Levodopa taken at bedtime can help with quality sleep

Taking levodopa before bedtime can help people with Parkinson’s disease wake up fewer times during the night and spend less time awake, though these changes may not be noticeable to the patients themselves. These findings come from a small study involving patients in the early to middle stages of the disease, where an actigraphy device was used to track their sleep-wake patterns. The researchers emphasized the importance of using objective tools like actigraphy to measure sleep quality, especially when assessing the impact of medications. "Clinicians should consider these findings when deciding whether to prescribe levodopa to Parkinson’s patients before bed," said Fábio Barbieri, PhD, a professor of motor control at São Paulo State University in Brazil, who led the study. The study was supported by the São Paulo Research Foundation. "The actigraphy data showed an improvement in sleep quality after taking the drug, even though the patients didn’t report feeling any benefit. This is significant for clinical care," Barbieri added. Disturbed sleep and difficulty falling asleep are common issues for people with Parkinson’s disease. The study titled "Sleep ‘ON’, sleep better! Positive effects of levodopa on sleep behavior in people with Parkinson’s disease," published in the Journal of Sleep Research, explores this problem. Many people with Parkinson’s experience restless nights, vivid dreams, and trouble staying asleep, often years before motor symptoms appear. Poor sleep quality can, in turn, worsen other Parkinson’s symptoms. Levodopa, a key treatment for Parkinson’s, works by restoring dopamine levels in the brain areas that control movement. Dopamine, a neurotransmitter that gradually diminishes as the disease progresses, also plays a role in regulating sleep-wake cycles. By easing motor symptoms, levodopa may help reset sleep schedules, leading to more restful nights. To investigate how taking levodopa before bed affects sleep, a team led by Fábio Barbieri, PhD, at São Paulo State University in Brazil, asked 23 Parkinson’s patients aged 50 and older to wear a wrist-worn actigraph device for four consecutive nights to monitor their sleep-wake patterns. Each morning, the patients also rated their sleep quality. The participants, 11 men and 12 women, were in the early to middle stages of the disease, with scores of three or less on the Hoehn & Yahr scale. Most participants (69.5%) preferred morning activities, while others were neutral about their daily routines. All reported sleep problems, and nearly half (43.5%) had rapid eye movement sleep behavior disorder, a condition that often precedes Parkinson’s onset. The study compared sleep during nights when levodopa was active (on state) to nights when it was not (off state). All participants were on a stable dose of levodopa and were monitored for three nights in the on state and one night in the off state. Results showed that with levodopa, patients experienced better sleep. Researchers observed a 7.8% increase in total sleep time and a 3.7% increase in sleep efficiency, which measures the ratio of time spent asleep to the total time in bed. Additionally, there was a 29.2% reduction in the number of times patients woke up during the night and a 22.3% decrease in the amount of time they remained awake. Among those who responded well to levodopa, sleep efficiency decreased by 6.6% on the night without the medication, and the time spent awake after falling asleep increased by 25.7%. "Going to bed without the fourth dose was worse," Barbieri noted. On average, patients woke up about 10 times per night during the study. However, when asked about their sleep quality, patients reported little difference between on and off nights. Barbieri, who heads the university’s Human Movement Research Laboratory, was not surprised by the discrepancy between the actigraphy data and patient reports. "Parkinson’s affects patients’ perceptions, and with an average of 10 waking episodes per night, it’s understandable they didn’t notice an improvement," he said. "That’s why it’s important to consider the actigraphy measurements." Despite the study's small size and short duration, the researchers concluded that from a clinical perspective, sleeping during an on night led to more total sleep time and better sleep efficiency. They recommended further studies with a longer duration and noted that their findings might not apply to people in advanced Parkinson’s stages who are already taking higher doses of levodopa, as these higher doses are associated with poorer sleep quality.