![]() ![]() Objective PSG assessments show that interictal epileptiform discharges (IEDs), increase in sleep 17 especially in N3 nREM sleep, although seizures seem to predominate in lighter nREM sleep. The effects of epilepsy on sleep The effects and consequences of epilepsy on the sleep EEG 16 Diagnostic difficulty can arise when the arousal is due to a short seizure and the confusion due to postictal phenomena. Confusional arousals occur in adulthood when an abrupt but incomplete awakening occurs from slow wave sleep (SWS), often associated with distressing dreams which can be recalled, leading to confusion and sometimes injury. Events can last up to one hour but they are not remembered. Although deeply asleep, the child appears awake and is inconsolably terrified, often screaming loudly. Night terrors are exclusively a paediatric condition and don’t persist into adulthood. Night terrors and confusional arousalsÄifferentiating between these two types of common nREM parasomnias often causes difficulty. Excessive daytime somnolence (EDS) is generally not a direct consequence of nREM parasomnias but if severe one should consider comorbid sleep disorders such as obstructive sleep apnoea (OSA) and periodic limb movements in sleep (PLMS). Injury is rare, behaviour is often complex and episodes can be prolonged but usually not more than 30 minutes. ![]() ![]() ![]() Patients are more often amnesic to the event however, some recollection of the later stages of events is often reported due to awakening, often in a confused state. NREM parasomnias generally arise in childhood, they are less frequent and usually singular during the early part of a sleeping period. The American Academy of Sleep Medicine suggests RBD is diagnosed with polysomnography (PSG) as it can sometimes be dif cult to differentiate it from epilepsy on the history alone. Patients often recall their dreams, behaviour is often violent and episodes are repeated each night. Episodes occur late in the sleeping period where a higher concentration of REM sleep is seen. 14 Dream enactment occurs due to a lack of muscle atonia during REM sleep. REM parasomnia (REM behaviour disorder (RBD) is almost exclusively seen in elderly subjects with a male predominance, often associated with alpha synucleonopathies. Parasomnia episodes are seen in either rapid eye movement (REM) or non-REM (nREM) sleep. This review will begin with diagnostic issues, moving on to the effects of epilepsy and its treatments on sleep, the effects of sleep disorders on epilepsy and concludes with practical advice on assessment. Understanding this complex relationship can lead to better treatment outcomes for patients. 10 To add to this complexity, epilepsy treatments often have impact on sleep. Even when telemetry facilities are available, data can be difficult to interpret and EEG is not always diagnostic. Often diagnosis is difficult due to incomplete histories from sleep partners. 9 Many patients with epilepsy have seizures in sleep, some exclusively so. 8 Recognition of the comorbid sleep disorder and successful treatment can lead to significant improvements in seizure control. 4 Sleep disorders are up to three times as common in epilepsy 5 and can be a major contributor to refractory seizures, 6 poorer quality of life 7 and possibly SUDEP. 2 Sleep deprivation impairs this process 3 and epilepsy can upset this delicate balance. 1 Sleep has an important role in memory consolidation. Sleep and epilepsy are intimate bedfellows, having an impact on each other and adversely affecting quality of life and daytime performance. This article reviews this complicated but fascinating area addressing diagnostic issues, the effects of epilepsy and its treatments on sleep, the effects of sleep disorders on epilepsy concluding with some practical advice on assessment. Recognising this allows for a greater awareness of the importance of good quality sleep in epilepsy patients with potential benefits on seizure control and quality of life. Epilepsy and sleep have a close association and a two way interaction. ![]()
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