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Review
. 2020 Feb 3;7(3):250-266.
doi: 10.1002/mdc3.12899. eCollection 2020 Apr.

Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review

Douglas M Wallace  1   2 , William K Wohlgemuth  2   3 , Lynn Marie Trotti  4 , Amy W Amara  5 , Irene A Malaty  6 , Stewart A Factor  7 , Sagarika Nallu  8 , Lara Wittine  9 , Robert A Hauser  10
Affiliations
Review

Practical Evaluation and Management of Insomnia in Parkinson's Disease: A Review

Douglas M Wallace et al. Mov Disord Clin Pract. .

Abstract

Background: Insomnia is one of the most common nonmotor features of Parkinson's disease (PD). However, there are few practical guidelines for providers on how to best evaluate and treat this problem.

Methods and findings: This review was developed to provide clinicians with a pragmatic approach to assessing and managing insomnia in PD. Recommendations were based on literature review and expert opinion. We addressed the following topics in this review: prevalence of insomnia in PD, sleep-wake mechanisms, theoretical models of insomnia, risk factors, assessment, pharmacologic and nonpharmacologic treatments. Insomnia treatment choices may be guided by PD severity, comorbidities, and patient preference. However, there is limited evidence supporting pharmacotherapy and nonpharmacologic treatments of insomnia in PD.

Conclusions: We provide a pragmatic algorithm for evaluating and treating insomnia in PD based on the literature and our clinical experience. We propose personalized insomnia treatment approaches based on age and other issues. Gaps in the existing literature and future directions in the treatment of insomnia in PD are also highlighted.

Keywords: Parkinson's disease; insomnia; nonmotor symptoms; sleep disturbance.

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Figures

Figure 1
Figure 1
Insomnia risk factors in Parkinson's disease. PD, Parkinson's disease; RLS, restless legs syndrome; SDB, sleep disordered breathing.
Figure 2
Figure 2
Insomnia treatment algorithm. Bold medications represent PD‐specific data. BLT, bright light therapy; CBT‐I, cognitive behavioral therapy for insomnia; CR, continuous release; DIS, difficulty initiating sleep; DMS, difficulty maintaining sleep; PD, Parkinson's disease; PR, prolonged release; PSG, polysomnography; REM, rapid eye movement; SDB, sleep disordered breathing; SL, sublingual. *Consider “clinically useful treatments” as per the Movement Disorder Society's Evidence‐Based Medicine Reviews of Treatment for Nonmotor Symptoms of Parkinson's disease.62, 63
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