Sleep disturbances in patients with psychogenic non-epileptic seizures: Is it all subjective? A prospective pilot study of sleep-wake patterns

Purpose: Patients with psychogenic non-epileptic seizures (PNES) frequently complain of poor sleep, yet there are few and inconsistent data supporting objective sleep disturbances in this population. In this prospective observational study, we aimed to compare objective and subjective sleep-wake patterns in patients with PNES with those with epilepsy. Methods: Subjects were recruited through the Brigham and Women's Epilepsy Monitoring Unit (EMU) over a 6-month period, and were diagnosed as having PNES or epilepsy by experts using video-electroencephalography (v-EEG). Sleep-wake patterns were objectively examined using EEG and actigraphy during EMU admission. Subjects also completed several validated questionnaires on sleep. Results: Twenty-seven subjects, including 17 with PNES and 10 with epilepsy were enrolled in the study. Compared to controls with epilepsy, PNES subjects showed greater sleep onset latency (48.7 +/- 47.5 min vs 14.0 +/- 13.4 min; p = 0.02). Otherwise, sleep architecture was similar between the groups. However, subjectively, PNES subjects reported worse sleep quality (10.8 +/- 5.1 vs 5.8 +/- 2.9; p = 0.01) and were more likely to meet clinical criteria for insomnia relative to epilepsy subjects (50% vs 10%, p = 0.05). Moreover, a higher proportion of PNES subjects reported taking medications for sleep (44% vs 0%, p = 0.01). Conclusion: Overall, we found more evidence for a subjective basis rather than a pathophysiological nature for the reported sleep disturbances in PNES subjects. In addition to educating PNES patients on the importance of maintaining good sleep habits, clinicians should address sleep complaints and screen for insomnia, as effective treatments are available and may improve overall health.