My father dx PD 16 years, with mild cognitive impairment and Dysautonomia causing dizziness, bruxism, and urinary issues with nocturia. For a couple years or so he had a sweet spot sleeping wise of about 10 hours. While he doubtless has some sleep apnea, there is no way he would wear a device at night. He has hallucinations and often vocalizes or talks in his sleep. For a few years he took as high as 300mg/day Seroquel but after I started going to the neurologist with him we reduced it slowly to nothing with little seeming ill effect as it greatly improved his daytime sluggishness. In the past couple years it was started again slowly to 150mg due to increasing night hallucinations. In the past 8 months or so though my father has taken to sleeping around 12 hours a day. While very occasionally he will try to get up after 8 hours, that is not quite enough and from experience will lead to a bad day, and so I try to get him to sleep 2 more hours then.
On our recent visit to the neurologist, he said that as long as the hallucinations were not during waking hours, he would rather reduce or eliminate the seroquel to achieve more waking time and a better quality of life. So far I have slowly titrated him down to 50mg a day now with a view to stopping it soon. However in dropping 100mg a day so far the sleep time has remained unchanged.
I am moderately ambivalent about his sleep time because with sleeping so much he only very rarely has an off-time during waking hours, and previously used to have one or two and would take a couple hour nap often. However with taking Midodrine for dizziness, and having supine hypertension at night which we compensate for with a sloped bed, I actively discourage him from taking naps now. Also he has always seemed to enjoy the so-called "sleep benefit" of not taking Sinemet at night yet being able to get up in the morning unassisted and function before the first pill, and more sleeping time seems to equal less Sinemet side effects long term.
His neurologist said in response to a question whether he should try the Neupro patch or not, that it was worth trying with reduced Sinemet, though it may not help (he was unable to tolerate Requip XL in high doses four years ago when it came out as it made him confused and also without the Sinemet he was barely able to walk). However from what I read, all the agonists aggravate drowsiness and sleeping issues and he did seem to improve when he first went to an hourly regimen of Sinemet with removal of Requip.
My question is whether sleeping this much at this point should be a great cause for concern as long as his waking hours are otherwise mostly OK (while generally sedentary he can move around the house as needed), and whether I should try to force him to get up after 10 hours or so.
Sinemet 25/100 every hour
Namenda 10mg 2x/day
Midodrine 7.5mg 2x/day
+various vitamin supplements (nothing esoteric)
Edited by Dr. Okun, 18 November 2012 - 10:05 AM.