Nonepileptic Attack Disorder Is Associated With Poor Sleep Quality

Man trying to sleep in his bed but feeling frustrated
This study was designed to investigate subjective and objective sleep impairments of those with nonepileptic attack disorder (NEAD) and if reported sleep disturbances reflect objective sleep impairment.

Patient-reported sleep difficulties should be given careful clinical consideration among patients with nonepileptic attack disorder (NEAD) because poor sleep was found to be common in these patients during a 6-night sleep study, according to study results published in Epilepsy and Behavior.

Study researchers recruited participants (n=17) with NEAD and control group participants (n=20) from the National Health Service in the United Kingdom for this 6-night study of objective sleep variables, next-day functioning, and attacks. The research team assessed participants objectively using the Actiwatch, a device worn on the wrist to monitor activity, wakefulness, and sleep, and also assessed them with validated instruments. Participants kept a sleep and mood journal of subjective findings.

Participants with NEAD had a median of 8 (interquartile range [IQR], 18.75) attacks per month.

Participants with NEAD and those in the control group differed significantly for Pittsburgh sleep quality index (PSQI; d, 0.80; P =0.000), dissociative experience scale-II (DES-II; d, 0.72; P =0.000), generalized anxiety disorder 7 (GAD7; d, 0.76; P =0.000), and patient health questionnaire 9 (PHQ9; d, 0.84; P =0.000) assessments.

During the experiment, participants with NEAD had poorer sleep quality (d, 0.57; P =0.000), greater sleep latency (d, 0.52; P =.023), reduced sleep efficiency (d, 0.41; P =.027), increased wakefulness after sleep onset (d, 0.43; P =.030), and more awakenings (d, 0.43; P =.042) than control group participants.

During the week, control group participants had significantly higher reports of positive affect (t[31], -2.9; P £.01) and the participants with NEAD had more reports of dissociation (t[18.8], 6.9; P £.001).

Those with NEAD experienced daily attacks during the study duration (mean, 1.1; standard deviation [SD], 1.7). Attacks were associated with increased hours of sleep (odds ratio [OR], 2.78; 95% CI, 1.2-10.6; P <.05) and decreased awakenings (per event: OR, 0.8; 95% CI, 0.6-0.9; P <.05).

This study was limited by its small sample size and underpowered statistical analysis.

These findings suggested that participants with NEAD had poorer sleep and mood compared with members of the control group. Significant associations between total sleep time and awakenings and likelihood for attacks indicated an important clinical relationship between NEAD and sleep.

Additional studies that are higher powered are needed to better assess clinical implications of sleep quality among patients with NEAD.


Mousa S, Latchford G, Weighall A, et al. Evidence of objective sleep impairment in nonepileptic attack disorder: a naturalistic prospective controlled study using actigraphy and daily sleep diaries over six nights. Epilepsy Behav. Published online March 5, 2021. doi:10.1016/j.yebeh.2021.107867