**9. Effect of antiepileptic drugs on sleep**

Anti-epileptic drugs [AEDs] may reduce sleep fragmentation, while improving nocturnal seizures control. However, AEDs have differential effects on sleep architecture [66]. Several studies identified that gabapentin, tiagabine, pregabalin, clobazam, and carbamazepine reduce sleep latency and/or improve sleep efficiency. Phenobarbital, carbamazepine, phenytoin, valproic acid, and higher doses of levetiracetam may have an effect or aggravate daytime sleepiness. Felbamate, zonisamide, and lamotrigine at high doses may causes insomnia. Some AEDs

**45**

*Sleep Disorders and Epilepsy*

*DOI: http://dx.doi.org/10.5772/intechopen.93989*

insomnia

Pregabalin Increases NREM N3, improve insomnia Levetiracetam Decreases NREM N3 increases EDS Ethoxizimide Decreases NREM N3, increases REM

Benzodiazepines Decreases NREM N3 and SOL

*Common antiepileptic drug effect on sleep architecture.*

Carbamazepine Increases NREM N3, increases sleep fragmentation

*SOL: sleep onset latency, WASO: wake after sleep onset, EDS: excessive daytime sleepiness.*

**Drug Sleep effect**

have no effect or have minimal effect on sleep architecture such as topiramate, zonisamide, lamotrigine, vagabatril, lacosamide, and low doses of levetiracetam [66]. Dose-dependent sleep effects of antiepileptic drugs and nondrug treatments independent of the improvement of epilepsy have not been studies and may help to

Valproic acid Increases sleep fragmentation, increases WASO, increased daytime sleepiness

Phenobarbital Decreases SOL, decreases WASO, decreases REM, increases EDS

Phenytoin Decreases SOL, decreases REM, increases sleep fragmentation

Gabapentin Decreases SOL, decreases WASO, increases NREM N3, increases REM, improve

**Table 3** shows the most common antiepileptic drugs effect on sleep architecture.

Ketogenic diet improves total sleep time and NREM slow-wave sleep [67].

Vagus nerve stimulation [VNS] is used in some form of refractory epilepsy. VNS increases NREM N3 stage and reduces daytime sleepiness. VNS may worsen or

Epilepsy surgery has a positive effect on sleep. It improves total sleep time, decreases wake after sleep onset, increases REM sleep, and improves the subjective sleep quality. No changes were seen in the subjects who continued to have frequent

Parasomnias are disorders with undesirable physical and mental events that occur mainly or exclusively during NREM and REM sleep, often accompanied by skeletal muscle activity and autonomic arousal. Mental phenomena may also occur,

identify if these changes are clinically significant.

**11. Effect of vagal nerve stimulator on sleep**

increase risk for sleep-disordered breathing [67].

**12. Effect of epilepsy surgery on sleep**

including emotions, thoughts, and images.

seizures after surgery [67].

**13. Seizures and parasomnia**

**10. Effect of ketogenic diet**

**Table 3.**


#### **Table 3.**

*Updates in Sleep Neurology and Obstructive Sleep Apnea*

reading, or physical activity before sleep.

juvenile myoclonic epilepsy.

**8. Effect of epilepsy on sleep**

Environmental factors and sleep hygiene are also crucial in the control of seizures. Appropriate noise level, light intensity, surrounding temperature, humidity, and type of bed are needed for a comfortable sleep. Another important issue is sleep hygiene. Certain behaviors and practices interfere with normal nocturnal sleep. They include time of going to sleep, consumption of food and drinks before sleep, watching TV, working on the computer, using the phone,

Sleep deprivation is the most common trigger for awakening seizures seen in

The effect of epilepsy on sleep was first described in 1890 by Fere, based on clinical findings of difficulty falling asleep and impairing sleep efficiency. About two-third of patients suffering from epilepsy have sleep dysfunction [63]. Three main mechanisms that need to be considered regarding this topic are: 1. the epilepsy itself may be associated with sleep disturbance due to mechanisms intrinsic to the syndrome; 2. the effect of seizures on sleep architecture; and 3. the effect of AEDs

Experimental amygdala kindling, an animal epilepsy model involving temporal structures, showed disturbed sleep patterns with sleep fragmentation and a shift toward lighter sleep [64]. In humans, patients with epilepsy have reduced NREM N2 and N3 sleep and REM sleep [65]. Sleep abnormalities seem to be more marked in patients with temporal lobe epilepsy compared to generalized epilepsies [15]. The limbic system participates in the neural networks underlying sleep organization, sleep induction, and arousal. **Table 2** shows the effects of epilepsy on seizures. Patients suffering from nocturnal seizures show reduced sleep efficiency, increased time into REM period, and increased drowsiness [65]. The effects of

Anti-epileptic drugs [AEDs] may reduce sleep fragmentation, while improving

nocturnal seizures control. However, AEDs have differential effects on sleep architecture [66]. Several studies identified that gabapentin, tiagabine, pregabalin, clobazam, and carbamazepine reduce sleep latency and/or improve sleep efficiency. Phenobarbital, carbamazepine, phenytoin, valproic acid, and higher doses of levetiracetam may have an effect or aggravate daytime sleepiness. Felbamate, zonisamide, and lamotrigine at high doses may causes insomnia. Some AEDs

**44**

**Table 2.**

on sleep.

Increased sleep onset latency

Increased NREM N1 and N2

*Common effect of epilepsy on sleep.*

REM sleep suppression Increased sleep fragmentation

Increased awakening after sleep onset

Decreased frequency of spindles during N2

**9. Effect of antiepileptic drugs on sleep**

AEDs on sleep will be discussed separately in the next section.

*Common antiepileptic drug effect on sleep architecture.*

have no effect or have minimal effect on sleep architecture such as topiramate, zonisamide, lamotrigine, vagabatril, lacosamide, and low doses of levetiracetam [66]. Dose-dependent sleep effects of antiepileptic drugs and nondrug treatments independent of the improvement of epilepsy have not been studies and may help to identify if these changes are clinically significant.

**Table 3** shows the most common antiepileptic drugs effect on sleep architecture.
