AEDs, Sleep, and Epilepsy

Carl W. Bazil, MD, PhD, is an Associate Professor of Clinical Neurology, College of Physicians and Surgeons at Columbia University. He is the Director of Clinical Anticonvulsant Drug Trials and of the Neurology Division of the Columbia Comprehensive Sleep Center at the Neurological Institute in New York City.

Active in various organizations in his field of study, Dr. Bazil is a Board Member of the American Clinical Neurophysiology Society. He has been a Contributing Editor for Epilepsy Currents, and is a Member of the Editorial Board of Epilepsy Research and epilepsy.com. He is also an Ad Hoc Reviewer for Epilepsia, European Journal of Neurology, Physiology and Behavior, Annals of Neurology, Archives of Neurology, Sleep, Brain, Clinical Therapeutics, and Neuroscience Letters.

AEDs and How They Affect Sleep and Seizures

By Carl W. Bazil, MD, PhD

We all know that despite the importance of sleep in this busy modern world many people do not get enough sleep and overlook sleep problems. Lack of sleep can result in drowsiness, inattention, and sluggish memory. Chronic sleep deprivation, even by only an hour or two per night, can result in significant cognitive impairments. By cognitive impairments we mean the ways in which a person processes information, or perhaps uses the information they have to make choices and exercise judgments.

Persons with epilepsy are at increased risk for sleep-related problems because of seizures, underlying conditions causing epilepsy, medication effects, depression, and anxiety.

How sleep and epilepsy interact

First, sleep influences the frequency of abnormal brainwaves on the EEG, especially in deep, non-REM sleep. For this reason, sleep EEGs can be important diagnostically. Second, sleep influences the occurrence of seizures, and even brief seizures can result in prolonged alternation of sleep structure. Third, seizures can disrupt sleep. Fourth, many sleep disorders are more common in patients with epilepsy than in the general population. Finally, anti-epileptic drugs (AEDs) have the potential to either worsen or improve sleep overall, and many affect specific sleep disorders.

Effects of anti-epileptic medications

Despite the need that many have for seizure medicines, it is important to be aware of how these affect sleep. The following chart gives you information about the medicines you may be taking. Some anti-epileptic drugs (AEDs) are known to disrupt sleep and increase drowsiness; these include: phenobarbital, phenytoin, carbamazepine, or valproic acid. But many of the newer AEDs do not seem to be associated with such problems. These include: lamotrigine (Lamictal), gabapentin (Neurontin), pregabalin (Lyrica), and tiagabine (Gabitril).

The most important aspect of sleep

The most important aspect of sleep for the epilepsy patient is awareness of its importance. Too often, drowsiness and inattention are considered unavoidable effects of medication and/or seizures, but it is clear that sleep disruption is very common and can contribute to drowsiness and inattention. Seizures, sleep disorders, and mood disorders can easily form a cycle of dysfunction, with each independent problem contributing and worsening the others. If you are having sleep problems, it is important that you talk to your physician.

To find out ways to get a good night’s sleep, please go to:
www.epilepsy.com/articles/ar_1185464131.html

We present here a chart that may be beneficial in helping you determine if and how medications are affecting you.

Edited by Steven C. Schachter, MD