Medication, sleep and Parkinson's

If you have long-term problems sleeping, it’s possible that you are either taking, or have thought about taking, sleep medication such as sleeping tablets. In this section we look at the effects sleeping tablets can have on your sleep, becoming dependent on sleep medication and how to come off sleeping tablets.

When can sleeping tablets help?

Sleeping tablets can help in the short term (eg, up to 3 or 4 weeks) in some situations.

For example:

• if you have a short spell of insomnia due to severe stress, such as a bereavement, or after surge
• if you have temporary insomnia caused by a change in environment or circumstances, such as being in hospital

Understanding the side effects of sleeping tablets

Sleeping tablets don’t just affect sleep – they may also make you feel drowsy or ‘heavy’ in the morning, or anxious during the day.

They may interfere with your ability to perform some everyday tasks (like driving a car). The effects you may have will depend on the type of medication and dose taken. Older people are often given lower doses of sleeping tablets as they tend to be more sensitive to their effects.

Many people assume sleeping tablets will help them function normally the next day, but there is little scientific evidence for this. Rather than improving your alertness during the day, some sleeping tablets may actually make your memory and concentration worse.

For example, Benzodiazepines (a type of sleeping tablet) can affect your memory, particularly at night. People may wake up several times during the night, but do not remember doing so in the morning.

Rebound insomnia

Sleeping tablets may cause rebound insomnia. This is when your insomnia symptoms briefly become much worse when you try to stop taking the sleeping tablets. You might also have feelings of anxiety.

Although rebound insomnia is always temporary (perhaps lasting 2 or 3 nights), the effects may last long enough to convince a person that they can’t sleep without medication. So you may start taking sleep medication again, even after you’ve decided to stop.

This, in turn, can lead to the long-term use of sleeping tablets.

Dependency on sleeping tablets

In general, prescription sleeping tablets are safe and effective.

Dependence on these medicines does not develop over just a few nights, it develops gradually with long-term use.

Most people are given sleeping tablets by their GP during periods of illness, stress, when in hospital or when they can no longer cope with their insomnia symptoms.

If you use sleeping tablets regularly your body slowly gets used to the drug, and you develop what is called ‘tolerance’. This means that the effects of the medication on you is less, so you have to increase the dose in order to get the same effect.

Eventually, sleeping tablets may no longer work, but if you try to stop taking the tablets you can’t sleep because of rebound insomnia. You may come to depend on the medication long after it has stopped working.

Coming off sleeping tablets

When reducing or coming off sleeping tablets you will need help and support from your specialist or GP. They may advise you to reduce your sleeping tablets gradually (this is called ‘tapering’), and can also help you with this.

If you are regularly using sleeping tablets, never stop taking them without discussing it with your healthcare professional first.

You may find that your symptoms get worse as your Parkinson’s medication starts to wear off.

This may lead to stiffness, tremor, pain and being unable to move and turn in bed. When you take your next dose of medication, your symptoms may be less noticeable again.

If your medication is often wearing off during the night and is causing you problems, you may need to switch to a form that’s delivered to your body continuously. Examples are skin patches, an apomorphine infusion or an intrajejunal levodopa infusion (a tube that pumps levodopa directly into your stomach).

The continuous delivery means you get constant treatment throughout the night. Speak to your specialist or Parkinson’s nurse for more advice.

If changing your medication doesn’t help, your GP, specialist or Parkinson’s nurse may suggest referring you to a specialist hospital centre or sleep clinic for a sleep test.

But it's important that you don't stop taking your medication before you talk to a health professional, as this could be dangerous.

Find out more about drug treatments for Parkinson's