HYPERSOMNIA AND CIRCADIAN DISTURBANCES IN PARKINSON’S DISEASE

Abstract

Excessive daytime sleepiness (hypersomnia) is one of the clinically important, but inadequately studied symptoms of Parkinson’s disease (PD). It manifests as constant excessive sleepiness during the day and/or short unexpected (unintentional) naps. Hypersomnia negatively affects quality of life in patients; it is potentially dangerous in the situations requiring greater attention. The paper presents current approaches to diagnosing hypersomnia in PD. It discusses the multifactorial nature of its pathophysiology in patients with PD. The present-day ideas about the relationship of hypersomnia to degeneration of the brain structures involved in the regulation of sleep and wakefulness, to nocturnal sleep disorders and dopaminergic therapy are described. The paper gives the results of experimental and clinical studies confirming the role of circadian mechanisms in the manifestation of insomnia and hypersomnia in PD patients. It describes a clinical case of a patient with moderate motor and cognitive impairments, in whom hypersomnia is a leading factor in deteriorating daily life. The possible role of circadian disturbances in the development of hypersomnia and related mild manifestations of insomnia and parasomnia is discussed. A clinically significant effect in treating sleep and wakefulness disorders has been achieved in the prolonged use of melatonin and cognitive-behavioral therapy.

Keywords

• parkinson’s disease
• hypersomnia
• circadian disturbances
• melatonin