To Sleep, Perchance to Dream

Sleep is important for all of us because it enhances memory and attention. But according to Carl W. Bazil, MD, PhD, "Persons with epilepsy are more at risk for sleep related problems because of additional factors that can worsen cognitive function, including seizures, underlying conditions causing epilepsy, and medication effects." We will feature Dr. Bazil's article, adapted from the forthcoming book Behavioral Aspects of Epilepsy: Principles and Practice, edited by Steven C. Schachter, MD; Gregory Holmes MD, and Dorotheé Kasteleijn-Nolst Trenité, MD, (Demos) in September. However, since summer is often a time when people tend to overexert themselves, we bring you Dr. Bazil's prescription for a good night's sleep, which might be helpful for your patients. | Rita Watson, MPH, Senior Editor

The Importance of Sleep

by Carl W. Bazil, MD, PhD

General bedtime rules:

• Go to sleep at about the same time each night, and awaken at the same time each morning. Wide fluctuations between workdays and days off can further impair your sleep.
• Try not to nap. If you do, restrict this to about an hour per day, and do it relatively early -- before about 4 o’clock in the afternoon.
• If you are not sleepy, either don’t go to bed or arise from bed. Do quiet, relaxing activities until you feel sleepy, then return to bed.
• Avoid doing stimulating, frustrating, or anxiety provoking activities in bed or in the bedroom such as watching television, studying, or balancing the checkbook

Use of caffeinated beverages and medication

• Avoid coffee, tea, cola or other caffeinated beverages after about noon. Also avoid chocolate late in the day.
• If you smoke, avoid this in the hour or two before bedtime.
• If you drink alcohol (after discussion with your physician), limit this to 1-2 drinks per day and do not drink immediately before bedtime. Although you may find this relaxing, alcohol actually can interfere with sleep later in the night.
• If you take prescription drugs or over-the-counter drugs that can be stimulating, discuss dosing times with your doctor.

Exercise

• Exercise, particularly aerobic exercise, is good for both sleep and overall health and should be encouraged.
• Avoid stimulating exercise in the evening. If you are exercising, do this at least 5 hours before bedtime.

Bedtime ritual

• Perform relaxing activities in the hour before bedtime.
• Make sure your sleeping environment is as comfortable as possible, paying attention to temperature, noise, and light.
• Do not eat a heavy meal just before bedtime, although a light snack might help induce drowsiness.
• It is sometimes helpful to place paper and pen by the bedside. If you find yourself worrying about completing or remembering a task the next day, write it down and let it go.

During the night

• If you awaken and find you can’t get back to sleep, arise from bed and do quiet, relaxing activities until you are drowsy. Then return to bed.
• Place clocks so that the time is not visible from the bed.

Adapted from a chapter by Carl W. Bazil, MD, PhD, The Neurological Institute, New York in the forthcoming book Behavioral Aspects of Epilepsy: Principles and Practice, edited by Steven C. Schachter, MD; Gregory Holmes MD and Dorotheé Kasteleijn-Nolst Trenité, MD (Demos). Dr. Bazil is a member of the editorial board of epilepsy.com.

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