Medically reviewed by Meredith Goodwin, MD, FAAFP - Written by Rena Goldman - Updated on July 18, 2025
People move through the stages of Parkinson’s at a different pace. At each stage, treatments are available to help as symptoms progress.
The progression of Parkinson’s is described in five stages. Stage 1 is when early signs start to appear. Stage 5 describes the final stage of the disease, when a person needs around-the-clock nursing care.
For some people, it can take as long as 20 years to move through all the stages.
As you move through the stages, your doctor and care team will make changes to your treatment plan. That’s why it’s important to tell your doctor about any new symptoms or differences in how you feel.
1. Medication not working the way it used to
In the early stages, taking medication works well to manage symptoms. But as Parkinson’s progresses, your medication may work for shorter periods of time, and symptoms may return more easily.
Many people notice a decrease in effectiveness after around 5 years. You may experience involuntary movements or be unable to move at all.
If you notice your medication becoming less effective, inform your healthcare provider. They may:
- change the time of the day and frequency of when you use your medication
- switch to sustained-release tablets (which release the drug gradually)
- change the doses
- prescribe additional medications such as COMT inhibitors, NMDA antagonists, anticholinergic drugs or MAO-B inhibitors
- add a dopamine agonist in addition to levodopa
2. Increased feelings of anxiety or depression
Anxiety and depression have been linked to Parkinson’s and may occur before movement issues. Up to 40% of individuals with Parkinson’s will experience some form of anxiety, and up to 50% will experience some form of depression.
It’s possible that changes in your emotional well-being can be a sign of changing physical health as well. If you are more anxious than usual, have lost interest in things, or feel a sense of hopelessness, talk with your doctor.
A combination of therapy and medication may be used to help manage symptoms of anxiety and depression. Non-pharmacological complementary approaches can include mindfulness practices and social support.
3. Changes in sleeping patterns
As Parkinson’s progresses, you may also develop problems with sleep patterns. Alternatively, the onset of sleep disorders can precede movement difficulties. You might wake up often in the middle of the night or sleep more during the day than you do at night.
Excessive daytime sleepiness occurs in 30 to 50% of individuals with Parkinson’s disease. It may be related to medications or poor sleep. Some ways you may be able to prevent this can include:
- practicing good sleep hygiene, including a set bedtime and wake-up time
- getting exposure to light during the day and darkness at night
- avoiding sedentary activities during the day and getting regular exercise
Sleep apnea is also a common sleep disturbance, which occurs in 40% of people with Parkinson’s disease. A CPAP machine can help treat it.
Another sleep disturbance for people with Parkinson’s is rapid eye movement (REM) sleep behavior disorder. This is when you start acting out your dreams in your sleep, such as verbally and physically, which can get uncomfortable — or even dangerous — if someone is sharing your bed.
There are medications your doctor can prescribe to help REM sleep behavior disorder, such as melatonin or clonazepam.
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