Miya Pearson
Sleep and seizure disorders are closely linked, with seizures and their treatment affecting sleep, and sleep disorders influencing seizure control. Certain medications can be used to treat both sleep and seizure disorders. For example, gabapentin enhances slow-wave sleep and increases sleep continuity, while also being used to treat epilepsy. Benzodiazepines, such as diazepam and lorazepam, are used to treat seizure disorders and can help people fall asleep faster, but they also decrease REM sleep and slow-wave sleep. Melatonin is another supplement that can be used to treat insomnia and is safe for children with epilepsy, although clinical tests on its effectiveness have shown mixed results. Antihistamines should be avoided as a sleep aid for epileptic people as they destroy the ability to progress through all stages of sleep.
| Characteristics | Values |
|---|---|
| Sleep aids that may be harmful when mixed with seizure medication | Benzodiazepines (diazepam and lorazepam), barbiturates (phenobarbital, primidone), antihistamines (doxylamine and diphenhydramine), promethazine |
| Sleep aids that may be safe or beneficial when mixed with seizure medication | Gabapentin, melatonin, Z-drugs (non-benzodiazepine medication), orexin antagonists, zonisamide, eslicarbazepine acetate, lacosamide, perampanel, cannabidiol, carbamazepine, levetiracetam, epilepsy surgery |
| Sleep aids with mixed or unclear effects when mixed with seizure medication | Melatonin, clonazepam, valproic acid, lamotrigine, oxcarbazepine, zonisamide, topiramate |
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What You'll Learn
Melatonin supplements may help with epilepsy and sleep
Sleep and epilepsy have a complex relationship. Seizures and their treatment can affect sleep, and sleep disorders may influence seizure control. Certain anti-seizure medications (ASMs) can enhance or disrupt sleep independently of their effects on seizures. Benzodiazepines, for instance, are known to decrease REM sleep and slow-wave sleep despite reducing the time it takes to fall asleep. Gabapentin, on the other hand, has been shown to enhance slow-wave sleep and increase sleep continuity.
People with epilepsy have lower-than-average melatonin levels, and these levels fluctuate, dramatically increasing after seizures. Melatonin is a hormone naturally produced by the brain, helping regulate the body's internal body clock and signalling when it's time to fall asleep or wake up. Lower levels of melatonin are produced during the day or in brightly lit environments.
Research on melatonin as a treatment for epilepsy has yielded mixed results. While it may improve physical and social well-being and sleep, further studies are needed to establish its efficacy in treating epileptic seizures. A 2015 study found that children who took melatonin supplements at bedtime experienced improved sleep. Another study indicated that melatonin reduced the severity of epilepsy and improved sleep quality in 40% of subjects in the first round and 53.4% in the second round. Melatonin has also been shown to suppress seizure activity in animal models and human investigations of temporal-lobe epilepsy. However, the Food and Drug Administration (FDA) has not approved melatonin supplements for treating epilepsy or sleep difficulties.
If you are considering melatonin supplements, it is crucial to consult your doctor first, especially if you are already taking epilepsy medication, as mixing melatonin with other epilepsy medications can be dangerous.
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Gabapentin can improve sleep and treat insomnia
Gabapentin is a prescription medication that can help improve sleep and treat insomnia. It was originally designed for antiepileptic therapy, but studies have shown that it increases slow-wave sleep in healthy volunteers and patients with insomnia. It improves sleep quality by decreasing spontaneous arousal (i.e., waking up in the middle of the night) and increasing sleep efficiency. It also reduces nighttime awakenings and promotes more slow-wave sleep.
Gabapentin is an anticonvulsant that is primarily used to treat seizures, but it can be prescribed off-label as a sleep aid. While it has not been specifically approved by the Food and Drug Administration (FDA) to treat insomnia, it can be helpful for sleep issues. However, it is rarely prescribed for insomnia and is not typically a first or second-line sleep aid medication.
The average daily dose of gabapentin for improving sleep is about 1,800 mg. It takes about 2 to 3 hours for immediate-release gabapentin to reach its full effect, and it is typically taken 3 times per day. Mild sedation and lethargy are the most common side effects, but these tend to improve with continued dosing.
It is important to note that studies on the effects of gabapentin on primary insomnia are limited, so experts cannot say with certainty if the benefits outweigh the risks. Additionally, there is a risk of misuse and dependence on gabapentin, which raises concerns about its long-term use. As such, it is crucial to consult with a licensed medical provider to determine the most suitable treatment for insomnia.
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Benzodiazepines can be detrimental to sleep
While benzodiazepines are commonly prescribed for their sedative effects, they can also be detrimental to sleep. Benzodiazepines are a class of depressant drugs with sedative effects used to treat anxiety, panic disorder, convulsions, seizures, and other disorders. They are also highly addictive.
Benzodiazepines can cause sleeping issues rather than remedy them. Short-acting benzodiazepines are associated with lower nighttime sleep quality and longer daytime napping compared to long-acting regular benzodiazepines. This is because the quality of sleep induced by benzodiazepine is different from that of natural sleep in terms of brain activity. Benzodiazepines decrease the amount of REM sleep and slow-wave sleep.
Benzodiazepines are also known to cause weight gain and insomnia or similar sleep disorders, especially with long-term use. They can also impair natural sleep architecture and cause rebound insomnia upon cessation.
While benzodiazepines can be detrimental to sleep, they may benefit epilepsy patients with insomnia. However, it is important to note that benzodiazepines are used less commonly for the chronic treatment of seizure disorders.
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Anticonvulsants can enhance or disrupt sleep
Sleep disturbances are among the most frequent side effects of treatment with anti-seizure medications (ASMs). They can deeply modify both sleep architecture and the sleep-wake cycle. Severe daytime somnolence affects patients' activities and may even trigger seizures. Therefore, it is important to consider the effects of ASMs on sleep when treating epilepsy.
Some ASMs, such as eslicarbazepine acetate, lacosamide, and perampanel, have been found to improve or have no effect on sleep. Perampanel, for instance, is associated with a low incidence of insomnia, and lacosamide is linked to a low incidence of daytime sleepiness. Carbamazepine, levetiracetam, and cannabidiol also seem to have no detrimental effects on sleep. Gabapentin, a drug used to treat epilepsy, has been found to enhance slow-wave sleep and increase sleep continuity while decreasing awakenings. Limited studies suggest that it may also be useful in treating restless leg syndrome, a common sleep disorder.
On the other hand, certain ASMs, such as clonazepam, felbamate, lamotrigine, oxcarbazepine, and phenobarbital, have been associated with negative effects on sleep. Lamotrigine may increase the risk of insomnia, while phenobarbital may cause daytime sleepiness. Benzodiazepines (such as diazepam and lorazepam) and barbiturates (such as phenobarbital and primidone) are used less commonly for chronic seizure treatment, but they have the most convincing evidence for detrimental effects on sleep. They reduce the time it takes to fall asleep but also decrease REM sleep and slow-wave sleep.
While the effects of zonisamide, oxcarbazepine, and topiramate on sleep are not yet known, patients with sleep problems may need to adjust their anticonvulsant dosing or, in rare cases, switch to another drug. Additionally, epilepsy surgery may benefit sleep in patients with a good surgical outcome.
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Orexin antagonists can improve sleep architecture
While some seizure medications have been found to increase sleep stability, it is challenging to distinguish between the effects of these drugs on seizures and their independent effects on sleep. Benzodiazepines, for instance, decrease the time it takes to fall asleep but also reduce REM sleep and slow-wave sleep. Other medications, such as gabapentin, enhance slow-wave sleep and increase sleep continuity.
Orexin antagonists, also known as dual orexin receptor antagonists (DORAs), are a new type of prescription sleep aid that targets the body's orexin system. Orexin neuropeptides are produced in the hypothalamus and play a role in regulating sleep, energy metabolism, and mood. They are primarily excitatory, stimulating other neurons to become active. By blocking the effects of these neuropeptides, orexin antagonists reduce the drive to stay awake and facilitate sleep.
Several clinical studies indicate that orexin antagonists are effective hypnotics in older persons and dementia patients. They are generally well tolerated and have been shown to improve sleep quality in people with insomnia. They increase total sleep time by promoting REM sleep without negatively affecting non-REM sleep. This makes them particularly useful for treating insomnia, as they can improve sleep architecture by increasing the duration and quality of sleep.
While orexin antagonists offer a promising approach to treating insomnia, they may not be suitable for everyone. Before taking any sleep medication, it is essential to consult with a doctor or sleep specialist. Behavior changes, such as improving sleep hygiene, should also be considered as a first step before medication.
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Frequently asked questions
It depends on the type of sleep aid and seizure medication. Some sleep aids can be addictive or detrimental to sleep. It is important to consult a doctor before taking any medication.
Antihistamines such as Doxylamine and Diphenhydramine are not recommended for epileptic people as they can destroy your ability to naturally progress through all stages of sleep. Benzodiazepines, while effective, can be addictive and impair natural sleep architecture.
Melatonin is a natural sleep aid that can be helpful for people with epilepsy. It is a hormone that helps regulate your body's internal clock and is available as a synthetic supplement. However, it is important to consult a doctor before taking melatonin, especially if you are already taking epilepsy medication.
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