Milena Pavlova, MD, neurologist, and medical director of the sleep testing center at Brigham and Women’s Faulkner hospital, talks about how factors such as the sedative effects of anti-epileptic medications can mask sleep issues and diagnoses in people with epilepsy.
Milena Pavlova, MD, neurologist, and medical director of the sleep testing center at Brigham and Women’s Faulkner hospital, talks about how such factors as too little time in an appointment to screen for sleep as one of many possible reasons sleep disorders are underdiagnosed in people with epilepsy.
This interview took place at the American Academy of Neurology 75th annual meeting in Boston, MA.
Are sleep disorders underdiagnosed in people with epilepsy? If so, why?
Yes, is the short answer. Why is always a complex question, no matter what you're talking about. I feel that sleep has traditionally been undervalued by physicians, for one obvious reason. We go through a very strenuous process of residency during which we are implicitly told the sleep doesn't matter, because we don't get to sleep much.
That kind of joke aside, a patient with epilepsy has a chronic disease that requires a lot of complex treatment. There is the treatment with medications, there is the consequence of seizures, there is the consequence of having a chronic disease that affects your consciousness, and all the implications of this. So, it is a complex treatment altogether. Somehow sleep, it's just one component of many different things than the physician has to do. So, that's one reason; they simply might not have enough time to ask about the sleep of the patients.
The second thing is that some of the signs of sleep disorders can be attributed to something else. Because when a patient with frequent seizures has a seizure, often they would be afterward sleepy or confused. So, whatever sleepiness the patient reports can often be attributed to just uncontrolled seizures, appropriately so, but there might be a contributing factor of a sleep disorder. Another thing is that most of the anti-epileptic medications have more or less of a sedating effect. So, a lot of the times the symptoms of sleepiness is attributed to the sedating effect.
Having a chronic disease altogether can make you a little bit more anxious; a little bit more difficult to sleep at night. The whole process of having seizures during the daytime, potentially disrupting the regularity of sleep and wakefulness, can be another reason for poor sleep. So, a lot of the times the sleep complaint gets attributed to something else; that is very common in patients with epilepsy.
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