Tossing and Turning in Bed: Nocturnal Movements in Parkinson's Disease

Anat Mirelman*, Inbar Hillel, Lynn Rochester, Silvia Del Din, Bastiaan R. Bloem, Laura Avanzino, Alice Nieuwboer, Inbal Maidan, Talia Herman, Avner Thaler, Tanya Gurevich, Meir Kestenbaum, Avi Orr-Urtreger, Mirek Brys, Jesse M. Cedarbaum, Nir Giladi, Jeffrey M. Hausdorff

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Sleep disturbances and nocturnal hypokinesia are common in Parkinson's disease (PD). Recent work using wearable technologies showed fewer nocturnal movements in PD when compared with controls. However, it is unclear how these manifest across the disease spectrum. Objectives: We assessed the prevalence of sleep disturbances and nocturnal hypokinesia in early and advanced PD and their relation to nonmotor symptoms and dopaminergic medication. Methods: A total of 305 patients with PD with diverse disease severity (Hoehn and Yahr [H&Y] stage 1 = 47, H&Y stage 2 = 181, H&Y stage 3 = 77) and 205 healthy controls continuously wore a tri-axial accelerometer on the lower back for at least 2 days. Lying, turning, and upright -time at night were extracted from the acceleration signals. Percent upright time and nighttime walking were classified as sleep interruptions. The number, velocity, time, side, and degree of rotations in bed were used to evaluate nocturnal movements. Results: Nocturnal lying time was similar among all groups (healthy controls, 7.5 ± 1.2 hours; H&Y stage 1, 7.3 ± 0.9 hours; H&Y stage 2, 7.2 ± 1.3 hours; H&Y stage 3, 7.4 ± 1.6 hours; P = 0.501). However, patients with advanced PD had more upright periods, whereas the number and velocity of their turns were reduced (P ≤ 0.021). Recently diagnosed patients (<1 year from diagnosis) were similar to controls in the number of nocturnal turns (P = 0.148), but showed longer turning time (P = 0.001) and reduced turn magnitude (P = 0.002). Reduced nocturnal movements were associated with increased PD motor severity and worse dysautonomia and cognition and with dopaminergic medication. Conclusions: Using wearable sensors for continuous monitoring of movement at night may offer an unbiased measure of disease severity that could enhance optimal nighttime dopaminergic treatment and utilization of turning strategies.

Original languageEnglish
Pages (from-to)959-968
Number of pages10
JournalMovement Disorders
Issue number6
StatePublished - 1 Jun 2020


  • Parkinson's disease
  • accelerometers
  • nocturnal movements
  • sleep
  • wearable sensors


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