Elevated-head sleeping may ease morning dizziness in Parkinson's

22 Nov 2024, 13:00 by Andrea Lobo · Parkinson's News Today

For a 69-year-old man with advanced Parkinson’s disease, sleeping with the head of his bed elevated helped to decrease dizziness related to a sudden drop in blood pressure when he got up in the morning, according to a case reported in the Netherlands.

This drop in blood pressure is called orthostatic hypotension and happens when a person moves from sitting or lying down to standing up, which can cause lightheadedness, dizziness, or fainting.

“There is currently no evidence base on which to suggest a specific tilt angle that is likely to be most efficacious,” according to researchers. As illustrated by this case, “self-experimenting with … a gradual increase in angle seems helpful from a feasibility perspective, and to increase the likelihood that an effective and tolerable angle can be found for each individual patient.”

The case was described in an article, “Head-Up Tilt Sleeping to Treat Orthostatic Intolerance in a Patient with Advanced Parkinson’s Disease: A Case Report,” published in Case Reports in Neurology.

Parkinson’s disease is caused by the progressive dysfunction and death of dopaminergic neurons, the nerve cells responsible for making dopamine, which is a chemical that nerve cells use to communicate and is involved in motor control.

Third of Parkinson’s patients experience orthostatic hypotension

Besides motor symptoms that include tremors, rigidity, and slowness of movement, patients may also experience nonmotor symptoms, such as autonomic dysfunction. The autonomic nervous system is responsible for regulating involuntary bodily processes, such as breathing and blood pressure.

Autonomic dysfunction can cause orthostatic hypotension. About one-third of Parkinson’s patients experience orthostatic hypotension, which can significantly reduce mobility and quality of life.

In the report, researchers described the case of a man seen at the outpatient clinic of the Radboud University Medical Centre, in the Netherlands, with several nonmotor symptoms related to Parkinson’s and medication use.

The patient had experienced his first symptom, which was hyposmia, or the loss of the sense of smell, 20 years prior. He was diagnosed with Parkinson’s 10 years later based on his bradykinesia (slow movement), right-sided rigidity, and mild tremor. His positive response to levodopa, his hyposmia, and the slowly progressive course of the disease further supported his diagnosis.

At diagnosis, he was already experiencing cognitive problems, including difficulties in memory, concentration, planning, and logical thinking.

As the disease progressed, autonomic dysfunction became more evident, causing urinary issues, erectile dysfunction, orthostatic intolerance with near falls after getting up in the morning, and sleeping issues.

Patient on 4 medications, including antidepressant, levodopa/benserazide

At his most recent clinical visit, the patient was on four medications, including the antidepressant clomipramine, and levodopa/benserazide, which may contribute to autonomic dysfunction, the scientists noted. Benserazide is used outside the U.S. to prevent levodopa from breaking down before it reaches the brain; in the U.S., carbidopa is commonly used for the same indication.

The patient was advised to increase his liquid and salt intake, which only slightly eased orthostatic symptoms and increased urination at night.

He also started sleeping with his head elevated, or what’s called head-up tilt sleeping (HUTS), with the use of an automated bed that could be moved up and down. After lying down, the patient used the remote control to raise the bed to the desired position, and the footboard of the bed prevented him from sliding out of the bed at night. He implemented HUTS over two months in increments of about 10 cm, reaching a 38 cm elevation (15 inches), at an angle of 11 degrees.

At the indicated height, the patient reported less dizziness. He also reported better breathing and less cough during the night, which he was experiencing before implementing HUTS. Three months after starting HUTS, there was only a slight drop in blood pressure (107/75 mmHg to 97/64 mmHg) when he moved from lying down to standing for 3 minutes.

“Well-designed randomised controlled trials could presumably give a better insight into what a minimally effective tilt angle is and what a good starting position would be for most patients,” the researchers wrote. “These new studies should also examine which patient profiles are particularly eligible for this type of intervention, thereby gaining better insight into the mechanism by which HUTS increases orthostatic tolerance.”