Insomnia and brain fog: the Siamese twins of Parkinson’s symptoms.

The struggle to get a good night’s sleep is widespread in people with Parkinson’s. In turn, poor sleep can contribute to the daytime fatigue and brain fog many people with PD experience.

“To effectively deal with symptoms of brain fog, we must also deal with any sleep issues that the Parkinson’s patient is experiencing,” said Dr. Suketu Khandhar, a neurologist who heads the Northern California Movement Disorders Program at Kaiser Permanente in Sacramento.

According to the Parkinson’s Foundation, the most common sleep issues include:

• Trouble falling and/or staying asleep

• Talking or yelling during sleep

• Physically acting out dreams

• Problems turning over in bed

• Vivid dreaming

• Involuntary leg movements such as jerking and leg cramping

• Waking up to urinate

• Leg, arm, foot and wrist contractions.

Additionally, nearly half of people with PD will experience sleep apnea, where the windpipe become obstructed and breathing temporarily stops.

“Sleep issues in Parkinson’s disease are so misunderstood,” Dr. Khandhar said. “And poor sleep has such an impact on the health of everyone – especially those diagnosed with Parkinson’s.”

Before reaching inside the medicine cabinet to solve sleep issues, Dr. Khandhar first recommends people with PD speak to their providers. “If your provider has the right information about your sleep issues, he or she can help make changes to your medication and lifestyle to help you sleep more soundly.”

Certain medications can contribute to insomnia depending on what time of day they are taken. Undiagnosed depression and anxiety can contribute to frequent waking throughout the night and early in the morning.

Dr. Khandhar recommends keeping a sleep diary for at least a week to track the following information:
• Names and dosages of Parkinson’s medications

• Time of day that you took the Parkinson’s medications

• Names and dosages of other medications you take including supplements

• Time of day that you took these other medications

• How many minutes on average it takes you to fall asleep

• How many minutes after you fall asleep do you wake up again

• A daily assessment of your quality of sleep from the previous night

• Number of times you woke up per night

• Overall daily mood and anxiety level

• If and how frequently you experience involuntary movement of your arms and/or legs at night

• Average level of daytime sleepiness experienced

• Number and length of naps taken during the day

Additionally, Dr. Khandhar recommends asking your bed partner a few questions each day to give you and your provider additional information. These include:

• If you were thrashing around or otherwise physically acting out in your sleep

• If you were snoring and/or stopped breathing frequently throughout the night

• If you were talking or shouting in your sleep

• If your arms and legs were moving or jerking during sleep

Bring this information to your next appointment with your Parkinson’s provider. He or she will review the timing of your medications, your sleep hygiene and the information from your bed partner. From there, your provider may change your medication regimen or recommend lifestyle changes to improve sleep quality. Your provider may prescribe you additional medications to help you sleep for an extended period.

Addressing Brain Fog

Research suggests that approximately two-thirds of people with PD experience daytime sleepiness brought on in part by poor sleep quality. While several factors –
medications, low blood pressure and the disease itself – can contribute to brain fog in a person with Parkinson’s, fatigue itself has a big role its development.

Working with your provider to manage sleep problems can also help manage symptoms of brain fog. However, if your sleep issues have improved but your brain fog hasn’t, it may be time to go back to your doctor with additional information.

“There are some unexpected things that can help or hinder brain fog,” Dr. Khandhar explained. “Having undiagnosed depression can contribute to brain fog. So can low blood pressure.” He continued, “And social engagement – connecting and communicating with peers, family and friends – can reduce brain fog as the mind jumps back and forth when participating in a conversation. It’s like a high-intensity workout for the brain.”

To help your provider understand what may be contributing to your brain fog, Dr. Khandhar recommends you track the following information for a week:
• Number of brain fog episodes you experience per day

• Average length of time of the episode

• Names and dosages of Parkinson’s medications

• Time of day that you took the Parkinson’s medications

• Names and dosages of other medications you take including supplements

• Time of day that you took these other medications

• Average number of minutes per day you spent interacting with friends, family, neighbors and coworkers

• Your blood pressure

• Overall daily mood and anxiety level

Once your provider gets a sense of your medications and daily activities that may be contributing to brain fog, he or she can adjust or reduce your medication and activity schedule. As well, your provider may prescribe you an off-label treatment such as modafinil, a wakefulness agent, to reduce your number of daily episodes.

“I often in my clinic, I see patients with Parkinson’s who are taking medications prescribed by their primary care doctors that may work at cross purposes either with the PD drugs or with the symptoms of the disease, themselves,” Dr. Khandhar said. “Once we get the treatment regimen straightened out, the patient reports improvement in sleep and cognitive symptoms.”

Work with Your Provider

Though it’s tempting to ask Dr. Google how to handle brain fog and sleep issues as a person with Parkinson’s, it’s important that you begin by tracking your symptoms, medications and activities and bring this information to your provider. Your provider can help you make changes to your schedule and treatment regimen that may have a significant impact on your Parkinson’s symptoms and improve your everyday life.

Get a fresh start on your health this spring with seasonal produce to support a plant-based diet.

Eating a nutrient-dense, plant-based diet is recommended for people with Parkinson’s disease in particular because it helps us nourish our brains, optimize digestion and keep all the other complex systems of the human body in tip-top shape.

To get the best nutritional bang for your buck, choose fresh produce over their canned, frozen or dehydrated versions. If you really want to boost your health this spring with a healthy Parkinson’s diet, reach for the seasonal fruits and veggies.

Seasonal produce is fresher, tastier and packed with more nutrients. It’s also more cost-efficient since the rules of supply and demand dictate that the more abundant the produce, the lower the prices. Plus, acquiring seasonal produce from nearby farms boosts the local economy, which means you’re not only helping yourself, you’re helping your community.

Sometimes it’s hard to figure out which produce is in season because we live in an era of convenience. We see the usual staples, such as potatoes, bananas or spinach, lining supermarket shelves 365 days a year. But that doesn’t necessarily mean they are in season.

Where can I find seasonal produce in my area?

Seasonalfoodguide.org is one of the most comprehensive national databases of seasonal produce available in the U.S. You can search by state or month to learn where and when local produce in peak season in your area. To also find out where and when your favorite fruits and veggies are at their ripest you can search by produce, too. Backyard Boss also has a easy to understand article on seasonal produce with a month-by-month breakdown of fruits and vegetables that are in season.

The U.S. Department of Agriculture has a program called Supplemental Nutrition Assistance Program Education (SNAP-ED) that offers nutrition education to fight obesity and improve health outcomes. SNAP-ED also has a helpful seasonal nutrition guide that explains which produce is in season across the U.S.

Living in the era of convenience isn’t always a bad thing now that we have companies like Imperfect Produce, a weekly or biweekly subscription service that allows you to shop online for local, seasonal produce and have it shipped directly to your door. The company rescues fruits and veggies that would ordinarily go to waste because they don’t live up to the cosmetic standards of grocery stores and ships them to subscribers at a discount.

Which fruits and veggies are in season right now?

Spring marks the beginning of prime growing season, so there are too many seasonal fruits and veggies to list. Here are some of the more popular commodities available in March:

• Apples

• Avocados

• Bananas

• Broccoli

• Carrots

• Celery

• Eggplant

• Garlic

• Kale

• Lettuce

• Lemons

• Mushrooms

• Onions

• Peas

• Potatoes

• Spinach

• Strawberries

What are some easy recipes I can make at home for a plant-based diet?

Buddha bowls are all the rage these days because they are easy to put together and packed with nutritious grains, legumes and veggies, and topped with delicious sauces or dressing. You can prep the ingredients in advance for a quick meal that will keep your belly full for hours. Here is one of our favorite Buddha bowl recipes that incorporates broccoli and sweet potatoes.

Smoothies are excellent way to get your daily nutritional requirements while taking advantage of seasonal produce. Spring is definitely smoothie season because many popular smoothie recipes call for bananas, berries and lettuce. Check out our smoothie guide for some fresh ideas this spring.

Here are a few more recipes that incorporate spring seasonal produce:

• Grilled kale pasta salad

• Spicy lettuce wraps

• Smokey baba ghanoush

Getting ready to celebrate St. Patrick’s Day? Start the day off with a Shamrock shake. Some studies suggest that a type of nutrient known as anthocyanins may be beneficial for people with Parkinson’s. Anthocyanins are found in fruits and vegetables, especially dark leafy greens and berries, which are the main ingredients in the Shamrock shake.

Who knew that you could make spaghetti from squash! For the adventurous cooks, this recipe used spaghetti squash as a substitute for pasta. Filled with veggies, spices and legumes, this dish is light, vibrant and packed full of healthy goodness. Enjoy a Thai inspired dish with a nutritious twist!

Rajiv Harry is a Health and Wellness expert in Portland. Learn more about Rajiv at embracechange.me.

Amy Lavallee of Bend, Oregon was just 34 years old with a newborn when she was told she had Parkinson’s.

Four years later Amy is living a full life with the disease, managing her symptoms and organizing a family of five household. Her busy life includes traveling with her husband and three sons and caring for her parents.

Amy says she can’t think about what could have been or who she was before being diagnosed. Instead she tries to focus on what she can control now.

“When you’re diagnosed at such a young age, you feel like you got robbed,” Amy said. “Everyday I tell myself “I am who I am today” and try to accept it.”

Amy connects with others who have the disease to get advice and talk about symptoms. But as a young mom she says it’s tough to relate with her additional mom duties and experiences. Even her doctors aren’t always sure how her symptoms relate to her being a young female in her reproductive years. Most research and data is conducted on older adults.

“I didn’t fit into many of the support groups and didn’t relate to the literature I was first given at diagnosis,” she says.

A turning point for Amy came when Brian Grant was featured in Sports Illustrated in 2018.

“When I read the article, I could relate to what Brian was saying about his Parkinson’s journey starting at a young age as a young parent with so many additional obligations,” she said. “I also perfectly understood his compensation techniques to hide tremors.”

That article also helped Amy educate her family and friends about what she was going through.

“It’s extremely hard to live with Parkinson’s while at the same time feeling the pressure to educate others about the disease,” she said. “With the article I could easily say, “Here, read this,” to help my friends and family understand what I was feeling.”

Amy also finds a lot of encouragement and inspiration through BGF’s community programs and social connections. She follows BGF’s social media networks where she finds motivation to exercise, comes up with new dinner recipes and gets involved in social outings, like one of her favorite programs, Pints for Parkinson’s.

“I can easily incorporate BGF’s nutrition and exercise resources into my busy, daily life,” she said. “I really like BGF’s recipes and now I realize the power that food has to ease symptoms.”

Before Covid, Amy loved attending Zumba class. And now with gym closures and stay at home orders, Amy said she stays active with a rowing machine at home and goes for walks. But like many others, she says it’s hard to stay motivated and looks forward to classes opening up again soon.

Amy appreciates BGF’s positive outlook and programs to help make a difference in the lives of people living with Parkinson’s. BGF helps her make little changes that balance having Parkinson’s and what can be a grim future with not letting it overrun her whole life.

“I strive to be a good mom,” she says. “Maybe not a Pinterest mom! But a devoted mom and wife who might need help from time to time, but doesn’t put things off and lives for today.”

2020 has been a challenging year for community-based exercise programs for Parkinson’s.

But these programs are needed now more than ever as people with the disease struggle to manage their symptoms and stay connected to others during the pandemic. Two recent research studies highlight the benefits of exercise to reduce the impact of home confinement and the promise of telehealth as a way to motivate people with Parkinson’s to engage in fitness programs.

Exercise and hobbies improve sleep

The sleep disturbances that are common in Parkinson’s may be increasing due to home confinement during Covid-19, according to a recent study published in Sleep Medicine. The authors of the study list a number of reasons for this increase, including fewer face to face social interactions, more screen time and an increase in stress from working from home and managing online schooling of children. Nearly one-fourth of the 832 respondents to the survey used in the study reported new onset or worsening of sleep disturbances during home confinement. The study also found that physical activity and adoption of new hobbies during home confinement was associated with better sleep. Read the full results online.

Telehealth coaching increases physical activity

Physical activity coaching delivered through a telehealth platform may improve utilization of the program and increase rates of exercise, according to a recent paper published in Physical Therapy. In the paper, clinicians at Columbia University Parkinson’s Foundation Center of Excellence describe how the rapid modification of their coaching program to telehealth in response to the coronavirus pandemic increased recruitment and physical activity rates. The physical activity coaching program, called Engage-PD, helps to increase referral and implementation of exercise programs for people newly diagnosed with Parkinson’s or in the early stages of the disease. Key components of the program include disease-specific education, personalized coaching by trained professionals and individualized goal-setting. Read the paper online to learn more about the program and the findings of the telehealth study.

InMotion’s holistic and integrated approach to helping people with Parkinson’s feel better every day is getting results – and showing how a small group of dedicated people can make a big impact.

Cleveland-based InMotion opened its doors in March 2015. Within a couple of hours of opening, 60 people had signed up for group exercise classes. Six months later, the nonprofit organization expanded its programs to include multiple classes offered five days a week. In addition to exercise and mindfulness classes, InMotion offers creative classes such as drumming, dance, singing, painting and handwriting. The center also has educational offerings that help people understand the disease and connect with a community that supports them.

“Our mission is to help people with Parkinson’s disease feel better every day,” says Cathe Schwartz, InMotion’s chief executive officer. “It’s simple and easy to understand and guides everything we do.”

Getting started in the InMotion community

Ben Rossi, InMotion’s chief program officer and one of its five co-founders, had worked in the fitness industry for more than two decades when a longtime client was diagnosed with Parkinson’s. He sent Ben for training at Delay the Disease™ where the fitness pro become a qualified community exercise instructor for Parkinson’s. After returning to his performance training center in Cleveland, Ohio, Ben started a community class for people with Parkinson’s. As his involvement with the PD community in Northeast Ohio grew, he realized that there was a lack of programming for people with Parkinson’s disease.

Shortly after, Ben met Drs. Karen Jaffe, a person with Parkinson’s disease and David Riley, a movement disorder specialist, and together with the late Lee Handel and the late Allan Goldberg, the group recognized the large demand for exercise programs for the 30,000 people living with Parkinson’s in northeast Ohio. Each person brought a unique set of skills, background and expertise that contributed to InMotion’s founding.

“The mix of talent in this group of people was a recipe for success,” says Cathe Schwartz, chief executive officer of InMotion. “It was the right people, at the right time, in the right place, and for the right reason.”

Almost six years later, InMotion serves approximately 1,100 people in Northeast Ohio, has an operating budget of $1m which is all philanthropically generated, an active board of 28 individuals, a staff of eight employees and over 30 qualified coaches and trained volunteers.

InMotion’s success is evident by the testimonials available on its website. But the center doesn’t just rely on anecdotal evidence from participants. It also collects data from assessments of participants at regular intervals.

“From day one we started with assessments,” says Ben. “They help open conversations with providers, show our funders that we are making a measurable difference, and provide motivation and encouragement to our participants.”

Ben has developed a comprehensive assessment protocol with criteria that allows him to group participants into four color-coded levels that ensure everyone is attending the most appropriate classes. The assessments are conducted when a participant starts at InMotion and at regular six-month intervals afterwards. The assessments are also held in a fun group format that is motivating for participants.

“When someone completes an assessment, it’s very powerful,” says Ben. “At the end of the assessment they are fired up. I use that opportunity to remind them they have six months until the next one so get involved and try something new.”

Data from InMotion’s assessments was recently used in a paper published in the August 2020 issue of Topics in Geriatric Rehabilitation. The results demonstrate the effectiveness of exercise, mindfulness and education in a community and group setting.

After the initial assessment participants take an 8-week foundations program to learn about the basics of exercise for Parkinson’s. InMotion has also paired up with the Davis Phinney Foundation to offer a PD 101 course that teaches participants about Parkinson’s, how to advocate for themselves and how to cope with the disease. The course is followed with a PD 201 class that takes a deeper dive into the topics.

“We strive to offer classes, educational programs and camaraderie all under one roof,” says Ben. “Our programs and services are offered to both people with Parkinson’s and their care partners.”

Sustaining the center with the support of the philanthropic community

Thanks to the philanthropic community, all InMotion programs are offered for free to the Parkinson’s community. The center is committed to keeping its programs accessible to people with Parkinson’s disease and their care partners.

“We are 100% donor funded,” says Cathe. “We have a terrific board and are located in a very philanthropic community that includes individuals, companies and foundations.”

InMotion’s annual event, Pals In Motion, raised more than $300,000 this year. The event was virtual and highlighted videos from guest speakers, including our founder, Brian Grant.

Looking to the future and expanding online and community programs

In response to the pandemic, InMotion began offering virtual classes in 2020. Today anyone, anywhere, can join the center and participate in its classes. The center has expanded services online and has welcomed clients from California, Florida, Georgia and New York. They are even talking to a group in Chile that is interested in their services.

All InMotion classes are now available through Zoom and the instructors work hard to keep the sense of community that is the backbone of all programs at the center.

“Our classes always start with a time to check in with participants,” says Ben. “Our instructors are also available to meet with people before class and privately through Zoom.”

In addition to expanding its online offerings, InMotion also purchased a building and moved in this year. The 20,000 square foot space will allow the center to offer simultaneous classes and expand programs to more people when InMotion opens its doors once again. The move is partly driven by the recognition that nothing can replace the community that’s created when people come together in a space where everyone understands what they’re going through.

“We tell people to leave stigma at the door. Embrace their situation. Understand they are in control and that they have a choice to be a worrier or a warrior,” says Ben. “It’s a can-do mentality that’s unstoppable. The bonds that are created here at InMotion can’t be broken.”

To learn more about InMotion, visit beinmotion.org.

Whether it’s a pickup game at your local community center or playing H.O.R.S.E. in your driveway with friends and family, basketball can ease symptoms of Parkinson’s and reenergize your social life.

When he played basketball for the NBA, Brian Grant was a power forward known for his tenacious rebounding skills. After his retirement from the league, Grant announced he was living with Parkinson’s disease (PD). The diagnosis hasn’t kept him off the court, however. He continues to play for his love of the game, as well as to gain the many health benefits the sport offers to people with PD.

The quick, coordinated, whole-body movements of basketball are hallmarks of the kind of exercise that researchers have found can improve symptoms of PD and spur the formation of new neural connections in the brain—a process scientists call neuroplasticity. It’s an important concept in PD, as the formation of new synaptic connections can help improve both motor and thinking skills affected by the disease.

Playing basketball demands multidirectional moves, upper and lower limb coordination, and staying balanced while in motion. Dribbling, shooting and jumping build motor skills and create muscle memory you can use on and off the court.

The many health benefits of basketball

During a game, players typically repeat various movements, which have to be performed in a specific sequence to be effective. Studies have shown that physical activities featuring these components are especially good in people with PD for improving balance and gait, including taking faster, more rhythmic steps.

In basketball, players have to think about their next move while they’re running and dribbling—something scientists call dual-tasking. They also receive and act on verbal feedback and physical cues from other players while they’re on the move. Researchers have found that physical activity that requires this kind of cognitive engagement helps people with PD maintain and boost their motor skills and mental function.

As an aerobic activity, basketball helps keep the heart healthy, strengthens muscle, increases endurance, and torches 600 to 700 calories or more per hour.

It can also give people with PD sounder sleep. Regular exercisers with PD had less insomnia and daytime sleepiness than their sedentary counterparts, according to a review of studies published in 2016 in the journal Movement Disorders. The same review found that even a single session of aerobic exercise can produce an immediate improvement in sleep quality.

Any exercise—including basketball—that gets your heart pounding is a major mood-booster, warding off depression and anxiety, which are common among people with PD and can magnify the fatigue and pain of the condition. Research has shown that people often feel a lift in mood after just five minutes of aerobic activity, and more profound and longer-lasting effects with regular workouts.

A 2016 study in the Journal of the International Neuropsychological Society found aerobic exercise may also improve some of the speech problems people with Parkinson’s experience. After comparing language skills in groups of people with PD who did either aerobic workouts or stretch-and-balance exercises three times a week for 16 weeks, investigators found a significant improvement in some language skills in the aerobic group but not in the non-aerobic exercisers.

Basketball is a social sport

Isolation and loneliness are common experiences with PD, and here, as well, basketball can help. It’s a social sport that provides regular interaction with others as well as a shared interest that naturally builds community among players on and off the court.

By Emily Delzell

Turmeric – an ingredient in curry – is a powerful antioxidant that help keep cells healthy. This yellow Thai curry recipe can be added to your favorite pre-cooked veggies and served over brown rice for added fiber. Pre-cut veggies, such as broccoli, cauliflower, carrots and snap peas – can be found in most grocery stores to make this recipe easier.

Watch Alex from Swank & Swine prepare Thai Yellow Curry