Medications, especially levodopa, that have an “off” phase during the night, when the effect of the drug wears off or decreases before the next dose, can aggravate the symptoms, with stiffness, tremors, pain, and inability to move or turn over in bed, which can interfere with sleep and cause the patient to wake up frequently. Another factor that interferes with sleep is early morning dystonia, which is a painful cramp, mainly in the hands or feet, that causes a person to wake up. Morning dystonia is also a sign that Parkinson’s medications are not working at night or in the morning. Nocturia can also interfere with sleep. If the urgency to urinate is met with an “off” period, some patients experience incontinence due to the inability to reach the restroom. Anxiety, low mood, and “off” symptoms lead to sleep disorders such as insomnia and difficulty falling asleep. Other hypersomnolence is more common in Parkinson’s disease patients, especially when walking or during the transition from light to deep sleep, and includes nightmares and sleepwalking. In addition to abnormal rapid eye movement sleep during sleep, patients may have nightmares that cause them to fall out of bed, cry or scream or even injure someone sleeping in the same bed. During the night the patient is often unable to move their legs uncontrollably, this is known as restless leg syndrome. Sufferers may feel pins and needles at the calf muscles and usually need to walk to relieve the symptoms. Panic attacks can occur at night and interfere with sleep. The patient’s respiratory rate increases with panic attacks, and these are related to shutdown or anxiety. Other somnambulism may also affect sleep. Depression or other factors such as dementia may also cause sleep problems. Taking medication that interferes with sleep Some Parkinson’s medications can interfere with sleep, for example amantadine or selegiline can cause patients to wake up at night. Some people with severe Parkinson’s disease who take high doses of drugs such as levodopa may also suffer from insomnia. Other conditions can also affect sleep to varying degrees. These include: Large amounts of caffeine (from drinks such as coffee, tea, cola, etc.) taken before sleep Diuretics taken at night Coladin (for sweating disorders) Ephedrine (a stimulant drug used for postural hypotension)