In patients with epilepsy, insomnia is a less common complaint than daytime sleepiness. Potential causes can be divided into three groups:
- effects of epilepsy on sleep
- effects of medication on sleep
- the presence of another sleep disorder
A detailed history should include information regarding the clinical course, the degree of impact on the patient, the sleep-wake pattern, the report from the bed partner, dietary and activity changes, medications (including over-the-counter agents), and medical conditions.
Frequent arousals caused by epileptic activity are one possible basis for insomnia. Depression or anxiety, which are common in epilepsy patients, also may contribute.
Patients have reported insomnia with the use of felbamate and lamotrigine. Patients undergoing medication tapers for any reason may experience insomnia due to removal of sedating antiepileptic drugs (AEDs). When AEDs are the suspected cause of insomnia, giving the AED earlier in the evening and substituting a more sedating AED are useful strategies. Addition of a sedative agent may be necessary if the insomnia-producing AED is required for optimal seizure control.
Other sleep disorders such as psychophysiologic insomnia, inadequate sleep hygiene, restless legs syndrome, or periodic limb movements in sleep also should be considered in epilepsy patients complaining of insomnia.
Insomnia can be treated behaviorally, pharmacologically, or by a combination of modalities. Caffeine use in the late afternoon and evening hours should be avoided, as should heavy exercise or meals just before bedtime. Relaxation techniques and sleep restriction may also be helpful.