The Relationship Between Epilepsy and Sleep Disorders

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A 2015 study published in the journal SleepMedicine found that people with epilepsy suffered from higher rates of poor sleep quality, daytime sleepiness, clinical insomnia, and insufficient sleep compared to non-epileptic individuals.

The effect of epilepsy on sleep

2015 review published in Seminars in Pediatric Neurology set out to identify the relationship between epilepsy and sleep.

Perhaps unsurprisingly, the authors found epileptic seizures had a significant effect on sleep.

When seizures occurred during sleep, REM sleep was reduced, sleep efficiency dropped, and the light sleep stage (known as N1 sleep) increased.

The reduction in REM sleep and sleep efficiency was even more pronounced if a seizure occurred before the first REM sleep cycle.

Are antiepileptic drugs to blame?

To examine more comprehensively whether and how medication for epilepsy is affecting sleep, the National Institutes of Health funded a systemic literature review published in 2014. It identified 45 studies that investigated the effects of antiepileptic drugs on sleep.

The following drugs were found to decrease slow-wave sleep and/or reduce REM sleep:

  • Levetiracetam
  • Ethosuximide
  • Phenobarbital
  • Phenytoin

Yet, the following drugs were found to reduce the amount of time taken to fall asleep and/or improve sleep efficiency:

  • Gabapentin
  • Tiagabine
  • Pregabalin
  • Clobazam
  • Carbamazepine

The review also found that phenobarbital, valproic acid, and higher doses of levetiracetam may cause daytime sleepiness — but topiramate and zonisamide did not.

The sleep disorders associated with epilepsleep apnea

As many as one third of adults with refractory epilepsy also have obstructive sleep apnea (OSA).

In comparison, the prevalence of OSA in the general population is estimated to be between three and seven percent.

Restless legs syndrome

Restless legs syndrome (RLS) has been found to affect between 18 percent and 35 percent of adults with epilepsy.

The prevalence of RLS in the general population is estimated to be between five and ten percent.

Insomnia

A 2006 study found 34 percent of those with epilepsy suffered with sleep-onset insomnia and 52 percent experienced sleep-maintenance insomnia.

The prevalence of specific insomnia disorders in the general population is estimated to be between five and ten percent.

Hypersomnia

According to  the 2015 review, excessive sleepiness is reported by as many as 28 to 48 percent of patients with epilepsy.

This is in stark contrast to the excessive sleepiness reported by  four to six percent of the general population.

Addressing sleep issues may improve epilepsy symptoms

As many as a third of individuals with epilepsy sleep for six hours or less, yet most patients do not discuss sleep-related issues with their care providers.

This needs to change.

Treating underlying sleep issues is possible — but they need to be discussed before they can be addressedCarefully following a regimen of continuous positive airway pressure at night may help: In adults with epilepsy and OSA, the frequency of seizures decreased after six months of CPAP treatment.

Melatonin also might help some patients with intractable epilepsy reduce daytime seizures: A pilot study of 10 patients at the Schneider Children's Medical Center of Israel  found that melatonin reduced seizure frequency in those suffering from epilepsy and insomnia.

The bottom line: Sleep and epilepsy are closely related. Poor sleep worsens seizure control and poor seizure control worsens sleep.

This vicious cycle should never be ignored. If you have epilepsy, talk about your sleep with your care provider. If you have any concerns, mention them. You may need to start the conversation, but it's one worth having.

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