle disorder, leaving patients feeling exhausted and fatigued throughout the day.

Sleep apnea, where breathing pauses repeatedly during the night, is also remarkably common after stroke, affecting up to 70% of survivors, and most don’t know they have it.

Dr. Kandel’s Tip for Stroke Patients

• If you have difficulty falling asleep at night and waking in the morning, exposure to bright light in the morning may help reset your internal clock.
• If you fall asleep late and wake too early, limiting device use and blue light at night may help protect your circadian rhythm.
• Maintaining an effective night time sleep routine may help.
• Try to maintain consistent sleep and wake times each day to help reinforce your body’s natural sleep-wake cycle.

Dementia and Alzheimer’s

 In patients with dementia and Alzheimer’s disease, the sleep-wake cycle can become almost completely reversed. This often occurs because of dysfunction in the suprachiasmatic nucleus, the brain’s internal clock. Nighttime becomes restless and agitated, a pattern often referred to as sundowning, while much of the day is spent dozing.

This is not a behavioral problem or stubbornness. It is a neurological one, and it deserves to be treated accordingly. The disruption affects not only the person living with dementia but often everyone in the household.

Dr. Kandel’s Tip for Dementia and Alzheimer’s Patients

These conditions often disrupt the normal sleep-wake cycle, which can make nighttime rest more difficult.

• Limit daytime naps
• Avoid caffeine and other stimulants before bedtime
• Maintain a consistent daily schedule for waking, meals, and bedtime
• Increase exposure to natural light during the day to help regulate the sleep-wake cycle