The Treatment of Sleep Dysfunction in Neurodegenerative Disorders

Abstract

Sleep dysfunction is highly prevalent across the spectrum of neurodegenerative conditions and is a key determinant of quality of life for both patients and their families. Mounting recent evidence also suggests that such dysfunction exacerbates cognitive and affective clinical features of neurodegeneration, as well as disease progression through acceleration of pathogenic processes. Effective assessment and treatment of sleep dysfunction in neurodegeneration is therefore of paramount importance; yet robust therapeutic guidelines are lacking, owing in part to a historical paucity of effective treatments and trials. Here, we review the common sleep abnormalities evident in neurodegenerative disease states and evaluate the latest evidence for traditional and emerging interventions, both pharmacological and nonpharmacological. Interventions considered include conservative measures, targeted treatments of specific clinical sleep pathologies, established sedating and alerting agents, melatonin, and orexin antagonists, as well as bright light therapy, behavioral measures, and slow-wave sleep augmentation techniques. We conclude by providing a suggested framework for treatment based on contemporary evidence and highlight areas that may emerge as major therapeutic advances in the near future.

Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson's Disease

“…Some may self-medicate with alcohol to induce sleep, and some go to bed too early and watch TV or play with their phone in bed, which will surely affect the establishment of normal sleep. Exposure to caffeine, alcohol, tea or nicotine less than 4 h before going to bed will also result in poor sleep quality [ 5 ]. To improve the sleep-wake cycle and consolidate the effect of pharmacological treatments, it is necessary to maintain regular sleep patterns, increase daytime outdoor activity, limit daytime napping, and avoid prolonged bed rest during non-sleeping hours.…”

“…Despite the high prevalence, only less than half of sleep problems are reported to doctors and receive enough attention [ 3 ]. Sleep disorders are related to decreased cognitive function, increased risk of falls and worsen quality of life (QOL) [ 4 , 5 ]. It will not only increase motor dysfunction but also increase the non-motor symptom burden [ 6 ].…”

Hypnotic enhancement of slow-wave sleep increases sleep-associated hormone secretion and reduces sympathetic predominance in healthy humans

“…Our present findings reveal hypnotic suggestions enhancing SWS to be a simple to use technique to foster the beneficial effects of SWS on the endocrine system and the ANS. Given that these two systems mediate essential physiological functions of sleep in the entire body, this method of SWS enhancement appears well suited to further investigate the physiological functions of SWS and bears the potential for broad clinical applications, especially in conditions of impaired sleep, including e.g., insomnia, depression, and neurodegenerative disorders 51 , 52 . The effect on GH levels was remarkably large and might prove especially beneficial for situations in which GH levels and SWS amount are low, such as in aged people 53 – 55 where hypnotic suggestion proved effective in enhancing SWS as well 25 .…”

Sleep-Based Interventions in Alzheimer’s Disease: Promising Approaches from Prevention to Treatment along the Disease Trajectory

“…This is related to age-dependent functional changes and to degeneration associated with the central nervous system, with particular reference to the supra-chiasmatic nucleus in the hypothalamus [83], as specified concerning sleep-wake rhythm disorders. Light is considered as the most powerful zeitgeber of the human circadian system [84] and some evidence highlighted the efficacy of BLT-delivered by light emitters-on sleep, cognition and behavior in dementia (for a review, see [84]). In general, the beneficial effect of BLT remain controversial, possibly due to the fact that many studies based on BLT protocols have been conducted in institutions, hospitals, or nursing homes.…”