John Cobb was diagnosed with Parkinson's in August 2011. He is a retired pharmacist, a husband, a father and a grandfather. He blogs at Personal Parkinson's.

There is a certain clarity that comes with rising in the small hours of the night. The hours when the silence is broken only by sound of your spouse breathing or the movement of yellow dog Bella as she turns over in a dog's blissful dreams. I creep out of bed and position myself in the stuffed chair next to Bella. I open my iPad and begin to think about why I am awake at this time when most people are asleep. 

I am awake because this is one more piece of this puzzle known as Parkinson’s. Since the earliest days of Parkinson's disease (PD) I have awakened around 1:30 or 2 a.m., often unable to return to sleep. Frequently I wake up in the midst of a stage of sleep known as REM sleep, that period of sleep when your eyes move rapidly and dreaming occurs. In this stage the brain somehow finds rest while it links confusing pieces of information into a story of sorts. These dreams have been especially vivid for me and I sometimes wake up when I am acting out some portion of the dream.

One night I found myself being pursued and desperately trying to escape the pack competitors in a roller derby. I woke trying to hold back the pursuing pack on roller skates by slugging away with an elbow. Strangely I am neither a fan nor have ever had anything to do with roller derby. They say that usually the brain has a barrier that wakes us up prior to becoming physically engaged with a dream. In Parkinson's that barrier has been removed or at least messed with and so I have reached, kicked or slugged as a dream is happening.

Our patterns of sleep may modified by Parkinson's itself or by drugs intended for the purpose of inducing sleep. Changes may also be due to side effects of a drug never intended to influence sleep. For myself this is likely the case and it began a few months ago when I added a drug called Artane for tremors. For tremors it was and is helpful, but without explanation, both the early awakening and the vivid dreams stopped. I assumed that the better night's sleep was due to the addition of Artane since I knew that Artane could cause drowsiness and thereby assist sleep. Nice! But I also was puzzled by the disappearance of my vivid dreams or any dreams. 

I found among the list of side effects that Artane not only causes drowsiness but also suppresses REM sleep. REM sleep is quite important to achieving the natural restorative sleep the body needs. More sleep but lower quality of sleep has been a concern with sleeping pills for a long time. Now on Artane I sleep longer but seem to be nearly or as tired as when I woke early every day. 

There is little doubt that Artane has been very helpful for tremors but hidden among the side effects there is a price to be paid. It would seem that more sleep also means lower quality of sleep.