Treatment of sleep disorders in Parkinson’s disease

  Firstly, through the patient and the accompanying staff, we will understand in detail the past and present sleep status, medication use and the presence of concomitant psychiatric symptoms, etc. We will improve the sleep questionnaire of PD patients and perform the necessary PSG tests to clarify the diagnosis. To determine and analyze the main types of their sleep disorders and the possible causes, and then take corresponding treatment measures.  1.Establishing good sleep habits For all patients with sleep disorders, establishing good sleep habits is the most fundamental method. paln correction recommends that PD patients should have a comfortable sleep environment, such as appropriate room temperature and light; the bed mattress should not be too soft to avoid difficulties in turning over; provide facilities to facilitate getting in and out of bed for patients with bradykinesia and rigidity; put urinals and commodes in the bedroom to facilitate patients’ toileting at night, etc. The first step is to understand the cause of the disease.  2, psychosomatic treatment First of all, we should understand the patient’s psychological state, carry out targeted treatment, guide patients and their families to understand the disease, treat the disease correctly, lift negative, pessimistic, depressive, restless emotions, promote the patient’s adaptation to the reality of the situation, encourage and enhance, maintain the patient’s self-esteem and self-esteem of social value, provide patients with the opportunity to vent anxiety, and help them to return to normal, and at the same time set up the ability to The patient should be able to set up the life goals, so that he or she can actively exercise in a good mood.  (1) Adjustment of dopaminergic drugs: Unless the sleep disorder is due to nocturnal movement disorder, increase of dopaminergic drug dose should be avoided. In addition, excessive daytime sleepiness caused by taking dopamine control agents can be relieved by changing to fast-acting drugs. For patients taking dopamine agonists that cause sleep episodes and vivid dreams at night, the use of such drugs should be avoided as much as possible.  (2) The use of sedative-hypnotics: Patients with PD sleep disorders will eventually use sedative-hypnotic drugs, and the elderly are more prone to dependence and cognitive dysfunction and other side effects than young people on long-term sedative-hypnotic drugs. kapfer and Reynold¨ associate recommend the use of minimal doses, intermittent, short-term dosing and attention to discontinuation rebound, regular discontinuation, and selection of drugs according to the type of sleep disorder. Benzodiazepines are among the most commonly used, but the elderly are prone to excessive daytime sleepiness and cognitive impairment.  (3) Treatment of concomitant psychiatric symptoms: In addition to psychotherapy, anti-anxiety and depression medication should be selected if necessary, with 5. hydroxytryptamine reuptake inhibitors preferred. If depressive symptoms are obvious, taking 10-25 nag amitriptyline at bedtime can improve the difficulty in falling asleep and enhance the stability of sleep.  4.Surgical treatment Bilateral thalamic floor nucleus and medial nucleus pallidus group deep brain electrical stimulation can improve the motor symptoms such as tremor, rigidity and motor retardation in Parkinson’s disease, as well as the symptoms such as difficulty in turning over at night, which in turn can improve the total sleep time and efficiency and shorten the REM sleep latency in PD patients.  5, Chinese medicine treatment Studies have shown that Chinese medicine has shown better clinical efficacy in treating sleep disorders in Parkinson’s disease. Sleep disorder is the most common non-motor symptom in Parkinson’s patients, and the commonly used clinical tranquilizers such as sour date palm soup, tianwang tianxin dan, and glycoma dazao tang have better therapeutic effects on the sleep disorder appearing in this disease.  In addition, rehabilitation therapy also has a certain effect on the sleep disorder of Parkinson’s patients. In addition to drugs, psychotherapy, exercise therapy, acupuncture therapy and drug therapy are given at the same time for rehabilitation training, and patients with Parkinson’s disease have significantly improved their sleep by systematic rehabilitation therapy.  With the aging of the world population, the incidence of Parkinson’s disease, which is closely related to ageing, is increasing. In the treatment of Parkinson’s disease, western medicine mainly uses Medroba replacement therapy, but the side effects are obvious after long-term application, and there is an urgent need to find new methods and means. At present, Chinese medicine is in an important position in the treatment of this disease, and its characteristics and advantages are mainly manifested in the fact that Chinese medicine can improve both the motor symptoms and the non-motor symptoms of Parkinson’s disease, and at the same time, Chinese medicine can reduce the dose of western medicine and its adverse effects to play the function of reducing toxicity and increasing effectiveness, thus obviously improving the quality of life of Parkinson’s disease patients.