Non-pharmacological therapies for sleep disturbances in people with Parkinson's disease: A systematic review

Aim: To determine the effectiveness of non-pharmacological therapies for sleep disturbances in people with Parkinson's disease (PD). Background: Sleep disturbances, which are common in people with PD, may diminish their quality of life. Non-pharmacological therapies are preferred over pharmacological therapies for improving sleep quality, owing to fewer adverse effects. Design: Systematic literature review. Data sources: A systematic search of eight databases and hand searching was conducted for papers published between 1 January 2000 – 1 January 2016. Review methods: The Cochrane methods were followed. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool. Results: Eight studies were identified for data extraction. Therapeutic domains included physical exercise, cognitive behavioural and complementary interventions. Therapies in four of the eight studies significantly improved sleep quality and the unified PD rating scale score. Other studies showed no clear effects on sleep (N = 1), limited effects on sleep (N = 1) or effects in both the intervention and control groups, indicating that the intervention had no distinctive effects (N = 2). Conclusions: The non-pharmacological intervention types and sleep-related measured outcomes were heterogeneous. Most therapies had inconsistent effects on sleep. The insufficient evidence for non-pharmacological treatments seems related to the unique motor-associated clinical features of PD, which restrict the use of physical exercise therapy, or to individual “wearing-off” periods, which limit group therapy. Further studies on non-pharmacological therapies are required to identify the best interventions for improving sleep quality in people with PD.