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CLINICAL FEATURES AND UNDERLYING FACTORS OF INSOMNIA
IN PATIENTS WITH NEUROLOGICAL DISORDERS
Tolibova Muhabbat Murod qizi
Bukhara State Medical Institute
Abstract.
Insomnia is a common yet often underdiagnosed condition among
patients with neurological disorders, significantly affecting their overall quality of life
and disease progression. This study aimed to evaluate the clinical presentation,
underlying causes, and management outcomes of insomnia across different
neurological conditions, including Parkinson’s disease, epilepsy, multiple sclerosis,
and post-stroke states. Eighty patients aged 25 to 55 were clinically assessed using the
Insomnia Severity Index (ISI), structured interviews, and, for a subset, overnight
polysomnography. Participants were divided into four diagnostic groups to analyze the
prevalence and severity of insomnia symptoms, contributing factors such as medication
side effects, anxiety, neuropathic pain, and seizure activity. The findings revealed that
sleep disturbances were widespread, with significant intergroup variations.
Polysomnography confirmed substantial alterations in sleep architecture. Among the
therapeutic interventions, cognitive behavioral therapy (CBT) proved to be the most
effective. The study highlights the importance of comprehensive and tailored
approaches to insomnia management in neurological patients, underscoring the need
for integrated neurological and psychological care.
Keywords:
insomnia, neurological disorders, sleep disturbance, ISI,
polysomnography, Parkinson’s disease, epilepsy, multiple sclerosis, stroke, cognitive
behavioral therapy
Introduction
Insomnia is a prevalent and often debilitating condition that
significantly impairs the quality of life, especially among individuals with neurological
disorders. The bidirectional relationship between sleep disturbances and neurological
diseases has been well documented, with insomnia not only exacerbating the symptoms
of the underlying condition but also acting as a potential risk factor for disease
progression. Sleep disturbances are commonly reported in disorders such as
Parkinson's disease, multiple sclerosis, epilepsy, and cerebrovascular diseases. Despite
increasing recognition of the impact of insomnia in neurology, there remains a need
for comprehensive clinical evaluation of its manifestation and contributing factors.
This study aims to assess the clinical presentation of insomnia and identify its
underlying causes in patients with various neurological disorders.
Materials and Methods
This clinical study was carried out over a six-month
period in three tertiary-level neurology centers. A total of 80 patients, aged between 25
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and 55 years, who had confirmed diagnoses of neurological disorders and reported
symptoms consistent with chronic insomnia, were recruited for this investigation. The
inclusion criteria consisted of patients with at least three months of sleep-related
complaints such as difficulty falling asleep, frequent night awakenings, or early
morning awakenings, coupled with daytime impairment. Patients with psychiatric
disorders unrelated to the neurological condition, acute illnesses, or recent use of sleep-
altering substances were excluded.
Each participant underwent a comprehensive neurological evaluation followed by
a structured clinical interview designed to gather demographic information, sleep
history, psychological symptoms (e.g., anxiety and depression), medication intake, and
lifestyle habits (including caffeine consumption and physical activity). To assess the
severity of insomnia, the Insomnia Severity Index (ISI) questionnaire was
administered. Based on their neurological diagnoses, participants were divided into
four groups: Group I – Parkinson’s disease (n = 20), Group II – Epilepsy (n = 20),
Group III – Multiple sclerosis (n = 20), and Group IV – Post-stroke patients (n = 20).
To further investigate physiological sleep parameters, 30% of patients in each
group were randomly selected to undergo overnight polysomnography in sleep
laboratories equipped for neurological monitoring. This allowed the objective
evaluation of total sleep time, sleep efficiency, sleep onset latency, and REM sleep
percentages. Data were processed using SPSS software, and statistical significance was
assessed using ANOVA and chi-square tests. Ethical approval was obtained from the
institutional ethics committees, and all participants provided informed consent.
Results
The analysis of clinical and instrumental data provided a detailed picture
of how insomnia presents and evolves in the context of different neurological
conditions. The primary aim of the study was to delineate the frequency, severity, and
causes of insomnia across neurological subtypes to guide appropriate interventions.
All participants reported symptoms of insomnia, with varying degrees of severity.
ISI scoring categorized the majority of patients as having moderate to severe insomnia.
Table 1 illustrates the prevalence of specific insomnia symptoms (difficulty initiating
sleep, nighttime awakenings, and early morning awakenings) across the four diagnostic
groups.
Table 1.
Prevalence of Insomnia Symptoms in Patient Groups
Symptom Type
Parkinson’s
Epilepsy
MS
Stroke
Difficulty falling asleep
85%
70%
75%
65%
Frequent awakenings
90%
80%
85%
80%
Early morning awakening 75%
55%
60%
70%
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Across all groups, frequent awakenings were the most prevalent symptom,
particularly among Parkinson’s and MS patients. Difficulty falling asleep was most
pronounced in Parkinson’s disease, likely reflecting motor symptom interference and
dopaminergic medication side effects. Stroke patients reported high rates of early
morning awakening, potentially linked to anxiety and altered circadian rhythms.
Table 2.
Average ISI Scores by Group
Group
Mean ISI Score
Parkinson’s disease
21.4 ± 3.2
Epilepsy
18.9 ± 2.7
Multiple sclerosis
19.6 ± 3.1
Post-stroke
20.2 ± 2.8
ISI scores reflect more severe insomnia in patients with Parkinson’s disease and
stroke, while epilepsy and MS patients reported slightly lower scores but still within a
clinically significant range.
Table 3.
Identified Causes of Insomnia by Percentage
Cause
Parkinson’s
Epilepsy
MS
Stroke
Medication side effects
50%
30%
40%
35%
Anxiety/depression
65%
55%
70%
60%
Neuropathic pain
25%
20%
60%
40%
Nocturnal seizures
-
40%
-
-
Psychological factors such as anxiety and depression emerged as the leading
causes across all groups, with neuropathic pain notably impacting MS and stroke
patients. Nocturnal seizures were a unique cause in the epilepsy group, contributing
to fragmented and unrefreshing sleep.
Table 4.
Polysomnography Findings in Subsample
Sleep Parameter
Normal Range
Avg in Sample
Deviations
Total Sleep Time
6–8 hrs
4.9 hrs
↓
Sleep Efficiency
>85%
72%
↓
REM Sleep (%)
20–25%
15%
↓
Sleep Latency (min)
<20 min
38 min
↑
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Polysomnographic evaluation confirmed substantial deviations from normal
sleep patterns, with most patients exhibiting reduced total sleep time, lower REM
percentage, and prolonged sleep latency. These findings were most pronounced in
Parkinson’s and post-stroke patients.
Table 5.
Effectiveness of Interventions Tried
Intervention Type
% Reporting Improvement
Sleep hygiene education
45%
Cognitive behavioral therapy (CBT)
60%
Pharmacological treatment
55%
Cognitive behavioral therapy emerged as the most effective non-pharmacological
intervention, especially in addressing insomnia driven by anxiety and maladaptive
sleep behaviors. Sleep hygiene education provided modest benefits, while
pharmacotherapy had varied results depending on the underlying neurological
condition and medication tolerance.
Discussion
The results of this study confirm that insomnia is a highly prevalent
but frequently underestimated symptom among patients with neurological conditions.
The interplay between disease-related neurophysiological changes, psychological
distress, and pharmacological treatments collectively contributes to the development
and persistence of sleep disturbances. The findings underscore the importance of
individualized assessment and multidisciplinary care in managing insomnia.
Parkinson’s disease patients were the most severely affected, largely due to motor
symptom fluctuations, dopaminergic therapy, and coexisting depression. Epilepsy
patients exhibited disrupted sleep mainly due to nocturnal seizures and sedative effects
of antiepileptic drugs. In multiple sclerosis, neuropathic pain and fatigue-related
psychological burden were prominent insomnia drivers. Stroke survivors struggled
with sleep continuity and early awakening, often linked to anxiety, reduced mobility,
and altered circadian mechanisms.
The use of polysomnography strengthened the reliability of subjective complaints
and allowed a more precise characterization of sleep structure disturbances. This
multimodal approach provided compelling evidence of the need for targeted insomnia
management strategies that go beyond general sleep advice.
An important implication of the study is the demonstration that non-
pharmacological approaches, particularly cognitive behavioral therapy, can produce
significant benefits even in the context of complex neurological pathology. These
findings align with existing literature on the role of CBT-I (CBT for insomnia) as a
gold standard intervention, adapted here for a neurological population. The relatively
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lower impact of pharmacotherapy reflects the need for careful selection of agents that
do not exacerbate neurological symptoms.
Taken together, the evidence suggests that early identification and comprehensive
treatment of insomnia should be integrated into routine neurological care. Addressing
insomnia not only improves quality of life but may also enhance cognitive function,
emotional regulation, and disease management.
Conclusion
Insomnia is a prevalent, multifaceted issue in patients with
neurological disorders. This study emphasizes the critical need for its identification and
integrated management. By understanding the condition-specific mechanisms and
responses to intervention, healthcare professionals can develop more effective
treatment strategies to improve sleep quality and enhance quality of life for this
vulnerable population.
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