Frequent phase shifts increase the frequency of seizures and interictal epileptiform discharges. Frequent clinical and subclinical arousals as well as changes in the amount of time spent in a particular stage of sleep independent of nocturnal seizures or AED use have been described in patients with epilepsy. In normal subjects this value should be more than 90%. Sleep efficiency is the time spent asleep divided by the time spent awake during a given sleep period. A number of authors attribute facilitation of epileptiform activity during NREM sleep to increased synchronization of the EEG pattern in contrast, inhibition of epileptiform activity during REM sleep could be explained by desynchronization of cerebral networks. In contrast, during REM sleep, the topology, distribution, and frequency of epileptiform discharges are decreased. īoth NREM sleep and its deficit promote epileptiform discharges, with more profound effect on diffuse discharges. Sleep complaints in adult patients with epilepsy reported in other questionnaire-based studies varied from 16.9% to 36%. The authors concluded that sleep disturbance contributes to a lower quality of life independent of epilepsy diagnosis or its treatment. ![]() The largest differences were observed in measures of excessive daytime sleepiness (13.8%) and psychiatric sleep disorder (14.1%). Subjective sleep complaints in the prior 6 months were reported by up to 39% of patients with partial epilepsy as compared to 18% of controls. Disturbance of sleep is consistently ranked among the top three adverse side effects in patients with epilepsy. The non-REM phase consists of the light stages of sleep-N1 and N2 (previously designated stages 1 and 2), followed by deeper predominantly slow wave sleep (SWS)-N3 (previously divided into stages 3 and 4). Sleep is classically divided into REM and non-REM phases as defined by the parameters of electroencephalography, respiration, eye movement, and electromyography. A search of relevant primary research and review articles was performed utilizing the PubMed database. This review systematically evaluates the currently available literature, elucidating the effect of antiepileptic drug therapy upon the sleep cycle. It is important for clinicians to understand the proclivity of a specific AED to affect the quality of sleep in order to guide epilepsy therapy and prevent disturbance of a patients' nocturnal recovery. Accordingly, one would expect that lack of sound sleep would significantly impact neurocognitive and psychological function, especially in patients treated with AEDs for their seizures. As previously recognized, the relationship between epilepsy and sleep disturbance is likely multifactorial: the direct effect of seizures, adverse events due to AED therapy, presence of psychiatric comorbidity, and coexisting sleep disorders all have the potential to contribute to alteration of sleep architecture and the subjective quality of sleep. Sleep is an essential physiologic state that influences restorative and memory consolidating functions. ![]() ![]() Some AEDs tend to cause sleepiness or drowsiness while others can lead to insomnia. In addition, antiepileptic drugs (AEDs) that are commonly used for seizure treatment affect sleep quality and architecture. ![]() Although the complex relationship between sleep and epilepsy has not been fully elucidated, it is well known that sleep disturbance provokes seizures and that seizure activity may influence the quality of sleep.
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