[Sleep-Wake Disturbances in Advanced Parkinson's Disease]

Insomnia, one of the non-motor symptoms of Parkinson's disease (PD), affects approximately 80% of patients with advanced-stage PD. In such cases, it is necessary to evaluate and treat the condition with the understanding that various factors may be involved, such as side effects or complications of medications and comorbid conditions and diseases, including primary sleep disorders and motor symptoms of PD. The principles of treatment include sleep hygiene education, control of nocturnal motor symptoms through adjustment of anti-parkinsonian medications with consideration of continuous dopaminergic stimulation (CDS), treatment of non-motor symptoms that interfere with sleep, discontinuation of medications that disturb sleep, and management of primary sleep-related disorders. Insomnia in PD can affect not only patient quality of life but also motor functions, making individualized and appropriate assessment and management essential.