Table 1.
Sleep problem | Recommended pharmaceutical approach | Recommended nonpharmaceutical approach |
---|---|---|
Insomnia | Low dose (25–50 mg) trazodone; mirtazapine; melatonin | Bright light therapy; reducing or eliminating caffeine and alcohol; dark and quiet bedroom; not drinking near bedtime; avoid daytime napping; daytime physical activity |
Daytime sleepiness | Melatonin; changing current medication type and dosing; modafinil (in PD patients) | Daytime physical activity |
SDB | Consider discontinuation of medications that may worsen SDB (e.g., benzodiazepines, opioids, testosterone) | CPAP |
RBD | Melatonin; clonazepam (with caution) | Remove potentially injurious objects from bedroom; create barriers; avoid antidepressants, caffeine, chocolate |
Abbreviations: CPAP, continuous positive airway pressure; PD, Parkinson’s disease; RBD, rapid eye movement sleep behavior disorder; SDB, sleep disordered breathing.