Epilepsy Causes Disturbed Sleep Patterns in Pregnant Women

Epilepsy is a neurological disorder which predisposes to developing seizures. Epilepsy and sleep have a bidirectional relationship that is poor sleep can provoke seizures and at the same time having epilepsy can predispose to sleep problems.

Sleep is essential for various physiological functions like memory consolidation. Epilepsy disrupts sleep and sleep deprivation can provoke seizures. Sleep disorders like obstructive sleep apnea are more common in epileptic patients.

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Sleep disorders are common among pregnant women ad to worsen across gestation from the first to the third-trimester pregnancy-related sleep disorders can lead to poor maternal quality of life as well as increase risk to the unborn child. There was a study done recently called The Maternal Outcomes and Neurodevelopmental Effects of Antiepileptic Drugs (MONAD STUDY) which was funded by NIH (National Institute of Health, USA) and studied how sleep is affected in pregnant women with epilepsy, healthy women and non-pregnant women with epilepsy. Pregnant women with epilepsy had worse sleep during pregnancy compared to healthy pregnant women. During postpartum, pregnant WWE (Women with Epilepsy) had similarly impaired sleep compared to healthy pregnant women.

Sleep and epilepsy share the involvement of the thalamocortical network. Neurotransmitters involved in sleep like adenosine, melatonin, prostaglandin D2, serotonin, and histamine have anti-seizure effects. Children with epilepsy have less REM sleep. Insomnia in epileptic patients may be due to nighttime seizures, or anxiety. Obstructive sleep apnea is a respiratory disorder associated with the collapse of the upper airways during sleep. OSA affects 30% of epileptics. NREM sleep disorders include sleepwalking, sleep, and terror. They may mimic seizures seen in nocturnal frontal lobe epilepsy. REM sleep disorders like vocalizations and sudden body movements during sleep occur in 12% of older patients with epilepsy. Pregnant women have poor sleep efficiency with poor quality of NREM sleep with more arousals.

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Pregnancy alters sleep. NREM sleep is enhanced by progesterone and prolactin, and REM sleep is enhanced by estrogen and progesterone drop. Oxytocin-induced uterine contractions that peak during the night also lead to sleep fragmentation. Besides hormones, other factors that lead to sleep disruption in pregnancy include gastroesophageal reflux which affects 75% of pregnant women. Increased nocturnal urination due to increased nocturnal sodium excretion as well as anatomical changes in the uterus disturbs sleep. Iron and folate deficiency may also play a role in sleep-induced movement disorders. Recent studies show that 46 % of pregnant women have poor sleep quality during pregnancy. This worsens from the second to the third trimester. During early gestation, sleep is disturbed due to nausea, back pain and urinary frequency. In late gestation 70% of women report difficulty in maintaining sleep, 34% have early morning awakenings and 23% have difficulty falling asleep. This is mainly due to fetal movements, cramps, heartburn and shortness of breath. These symptoms are more severe in WWE as compared to Non-epileptic pregnant women. We have seen similar statistics in our hospital KMC Hospital Mangalore.

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Though a majority of epileptic pregnant women have no change in seizure frequency during pregnancy, the increase in frequency is related to drug noncompliance or sleep deprivation.

With good medical attention pregnancy, it seems to have a minimal influence on epileptic women. Proper sleep hygiene during pregnancy can help in preventing seizures.