Science Sunday: The Benefit of Taking Naps and Using Non-Sleep Deep Rest to Improve the Quality-of-Life in Parkinson’s

“I usually take a two-hour nap from one to four.” Yogi Berra

“Persevere. Plan. Strategize. Focus. Breathe. Write. Let go: relax. Forgive. All this failing: take a nap.” Mary Anne Radmacher

Introduction: Many experts in the field of neurology believe that most if not all, neuropsychiatric disorders are linked to atypical sleep patterns. And guess what? Our favorite neurotransmitter, dopamine, is central in modulating the sleep process. Thus, if you have Parkinson’s and you have difficulty sleeping, then you are not alone.

My new neurologist strongly encouraged me to nap if I was tired. She said that some of her patients now take two naps each day. After returning home from the clinic visit, I decided that why not? I am retired, and if I get tired in the afternoon, I would start taking a nap. And guess what? I do feel better, more energized, and renewed after the nap.

“Naps are a way of traveling painlessly through time into the future.” ~ Thomas Carlyle

Naps and Non-Sleep Deep Rest (NSDR): The Sleep Doctor says there are several different kinds of naps. The power nap typically lasts 10 to 20 minutes. The power nap helps one stay alert, such as during the middle of a work day. A recovery nap is a daytime sleep that is meant to make up for lost nighttime sleep. One can read about the other types of naps (click here). However, these two types of naps seemed to be most relevant to my sleep deprivation experience from Parkinson’s.

By contrast, non-sleep deep rest (NSDR) refers to a state of rest similar to deep sleep but without actual sleep. It is a profound relaxation where the body and mind experience therapeutic benefits. Dr. Andrew Huberman coined the term non-sleep deep rest, and it otherwise is the same as yoga nidra. However, Dr. Huberman uses the non-sleep deep rest term (NSDR) for group naps, hypnosis, and meditation. He describes these events to enable people to down-regulate the thinking brain and to move to a calmer state. A further comparison of naps and NSDR, including an instruction manual for practicing NSDR/yoga nidra, is given in the excellent overview “Guide to non-sleep deep rest (NSDR) and how to get started” (click here).

“A 10-20 min nap or NSDR (Non-Sleep-Deep-Rest) have both been shown to replenish physical energy & increase cognitive function. NSDR, however, also increases striatal dopamine & improves one’s self-directed-relaxation ability, which in turn improves sleep.” Andrew Huberman, PhD (click here).

“Nap time over. Gonna go be active. Do it people!!! In the end all you have is your health.” Scott Eastwood

Science of Naps and Sleeping: Understanding sleep is not trivial because it is a complex process. Multiple unique stages describe sleep. The two major components are non-rapid eye movement (NREM), which itself is further divided into three sub-stages [stage 1 (N1), stage 2 (N2), and stage 3 (N3 or slow wave sleep (SWS)]. NREM is linked. to low energy expenditure and high neuronal synchronization. Rapid eye movement (REM) sleep is associated with higher brain function and energy expenditure. In a less scientific description, sleep has these four phases: awake, light sleep, deep sleep, and REM sleep.

The sleep mechanism is hypothesized to be regulated by two processes: circadian rhythms and sleep-wake homeostasis. Circadian rhythms orchestrate a process that leads to daily fluctuations in wakefulness to body temperature, metabolism, and the release of hormones. Circadian rhythms cause you to be sleepy at night and your tendency to wake in the morning without an alarm. In comparison, sleep-wake homeostasis monitors your need for sleep, which reminds the body to sleep after a particular time and regulates sleep intensity. For a further overview of the sleep mechanism, please see the outstanding review from the NIH entitled “Brain Basics: Understanding Sleep” (click here).

The physiology of naps shows the following characteristics:
•In infants, naps are the same as nocturnal sleep;
•In early childhood, naps are mainly composed of NREM sleep;
•In young adults, naps will contain both NREM and REM sleep;
•In older adults, naps typically are found to be associated with lighter NREM stages but with some SWS and less amount of REM sleep.

“I eat really healthy, and if I’m tired, I take a nap.” Casper Van Dien

Sleep, NSDR, and Dopamine: The mesolimbic dopamine pathway is between the ventral tegmental area (VTA) and the nucleus accumbens (NAc), and it plays a crucial role in our motivation. Interestingly, there is also a regulatory role for dopamine and other neurotransmitters and neuromodulators from this brain region to control sleep and wakefulness. Furthermore, striatal dopamine levels were increased in participants during yoga nidra/NSDR meditation. The implication here is that NSDR, for a short time, may generate additional striatal dopamine due to this meditation/profound relaxation.

“Figure out what to do, then take a nap.” Adam Carolla

The Benefits of Taking a Nap:
•Cognition. If one experiences sleep deprivation, sleepiness will increase while awake, with a decline in cognitive ability. Naps have been found to assist in the recovery process and returning cognition because they minimize homeostatic sleep pressure.

•Executive function. Naps have been found to boost executive function. There is evidence this process is supported by adenosine (needed to provide energy replenishment) and. dopamine interactions in the cortico-striatal regions of the brain.

•Memory Consolidation and Declarative Memory Consolidation. While we are awake, we process certain information to either be permanently retained or other information to be discarded. Naps, like nocturnal sleep, enhances memory consolidation.

•There are other benefits to taking a nap, including these processes of subsequent learning and promoting emotion processing.

•After describing these positive benefits of taking a nap, there is also evidence of adverse outcomes associated with taking a nap. Several studies have reported that frequent habitual napping (also called “essential napping”) is associated with an increased risk of cardiovascular disease, hypertension, diabetes, osteoporosis, decreased cognition, and increased mortality. You will notice that Parkinson’s and other neurodegenerative disorders are not listed here. However, I will offer the usual medical disclaimer because I am not saying everyone with Parkinson’s should take a nap.*

*This blog post contains advice and information related to health care. It is not intended to replace medical advice. It should be used to supplement rather than replace regular care from your neurologist. It is recommended that you seek your physician’s advice/approval before embarking on any new health plan or changes to your existing plan/routine.

“There are two ways to get rid of an anxiety monster, my friend-you either have a bath or a nap.” Andrew Kaufman

Sleep Disorders with Parkinson’s and the Potential Benefit of Taking a Nap or Using NSDR: Unfortunately, many people with Parkinson’s have a sleep dysfunction. Sleep deprivation, vivid dreams and nightmares, and acting out dreams constitute some of the sleep disruptions that can occur with Parkinson’s. We now know that not only does our physiology change with Parkinson’s to disrupt the normal sleep cycle, but we also know that our pharmaceutical drugs like dopamine agonists and even carbidopa/levodopa can contribute to sleep issues. Thus, this blog post is not a cure-all for anyone with sleep issues from Parkinson’s. For me, sleep deprivation is one of the biggest culprits in my daily life with Parkinson’s.

I have been trying different combinations of Complementary & Alternative Medicine (CAM) methods and compounds to help facilitate my sleep issues. My regime includes the following:
•Not drinking caffeinated beverages past mid-afternoon;
•Trying (very hard) to get in bed around the same time each night (by 11:00 PM). I am trying very hard to calm my brain down by late evening, usually by listening and watching some YouTube Music videos.
•Taking magnesium threonate (Magtein^TM), 500 mg in the morning and 500 mg 30-60 min before bedtime.
•Melatonin (10 mg) 30-60 min before bedtime (see the now below because I have stopped taking melatonin).
•Recently, I have adopted part of the regimen suggested by Dr. Andrew Huberman, which consists of Magtein [(already being used); see blog post on Magtein (click here) ] and taking apigenin (50 mg). Apigenin is a plant polyphenol, and it is considered a flavonoid. Apigenin promotes sleep due to the activation of chloride channels. Apigenin also decreases cortisol levels, which contributes to stress reduction and relaxation. However, I have not added L-theanine to this sleep mixture since it enhances vivid dreams (as noted by Dr. Huberman). He also suggests using myo-inositol if you are waking up in the night while sleeping; however, I have not added myo-inositol to my protocol. Therefore, to recap, I take Magtein (500 mg twice daily) and apigenin (50 mg) 30-60 min before going to bed each night. •NOTE: Due to this new sleep protocol, I have stopped taking melatonin.
•My latest sleep analysis from my iWatch (using the Health app) shows that for the last month, my average time in bed was 6 hr 37 min. I consider this a substantial improvement to the 3 to 4 hours I have recorded in the past months. I am on the way to hopefully get 7 hours (that’s the ultimate goal).
•I will try to learn the NSDR/yoga nidra technique. It sounds like it would be very beneficial to assisting our sleep disorder from Parkinson’s.
•Adding a nap a couple of days per week has been beneficial, in my opinion. I feel more alert, alive, and able to do more to finish the day strong, or at least better than before taking a nap.

In summary, my attempt to improve my sleep time includes changing routines, adding CAM products, and altering my day’s pattern by taking a nap. Is this the answer for everyone with Parkinson’s? I doubt it, especially since we are all so different in expressing our symptoms. Sleep, like Parkinson’s, is very individualized. However, sleep is essential to our existence. We cannot live without it. I would welcome your input as to what works for you as you deal with your sleeping issues from Parkinson’s.

“Just as important as getting enough sleep is thinking about sleep in the right way. Stop thinking of sleep and naps as “downtime” or as a “waste of time.” Think of them as opportunities for memory consolidation and enhancing the brain circuits that help skill learning. Nor should you feel guilty about sleep. It’s just as crucial a part of successful brain work as the actual task itself.” Richard Restak

Besides the on-line sites mentioned above, hee are some useful publications about sleep and naps:
Winkelman, John W., and Luis de Lecea. “Sleep and neuropsychiatric illness.” Neuropsychopharmacology 45, no. 1 (2020): 1-2.

Oishi, Yo, and Michael Lazarus. “The control of sleep and wakefulness by mesolimbic dopamine systems.” Neuroscience research 118 (2017): 66-73.

Alonso, I. P., J. A. Pino, S. Kortagere, G. E. Torres, and R. A. España. “Dopamine transporter function fluctuates across sleep/wake state: potential impact for addiction.” Neuropsychopharmacology 46, no. 4 (2021): 699-708.

Igloi, Kinga, Giulia Gaggioni, Virginie Sterpenich, and Sophie Schwartz. “A nap to recap or how reward regulates hippocampal-prefrontal memory networks during daytime sleep in humans.” elife 4 (2015): e07903.

Mantua, Janna, and Rebecca MC Spencer. “Exploring the nap paradox: are mid-day sleep bouts a friend or foe?.” Sleep medicine 37 (2017): 88-97.

Kesner, Andrew J., and David M. Lovinger. “Wake up and smell the dopamine: new mechanisms mediating dopamine activity fluctuations related to sleep and psychostimulant sensitivity.” Neuropsychopharmacology 46, no. 4 (2021): 683-684.

Ford, Daniel E., and Douglas B. Kamerow. “Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention?.” Jama 262, no. 11 (1989): 1479-1484.

Kjaer, Troels W., Camilla Bertelsen, Paola Piccini, David Brooks, Jørgen Alving, and Hans C. Lou. “Increased dopamine tone during meditation-induced change of consciousness.” Cognitive Brain Research 13, no. 2 (2002): 255-259.

Fialoke, Suruchi, Vaibhav Tripathi, Sonika Thakral, Anju Dhawan, Vidur Mahajan, and Rahul Garg. “Brain Connectivity Changes in Meditators and Novices during Yoga Nidra: A Novel fMRI Study.” bioRxiv (2023): 2023-09.

Thurman, Joey. The Minimum Method: The Least You Can Do to Be a Stronger, Healthier, Happier You. BenBella Books, 2022.

Nakamura, Sachiko. “Emotion Regulation and Emotion Regulation Strategies.” In Emotion Regulation and Strategy Instruction in Learning, pp. 49-87. Cham: Springer International Publishing, 2023.