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Diagnosed With Parkinson's. Taking Sinemet. How To Bring Sleep Pattern To Normal?

Posted on Wed, 11 Dec 2013

Question: I was diagnosed with Parkinson's 3 years ago and since then have been taking Sinemet. The drug works in reducing tremors, etc, but takes its toll on me in terms of sleep disturbance. What can be done to return my sleep pattern to something more normal?

Answered by Dr. Sudhir Kumar (6 minutes later)

Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. Sleep disturbance in your case could be related to the medication (sinemet), which contains levodopa. Levodopa is known to reduce sleep. In addition, sleep disturbance could also be due to the Parkinson's disease. In the first case, taking the last dose of sinemet before 6 pm is helpful. If it is the second case, you can take a medication such as zolpidem tablet to help in getting sleep. Since, it has a short duration of action, it just helps in sleep initiation and later on, your natural sleep takes over. I hope it helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (8 hours later)

Dr. XXXXXXX I will reschedule my sinemet dosage to earlier in the day. Thank you. Many thanks also for your reply and suggestion of zolpidem. If I may, I have a few more questions about this drug... First of all I have scanned the internet carefully, including Wikipedia, to familiarize myself with zolpidem. I will make an appointment to see my family doctor as soon as he opens and ask him to consider me for a prescription and recommend a dosage schedule for me. In your opinion, 1) Can zolpidem be used for, say, 4 days of the week, concurrent with another sleep aid such as Lorazepam or Trazodone (perhaps for the remaining 3 days of the week) and then gradually reduce the quantity of both? My goal with this approach is to provide the patient (me!) 7 good functional mornings per week, rather than only 4. 2) What about Trazodone all by itself? Would you care to comment on this drug as an aid to sleeping? This drug is taken 50 mgs per night and, over time, is supposed to accumulate in my system making it easier for me to fall asleep. It takes a month before its effects become noticeable. XXXXX

Answered by Dr. Sudhir Kumar (25 minutes later)

Brief Answer: Zolpidem is better than lorazepam and trazodone Detailed Answer: Hi, Thank you for getting back. I would prefer to use zolpidem all 7 days of the week, should there be a need of a sleeping aid. This is because it does not cause addiction (such as what we see with lorazepam and other benzodiazepines). Trazodone would be my second choice after zolpidem. This is because hangover may occur with this (sleepiness during the day). Lorazepam would be the least preferred. However, is someone has agitation or associated psychotic symptoms, then, it would be the drug of choice. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (28 minutes later)

Dr XXXXXXX One question. I'm often told that chamomile tea helps induce sleep, but I don't see this mentioned in Wikipedia. I am interested in your opinion on this, and any other herb/tea that has proven sleep-producing qualities. XXXXX

Answered by Dr. Sudhir Kumar (46 minutes later)

Brief Answer: Tea does not help in inducing sleep. Detailed Answer: Thank you for getting back. Generally, tea or coffee does not help in inducing sleep. I am not specifically sure about chamomile tea. I am also not aware of any herb for inducing sleep. However, milk does induce sleep. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (45 hours later)

Dr XXXXXXX I will be seeing my Doctor today re: Zolpidem. I have some questions about water consumption while taking this drug. I would be disappointed to be woken up just to urinate and then find myself unable to return to sleep. So, should I sip only small quantities of water after a certain time, and/or suck on ice chips, and/or other ideas? XXXXX BTW, do I take a zolpidem tablet with food or water?

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: You can take zolpidem tablets with small amounts of water. If you do not want to consume water, then, there are other options that do not require water usage, such as sublingual tablets (which can be placed underneath the tongue) and oral spray of zolpidem. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (48 hours later)

Dr XXXXXXX I took my first dose of zolpidem last night. It provided as promised, about 2 hours of sleep. Soon after that I awoke to attend the urinal and had difficulty getting back to sleep again. I suppose the word to describe my sleep after that might be 'intermittent' or 'sporadic'. The pill was taken sublingually and required no water. It was taken on an empty stomach, as requested on the information sheet that accompanyed the pills. The information sheet also gave the maximum number of consecutive nights I should take this pill at 7 to 10 days, but my family doctor suggested "less than that, to be on the safe side." I believe he ie is concerned about the addiction potential of this drug. I'm interested in all your thoughts and opinions on how I can use this drug to help restore my sleep pattern to a more normal one. XXXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: I think looking at your sleep problem, you would benefit more with zolpidem extended release tablets, which have a duration of action extending from 6 upto 8 hours. Stilnox (made by Sanofi) is a widely used zolpidem extended release preparation. Regarding addiction potential, it is very uncommon with zolpidem. I am not concerned about the addiction potential of zolpidem. This is because I have treated a young woman who took zolpidem every night for 10 years, and I was able to get her off it within one month. However, I agree that some people do develop addiction with zolpidem, but the incidence is much lesser than that of benzodiazepines. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar