The Effect of Sleep Hygiene Given to Epilepsy Patients on Seizure Frequency and Sleep Quality

The Effect of Sleep Hygiene Training on Seizure Frequency and Sleep Quality in Epilepsy Patients

Epilepsy is a disease that can be seen in everyone, including neurological, chronic, elderly and children. An estimated 50 million people in the world have epilepsy, patients have a history of two or more seizures, the exact cause is unknown, it negatively affects home, work and school life, and it directs individuals from their independent roles to semi-dependent and fully dependent roles (Smith & Wagner & Jonathan, 2015). "Neuronal networks hypersynchronization" develops epileptic seizures, can cause insomnia, and sleep quality may decrease with drug treatment (Sünter and Ağan, 2019). NREM sleep causes seizures through the "ictal and interactive effect" of sleep (Alp and Altındağ, 2014). Insomnia increases seizure discharges, neurological and systemic complications may develop, and serious morbidity and mortality may occur (Özer, 2005). Epilepsy patients frequently experience daytime sleepiness and nighttime insomnia (Gümüşyayla and Vural, 2017). Complementary medical approaches are also recommended along with drug treatment. Sleep hygiene training is recommended for sleep health in epilepsy as in chronic diseases. With good sleep health, symptoms can be eliminated and sequelae can be prevented by reducing epileptic discharges (Gammino at all., 2016). Quality sleep is essential for physiological and psychological health, and sleep disorders can be corrected with sleep hygiene training (Günaş, 2018). Randomized studies including sleep hygiene training are needed to prevent seizure recurrences, prevent or treat comorbid psychological diseases, and improve life activities of epilepsy patients (Lee at all., 2015). One-third of people's lives are spent in sleep, regular and adequate sleep protects physiological and psychological health, sleep hygiene training contributes to the recovery of sleep disorders and accompanying psychological comorbid diseases, sleep hygiene training is cost-free and easy to implement, where daily activities and behaviors are regulated, appropriate environmental conditions are provided. By regulating the circadian rhythm, melatonin is released during sleep at night and sleep disorders are prevented by preventing excessive cortisol release (http://www.psikiyatri.net/uyku-hijyeni / Access date: 28 May 2022; Alp and Altındağ, 2014; Güneş, 2018). . No research has been found on sleep hygiene training to relieve sleep deprivation, which is common in epilepsy patients. With good sleep hygiene, sleep and quality of life can be improved and epileptic seizures can be prevented or reduced.

Purpose of the research; To determine the effect of sleep hygiene training given to epilepsy patients on seizure frequency and sleep quality. Non-drug clinical research is an experimentally planned research with a pre-test post-test control group trial model.

Study Overview

• Status: Active, not recruiting
• Conditions: Epilepsy
• Intervention / Treatment: Behavioral: Sleep Hygiene Training

Detailed Description

Epilepsy is a non-communicable disease and is included in chronic diseases, it can be seen in all age groups (WHO, 2022) https://www.who.int/en/news-room/fact-sheets/detail/epilepsy Access date:28 May 2022. Epilepsy patients were under intense stress during the coronavirus epidemic, experienced intense anxiety and sleep disorders, and their quality of life was negatively affected (Elmalı et al., 2020). In their routine lives, epilepsy patients should be compliant with treatment for epilepsy seizure control, provide adequate sleep hygiene, have a balanced diet, and prefer a stress-free life (Adadıoğlu and Oğuz, 2016). Epilepsy patients complain of excessive daytime sleepiness between 16.9% and 28%, more than 50% experience insomnia at night due to night seizures and accompanying anxiety and depression diseases, insomnia triggers epileptiform discharges (seizures) in 25% of generalized epilepsy patients, Studies report that in 97% of epilepsy patients, insomnia, stress, and fatigue worsen the frequency and pattern of seizures. When sleep hygiene is ensured; It inhibits the release of stress hormones such as cortisol and noradrenaline from the hypothalamic pituitary and provides epileptic seizure control (Nunes at all., 2020). With sleep hygiene training, it improves sleep quality and quality of life in chronic diseases and sleep disorders (Muz et al., 2021; Ekinci, 2020). Nurses play an important role in the management of epilepsy and in supporting patients and their relatives; individuals are negatively affected psychologically and socially, especially seizure control and preventing possible complications, protection from trauma during seizures and providing emergency intervention, detection of self-care deficiencies, compliance with medication treatment, emotional changes, preventing fatigue and weakness, correct exercise, avoiding stress, preventing eating disorders. They contribute greatly to the quality of life with their educational and consultant roles in correcting sleep disorders and preventing sleep disorders (Enç et al., 2017; Ovayolu and Ovayolu, 2017; Özer, 2005).

Our goals; Our aim is to improve sleep quality and control seizures with the sleep hygiene training we provide to epilepsy patients.

Research Questions:

1. How does the sleep hygiene training given to patients with epilepsy in the experimental group affect their sleep quality?
2. Is there a relationship between sociodemographic characteristics and insomnia in patients with epilepsy in the experimental group?
3. Is there a significant difference between the experimental group and the control group? Patients diagnosed with epilepsy who applied to the neurology outpatient clinic of the hospital where the research is planned to be conducted constitute the population of the study. The number of samples was determined by power analysis, and the experimental and control groups will be determined by randomization. Sleep hygiene training will be given to the experimental group, and before and after surveys will be filled out. The control group will not be trained. We aim to contribute to scientific knowledge with this study.

Non-drug clinical research pre-test post-test control group trial model experimentally planned research data. After obtaining written consent from the patients in a face-to-face interview by the researcher between 01 June 2023 and 01 December 2024, the experimental group was given an epilepsy patient introduction form and PSQI (Pittsburg Sleep Quality Index). ) and sleep hygiene training will be given to the patient, and a sleep hygiene booklet and training video will be given to the patient. A meeting with the patient is planned for one month later; The patient's seizure frequency will be evaluated with the seizure schedule and sleep quality will be evaluated with the Pittsburg sleep quality index, and sleep hygiene education will be given to the patient again. A follow-up meeting will be scheduled one month after the second interview, and seizure frequency and sleep quality will be re-evaluated with the forms. The research will be completed with the third interview with the experimental group. Three interviews will be held with the control group. After obtaining written consent from the patient to participate in the research, the epilepsy patient introduction form and PSQI (Pittsburgh Sleep Quality Index) are filled in, and a meeting with the patient is planned for one month later; The patient's seizure frequency will be evaluated with the seizure chart, and sleep quality will be evaluated with the Pittsburg sleep quality index. The third interview will be planned one month after the second interview, and the patient's seizure frequency and sleep quality will be evaluated with the seizure schedule, and the Pittsburg sleep quality index will be evaluated. Afterwards, the sleep hygiene booklet will be given to the patient and the study will be terminated.

In order for the research findings to represent the population of the study, the sample of the study was determined to be a total of 50 with 25 patients each, with 80% power for the experimental/control groups, using power analysis, with α=0.05 and β=0.3. Considering the patient participants' situations such as death and withdrawal from the study, and in order for the study to be parametric, it was determined that a total of 160 patients would be reached, 80 patients each in the experimental and control groups. Data analysis of the research will be carried out by performing the necessary statistical operations in a computer environment and evaluating the results at a 95% confidence interval and a significance level of p < 0.05. If the data shows a normal distribution, parametric tests (Student t test, Anova) will be used. If the data does not show a normal distribution, nonparametric tests (Wilcoxon, Kruskal -Wallis H Test) and Test-retest analyzes will be used.

• Study Type: Interventional
• Enrollment (Estimated): 160
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • Marmara University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

Diagnosed with epilepsy for at least one year Volunteer to participate in the research Able to read and write Turkish No communication barriers (psychiatric/hereditary problems, ability to speak and understand Turkish) Able to swallow antiepileptic drugs (Gabapentin, valproic acid, phenytoin, phenobarbital, carbamazepine, levetiracetam, etc.), Having had three or more epileptic seizures in the last year Epilepsies who declare that they have sleep problems and whose Pittsburgh Sleep Quality Index (PSQI) is 5 points or above.

Exclusion Criteria:

Want to leave work who underwent surgery during the study alcohol drinkers Benzodiazepine, sedative, etc. those who swallow tablets Those who do not swallow antiepileptic drug tablets deceased

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: sleep hygiene training; Experimental group first interview; Routine treatment of patients will continue. The interview will be face to face, and after obtaining consent from the patients, the Epilepsy Patient Information Form and Pittsburg Sleep Quality Index (PSQI) will be applied. Sleep hygiene training will be provided, and patients will be given a sleep hygiene training booklet and training video. After the training, the Pittsburg Sleep Quality Index (PSQI) will be applied. Patients will be given an Epileptic Seizure Diary and a Sleep Hygiene Chart, and they will be asked and evaluated together at the next meeting. Experimental group second interview; and the third meeting will be held once a month, and sleep hygiene training will be provided through face-to-face meetings with the patients. After the training, the Pittsburg Sleep Quality Index (PSQI) will be applied and the Epileptic Seizure Diary and Sleep hygiene chart will be requested from the patients and evaluated together.	Behavioral: Sleep Hygiene Training; The effect of sleep hygiene education in a pre-test quasi-experimental study.
No Intervention: Placebo Comparator; Routine treatment of the Control/Placebo group will continue. His insomnia and seizures will be monitored for three months. The survey will be filled out during monthly meetings.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pittsburgh Sleep Quality Index	Insomnia complaints of epilepsy patients who experience seizures due to insomnia	Three months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pittsburgh Sleep Quality Index	Sleep quality with sleep hygiene training given to insomniac epilepsy patients	Three months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
epileptic seizure diary	Seizure control with sleep hygiene training given to epilepsy patients	Three months

Collaborators and Investigators

• Sponsor: Marmara University

Publications and helpful links

General Publications

• Smith G, Wagner JL, Edwards JC. CE: Epilepsy Update, Part 1: Refining Our Understanding of a Complex Disease. Am J Nurs. 2015 May;115(5):40-7; quiz 48-9. doi: 10.1097/01.NAJ.0000465030.89975.e8.

Helpful Links

• It became a guide to the sleep hygiene training booklet

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2023
• Primary Completion (Estimated): December 1, 2024
• Study Completion (Estimated): December 1, 2024

Study Registration Dates

• First Submitted: March 24, 2024
• First Submitted That Met QC Criteria: April 2, 2024
• First Posted (Actual): April 8, 2024

Study Record Updates

• Last Update Posted (Actual): April 8, 2024
• Last Update Submitted That Met QC Criteria: April 2, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Sleep Hygiene; Epilectic Seizeures Related to Sleep Deprivation; Epilepsy; Sleep Deprivation
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Epilepsy; Seizures
• Other Study ID Numbers: 10881-669

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Since the research is currently in the data collection process, it will not be shared with other researchers. Once the research is completed, it can be shared with other researchers.

Study Data/Documents

1. Clinical Study Report
   Information comments: Bautista, R. E. D. Understanding the self-management skills of persons with epilepsy. Epilepsy & Behavior, 2017; 69, 7-11
2. Clinical Study Report
   Information comments: Buelow, J., Miller, W., & Fishman, J. Development of an epilepsy nursing communication tool: improving the quality of interactions between nurses and patients with seizures. The Journal of Neuroscience Nursing, 2018; 50(2), 74

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No