Sleep disorders with epilepsy. Paroxysmal and non-paroxysmal sleep disorders in epileptics

Sleep disorders in epilepsy are not adequately covered in the literature, therefore, we paid special attention to the state of sleep in the premorbid period and in the initial stage of epilepsy. Sleep is one of the most sensitive and subtle indicators of the functional state of the central nervous system. Sleep disorders (non-paroxysmal and paroxysmal), like other symptoms in the premorbid period, we can conditionally divide into two periods: 1) distant from the onset of the disease (history); 2) the closest, in the interval from several weeks to 3 years, immediately before the onset of the first epileptic seizures (prodromal period). Sleep was studied in 400 patients. In accordance with the division of sleep into 3 stages (falling asleep, flow, awakening), non-paroxysmal disorders were investigated in each of these stages. A sign of sleep disturbance was a slow transition from wakefulness to sleep. Most often, the reason for this was fixing attention on individual emotionally saturated thoughts, the most striking events of the current day, or individual memories. Some patients were prevented from falling asleep by phobias – fear of thieves, death, a seizure in a dream, or some unaccountable fear bothered. Typically, in the same patient, the phobias were uniform in content. The course of sleep was determined by a number of parameters: depth, duration, continuity. Violations of the sleep course included its surface, great sensitivity, motor anxiety with frequent turns, sobbing, smacking, gnashing of teeth, waking up at night with subsequent insomnia. A delayed transition from a state of sleep to wakefulness, a feeling of drowsiness, heaviness, unwillingness to get out of bed, lack of alertness and freshness after sleep, and headache were considered as an awakening disorder. Non-paroxysmal sleep disorders, as well as paroxysmal, show a tendency to a significant increase in the initial stage of the disease. The number of patients with non-paroxysmal sleep disorders in the initial stage increases 3 times compared with the period preceding the onset of attacks, and almost 7 times compared with the anamnesis. The increase in the frequency of sleep disturbances in the period preceding the onset of epileptic seizures, and at the beginning of the disease applies to all three stages of sleep: falling asleep, flowing and waking up. The greatest number of patients in the initial period of the disease was with impaired awakening. This is due to the fact that, in addition to the primary disturbance of awakening, it was influenced by disorders of the previous stages of sleep. So, the difficulty of falling asleep, insomnia, shallow sleep and other disturbances during sleep affect the rate of transition to an awake state and the patient’s well-being in the morning after sleep. A course of membrane plasmapheresis allows to improve sleep and awakening. Paroxysmal sleep disorders include nightly fears, dreams, and other twilight states, some dreams, sleeping, laughter, crying, and crying in a dream. Myoclonic tremors during falling asleep and in sleep are highlighted by us especially, since in these cases convulsive manifestations are the main symptoms. Before the first epileptic seizures (ranging from several weeks to 3 years), paroxysmal sleep disorders occurred in 31% of patients. In the initial stage of epilepsy, they were observed in 45% of patients, which significantly exceeds the percentage of patients with similar disorders in history and before the onset of seizures. In most cases, various sleep disorders were combined, for example, at the same time as dreams, there were night cries, phrases, etc. Paroxysmal sleep disorders are closely related to non-paroxysmal disorders and are intertwined with them. They are combined with disorders of falling asleep, the course of sleep or waking up in the anamnesis in 27%, before the onset of the first seizures – in 51.6% and “in the initial stage of the disease – in 37% of patients. Paroxysmal disorders such asnightmares, nightmares, nightly fears, prolonged dreams, repeated night awakenings, affect the depth and continuity of sleep. The well-being of the patient in the morning largely depends on them. A feeling of fatigue, weakness, drowsiness, irritability, headache – all these symptoms are often caused by paroxysmal sleep disturbances.