Sleep and other neurologic diseases

Patients with neurologic disease commonly report daytime sleepiness, insomnia, and poor-quality sleep. Damage to sleep and wake controlling areas of the brain from the underlying neurologic condition is one reason for this increase in sleep symptoms. In addition, symptoms related to the underlying neurologic condition, such as pain or muscle spasms or those related to comorbid conditions, may both contribute to disrupted sleep. Patients with neurodegenerative conditions such as Parkinson disease and Alzheimer disease may have circadian rhythm disorders, sleep-disordered breathing, and parasomnias such as rapid eye movement sleep behavior disorder. In some cases, the sleep symptoms appear before the other symptoms of the neurodegenerative condition. There is growing evidence that disrupted sleep may accelerate the degenerative process of some conditions. Sleep symptoms such as sleepiness, fatigue, and insomnia are also seen in patients with other neurologic diseases such as multiple sclerosis, spinal cord disease, traumatic brain injury, and headache syndromes. Neurologic disorders such as paraneoplastic syndromes and prion disease, which can cause devastating and sometimes life-threatening neurologic symptoms, may also present with significant sleep symptoms such as insomnia, hypersomnia, or loss of normal sleep features on polysomnography. Proper identification and treatment of sleep disorders in patients with neurologic conditions may not only improve sleep, but also improve caregiver and patient quality of life and may slow progression of the underlying neurologic disease.