Insomnia More Prevalent, Severe in Patients With Epilepsy

The prevalence and severity of insomnia is heightened among patients with epilepsy, found a new study published in Epilepsy Research.

Investigators also determined that insomnia was mostly driven by fear of sleep. Notably, fear of sleep did not differ significantly between the 184 patients with epilepsy and the 197 controls. The findings are the first of its kind, explained the researchers.

“Although additional research is warranted, our findings suggest that all individuals with insomnia, regardless of epilepsy status, may benefit from insomnia interventions that target trauma, depression, anxiety, and fear of sleep,” explained the researchers. “People with epilepsy are likely to benefit from an additional treatment component targeted at trauma specifically related to seizures, but also management of seizures themselves.”

For this analysis, patients completed a series of online questionnaires, including the Insomnia Severity Index (ISI) and the Fear of Sleep Inventory–Short Form. The researchers acknowledged that due to this data collection, they were unable to verify the epilepsy status of participants.

Over 80% of patients with epilepsy and more than 60% of controls scored above the ISI threshold for insomnia. This is higher than reported in previous studies, which have found a prevalence of approximately 50% among patients with epilepsy and 25% among controls.

A significantly higher proportion of patients with epilepsy scored above the threshold for clinically significant insomnia compared with controls (82.7% vs 62.4%), in line with previous research, some of which have attributed the increased insomnia to antiepileptic drugs.

These recent findings offer an alternative, albeit preliminary, explanation, with fear of sleep among their study population predicting insomnia. However, fear of sleep was the biggest driver of insomnia about both groups, potentially indicating it is not the only factor driving heightened insomnia among patients with epilepsy.

Questionnaire results also revealed differences in the drivers of the fear of sleep. Fear of sleep in the patients with epilepsy was largely attributed to trauma, particularly postseizure trauma. Nonseizure trauma was also reported, but to a much smaller extent. Other factors included seizure frequency, post-traumatic stress disorder (PTSD), and anxiety.

Meanwhile, in controls, PTSD and anxiety played large roles in their fear of sleep, although controls reported significantly less experience with trauma.

“Given the role of trauma in fear of sleep, treatment of trauma should be central in treating fear of sleep across epilepsy and general populations,” described the researchers. “In PWE, treatment should consider general trauma but also postseizure-related trauma that we found to play the most significant role in fear of sleep in people with epilepsy. Further, it may be important to keep in mind that interictal experiences themselves could induce PTSD (Cohen et al., 2010), but also that a traumatic event may lead to onset of epilepsy or trigger seizures (Greig & Betts, 1992).”

Reference

Norton SE, Hunt C, Lah S. Fear of seep in people with epilepsy. Epilepsy Res. Published online March 16, 2023. doi:10.1016/j.eplepsyres.2023.107124