A reciprocal relationship exists between sleep and epilepsy. The quality of sleep is affected by the presence and frequency of seizures, type of antiepileptic therapy utilized, and coexisting primary sleep disorders. Daytime somnolence is one of the most common adverse effects of antiepileptic therapy, with specific pharmacologic agents exhibiting a unique influence on components of sleep architecture. The newer generation of antiseizure drugs demonstrates improved sleep efficiency, greater stabilization of sleep architecture, prolongation of REM sleep duration, and increased quality of life measures. The emerging field of chronoepileptology explores the relationship between seizures and circadian rhythms, aiming for targeted use of antiseizure therapies to maximize therapeutic effects and minimize the adverse events experienced by the patients. 1. Introduction Although the complex relationship between sleep and epilepsy has not been fully elucidated, it is well known that sleep disturbance provokes seizures and that seizure activity may influence the quality of sleep. In addition, antiepileptic drugs (AEDs) that are commonly used for seizure treatment affect sleep quality and architecture. Some AEDs tend to cause sleepiness or drowsiness while others can lead to insomnia. Sleep is an essential physiologic state that influences restorative and memory consolidating functions . As previously recognized, the relationship between epilepsy and sleep disturbance is likely multifactorial: the direct effect of seizures, adverse events due to AED therapy, presence of psychiatric comorbidity, and coexisting sleep disorders all have the potential to contribute to alteration of sleep architecture and the subjective quality of sleep. Accordingly, one would expect that lack of sound sleep would significantly impact neurocognitive and psychological function, especially in patients treated with AEDs for their seizures. It is important for clinicians to understand the proclivity of a specific AED to affect the quality of sleep in order to guide epilepsy therapy and prevent disturbance of a patients’ nocturnal recovery. This review systematically evaluates the currently available literature, elucidating the effect of antiepileptic drug therapy upon the sleep cycle. A search of relevant primary research and review articles was performed utilizing the PubMed database. 2. Epilepsy and Sleep Sleep is classically divided into REM and non-REM phases as defined by the parameters of electroencephalography, respiration, eye movement, and electromyography. The non-REM phase
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