I have a similar situation with my wife. Similar disease stage, and paranoid delusions. When she was on up to 1500 mg Sinemet and 4 mg Requip, she ended up paranoid. At 940 mg Sinemet alone, the paranoia went away completely, but off times were frequent. No other medications. Recently converted to Rytary, which has turned out to be more complicated than Sinemet, even though the off times are far fewer. Can't be certain yet what is the best dosage and dose timing.

If you look at the pharmacokinetics of Rytary, which is published in the Journal of Clinical Pharmacology, 2015, there is a big tail on the amount of Rytary that stays in the body after the first 5 or 6 hours. This tail lasts up to 12 hrs. If you take a dose while the tail of the prior dose is still in existence my experience is that you end up high on dopamine due to the cumulative effect of the two doses. This is where to danger of hallucinations creeps in. Even the overnight does not really lose the tail, depending on when the last dose was taken. Heavy, but not light, meals change this, and things can change if you miss a does one day too. I have not sufficient experience yet to say what to do about it in precise detail, but waiting until a dose wears off, while helpful, is not exactly what to do, because wearing off does not mean you have no dopamine in you. It just is not enough to overcome the down times.