Expert Opinion: Managing sleep disturbances in people with epilepsy

TY - JOUR

T1 - Expert Opinion: Managing sleep disturbances in people with epilepsy

AU - Nobili, Lino

AU - Beniczky, Sandor

AU - Eriksson, Sofia H

AU - Romigi, Andrea

AU - Ryvlin, Philippe

AU - Toledo, Manuel

AU - Rosenzweig, Ivana

N1 - Funding Information: Medical writing support for the coordination and editing of this review was provided by Kate Carpenter and funded by Eisai Europe Ltd. The review article was suggested by LN, following an advisory board meeting on the topic of sleep and epilepsy, which was arranged and funded by Eisai Europe Ltd., and was attended by LN, SHE, MT, and AR. Publisher Copyright: © 2021 The Author(s)

PY - 2021/11

Y1 - 2021/11

N2 - Poor sleep and daytime sleepiness are common in people with epilepsy. Sleep disorders can disrupt seizure control and in turn sleep and vigilance problems can be exacerbated by seizures and by antiepileptic treatments. Nevertheless, these aspects are frequently overlooked in clinical practice and a clear agreement on the evidence-based guidelines for managing common sleep disorders in people with epilepsy is lacking. Recently, recommendations to standardize the diagnostic pathway for evaluating patients with sleep-related epilepsies and comorbid sleep disorders have been presented. To build on these, we adopted the Delphi method to establish a consensus within a group of experts and we provide practical recommendations for identifying and managing poor night-time sleep and daytime sleepiness in people with epilepsy. We recommend that a comprehensive clinical history of sleep habits and sleep hygiene should be always obtained from all people with epilepsy and their bed partners. A psychoeducational approach to inform patients about habits or practices that may negatively influence their sleep or their vigilance levels should be used, and strategies for avoiding these should be applied. In case of a suspected comorbid sleep disorder an appropriate diagnostic investigation should be performed. Moreover, the possible presence of sleep fragmentation induced by sleep-related seizures should be ruled out. Finally, the dose and timing of antiepileptic medications and other co-medications should be optimized to improve nocturnal sleep and avoid daytime sedation.

AB - Poor sleep and daytime sleepiness are common in people with epilepsy. Sleep disorders can disrupt seizure control and in turn sleep and vigilance problems can be exacerbated by seizures and by antiepileptic treatments. Nevertheless, these aspects are frequently overlooked in clinical practice and a clear agreement on the evidence-based guidelines for managing common sleep disorders in people with epilepsy is lacking. Recently, recommendations to standardize the diagnostic pathway for evaluating patients with sleep-related epilepsies and comorbid sleep disorders have been presented. To build on these, we adopted the Delphi method to establish a consensus within a group of experts and we provide practical recommendations for identifying and managing poor night-time sleep and daytime sleepiness in people with epilepsy. We recommend that a comprehensive clinical history of sleep habits and sleep hygiene should be always obtained from all people with epilepsy and their bed partners. A psychoeducational approach to inform patients about habits or practices that may negatively influence their sleep or their vigilance levels should be used, and strategies for avoiding these should be applied. In case of a suspected comorbid sleep disorder an appropriate diagnostic investigation should be performed. Moreover, the possible presence of sleep fragmentation induced by sleep-related seizures should be ruled out. Finally, the dose and timing of antiepileptic medications and other co-medications should be optimized to improve nocturnal sleep and avoid daytime sedation.

UR - http://www.scopus.com/inward/record.url?scp=85116354872&partnerID=8YFLogxK

U2 - 10.1016/j.yebeh.2021.108341

DO - 10.1016/j.yebeh.2021.108341

M3 - Article

SN - 1525-5050

VL - 124

JO - Epilepsy & Behavior

JF - Epilepsy & Behavior

M1 - 108341

ER -