“Ask the Doctor” with Dr. Rebecca Gilbert
Q. Do the medications for PD cause nightmares? I sometimes wake up screaming as if I just had a nightmare. I don’t remember the dreams, so this symptom doesn’t bother me too much, although it bothers my wife!
A. There are two potential explanations for what you are describing:
- You are having nightmares as a side effect from carbidopa/levodopa
- You have REM sleep behavior disorder (RBD), which means that you are acting out your dreams. In the non-pathologic situation, people are paralyzed during REM sleep, so they can’t thrash and scream during their dreams. In RBD however, the person dreaming is not paralyzed and can yell and move during their dreams. This sleep disorder is highly linked to PD itself (and not the medications for PD).
Or you could have both.
If you are having nightmares as a side effect of carbidopa/levodopa, lowering the dose of before bed, or moving it further from sleep can be helpful. If this is RBD, it is important to create a safe sleeping environment for yourself and your bed partner. But if you are not harming yourself (e.g. hitting furniture, throwing yourself out of bed) or others (e.g. hitting your bed partner), there is no absolute need to treat it. If you need treatment, there are medications that can help, so speak with your neurologist about this.
Q. Are there other ways to treat specifically the tremor of PD besides medications and surgical procedures such as DBS or focused ultrasound?
A. Yes. Botulinum toxin injections can be used in some situations to reduce tremor. However, not every neurologist or movement disorders specialist will feel comfortable with their ability to reduce tremor in this way, and not every tremor will be amenable to this treatment; but in the right situation, it can be effective. Ask your neurologist about this.
In addition, there are some wearable devices on the market that are designed to reduce tremor. There is variability in patient response to these devices, but they may be worth a try.
Q. I have PD, and the symptom that affects my quality of life most is dry eyes. Any suggestions?
A. Dry eyes can be a symptom of PD since the person with PD does not blink as much as other people. With decreased blinking, there is less moisture that bathes the eye. The solution to this problem is using natural tears eyedrops. Also remember that dry eyes can be a side effect of some of the medications used for PD or for other medical problems you may have. Review your medications with your neurologist to determine if any of those can be changed to help with this symptom.