Professor Rabei - director of the clinic for Parkinson's disease in Assaf Harofeh

Sleep is a physiological activity in which changes occur in brain wave activity (EEG) and also metabolic changes essential to life. Humans spend about a third of their lives in different stages of sleep (8 hours average out of 24).

Thanks to the inclusion of electrophysiological techniques, primarily the EEG, differences in brain activity during wakefulness and sleep were discovered. In 1937, a team of researchers in a laboratory in the United States classified the division of sleep into five stages:

the first stage:

which lasts several minutes is the transition from a state of wakefulness to sleep. It is characterized by disturbances in muscle tone and a decrease in heart rate.

Step two:

He slept lightly.

The third and fourth stage

They are stages of deep sleep in which maintenance and restoration processes of the body, renewal of energy reserves, secretion of growth hormone, metabolism, breakdown of waste, and elimination of toxins take place.

The fifth step:

where unlike the previous stages characterized by a general deceleration, the whole system accelerates, a machine of "rapid eye movements" (Rapid eye movements) - in most people in the REM stage, which is a stage of dreams, there is muscle relaxation and the person dreams that he is running, or riding a horse, or Fights, but there are no movements in the limbs at that stage, he is "as if paralyzed" in all four limbs. Sometimes a percentage of the population dreams in the REM phase and also "lives the dream", kicking, shouting, pushing - this happens in people who, in the REM dreaming phase, remain with a non-reduced tonus. Behavioral disorders in the dream phase (REM). It is called REM sleep related behavior and affects Parkinson's patients with a frequency of about 20-30% of patients. Patients with these symptoms during sleep are treated with preparations of the Clonazepam type (Clonex). And also with dopaminergic preparations (Sifrol and Requip).

The duration of sleep required for living creatures is not determined on the basis of evolutionary proximity between them, but on the basis of their size. The greater the live production, the fewer hours of sleep it needs. The tiny animals spend most of their lives sleeping.

In addition to sleep disorders in the stage of REM dreams related behavior there are also patients with Parkinson's disease who suffer from a state of anesthesia during the day. (Hypersomnia) - excessive sleepiness during the day seriously harms the quality of life of Parkinson's patients. One of the first things that must be checked in Parkinson's patients who show excessive daytime sleepiness is to check if they do not suffer from snoring at night. It turns out that one of the common reasons for a tendency to doze off during the day is snoring during the night with sleep apnea (Sleep apnea). Most cases express problems of obstruction in the airways (Obstructive Sleep Apnea). Patients who snore at night can go to sleep clinics and then undergo an examination at home and do not need to go to sleep in a sleep laboratory. .

Once a patient snores at night, he wakes up many times without being aware of it. Once a night's sleep is fragmented, then the patient does not take advantage of the sleep and is tired and tends to fall asleep during the day.

These patients can get sleep relief with an easy-to-use mask. The device is recognized as an essential device and is provided with a minimal payment.

Another reason for excessive sleepiness during the day was described about 20 years ago when Prof. Stanley Fahn reported that patients who regularly take dopamine agonists such as Siprol or Requip may suddenly fall asleep during the day. Furthermore, he claimed that these patients could have a car accident and the phenomenon was called the "Sleep on the wheel" phenomenon.

I conducted a comprehensive study on 60 patients who came to sleep in Assaf Harofeh's sleep laboratory, which was published in the Movement Disorders newspaper. Analysis of the results showed us that basically all preparations containing Dopa (Stalevo, Dopicar, Sinemet) as well as Sifrol and Requip may cause excessive drowsiness during the day. The difficult dilemma in treating these patients is that Parkinson's patients need preparations that contain Dopa or Dopamine agonistis on a regular basis, so it is possible to overcome excessive drowsiness resulting from the use of Dopa by means of drugs such as Ritalin, Selegiline or Provigil which are supposed to improve his state of alertness.

Another problem that sometimes occurs at night in Parkinson's patients is the appearance of jumping in the legs - this phenomenon is called periodic leg movements and also affects the quality of sleep. The last thing I want to mention is that many patients wake up in the wee hours of the night with severe leg pain - this phenomenon expresses a lack of dopa in the brain and is called off dystonia - the solution is to recommend another dose of dopa in the middle of the night (usually recommended when the patient gets up to go to the bathroom between 2:00 and - 5:00 in the morning.

This review covers all the problems that a Parkinson's patient may encounter. Of course, the review is a help to the patient, but you should contact a neurologist in the community who is knowledgeable in the treatment of patients and he will answer the various issues.

Another problem for patients with Parkinson's disease is insomnia and multiple awakenings during the night. One of the main things that can be done is to concentrate the administration of pills until 19-20 hours, since sometimes dopaminergic preparations cause insomnia. These patients can receive a sleep preparation such as Bondormin Nocturno, Clonex. Like any adult patient without Parkinson's disease with insomnia.

Another drug that has recently been put into use that helps is Circadin which improves sleep. Many patients respond well to these drugs and as a result their quality of life improves.

Regarding insomnia problems, it must be noted that patients with depression also suffer from insomnia and anti-depressant treatment helps.

On the other hand, depressed patients also sometimes tend to forget excessively as a mechanism to "escape from reality" in such cases they stay in bed for many hours and try to sleep for long hours.

Psychiatric consultation should provide an answer.

In summary:

A sleep problem is a complex issue in itself and must be taken seriously considering that, as I mentioned at the beginning of the review, we spend a third of the day's hours in a state of sleep.