Abstracts

Rationale: Insomnia in patients with epilepsy has been well described. However, there have been no studies documenting the self-directed sleep medication usage of patients with epilepsy and insomnia. The purpose of this study is to explore the tendency of patients with epilepsy and insomnia to try either over-the-counter sleep medications or prescribed sleep medications before presenting to a Sleep physician. Methods: We performed a retrospective chart review of patients with epilepsy and insomnia. The inclusion criteria included patients with epilepsy and insomnia who presented to the New York Sleep Institute over a one-year period. Results: There were 50 patients with epilepsy and insomnia included in the study. Average age was 48.4 years. Patients’ ages ranged from 16 to 91 years. 13 patients had excessive daytime sleepiness as determined by a score greater than 10 on the Epworth Sleepiness Scale (ESS). 24 patients snored. 25 patients reported trouble falling asleep. Five patients reported difficulties staying asleep. Two patients had nocturnal seizures. One patient was not on an anti-epileptic drug (AED). 21 patients were on one AED. 20 patients were on two AEDs. Six patients were on three AEDs. Two patients were on four AEDs. 29 patients (58%) did not take medications for sleep prior to presenting to Sleep clinic. 21 patients (42%) took medications for sleep. 13 patients took zolpidem; three patients took diphenhydramine; two patients took melatonin. Three patients took more than one medication: one patient took a combination of zolpidem and quetiapine, one patient took a combination of zolpidem and eszopiclone, and one patient took a combination of zolpidem, eszopiclone, trazodone, and mirtazapine. The average ESS score for patients who took medications for insomnia was 4.9/24 (range, 1/24 to 14/24). The average ESS score for patients who did not take medications was 8.75/24 (range, 0/24 to 24/24). Two of 13 patients with excessive daytime sleepiness (15.4%) took medications for insomnia. 19 of 37 patients without excessive daytime sleepiness (51.4%) took medications. 10 of 21 patients on one AED (47.6%) took medications for insomnia. Nine of 20 patients on two AEDs (45%) took medications for insomnia. Two of eight patients on three or more AEDs (25%) took medications for insomnia. Conclusions: Many patients with epilepsy and insomnia take sleep medications prior to presenting to a Sleep physician. Patients on one or two AEDs were more likely to take medications for insomnia than patients on three or more AEDs, which suggests that patients on multiple AEDs may be hesitant to take additional medications. Interestingly, patients without excessive daytime sleepiness were more likely to take medications for insomnia than patients with excessive daytime sleepiness.