Why Does Epilepsy Affect Sleep?

Why Does Epilepsy Affect Sleep?

As the fourth most common neurological disorder, epilepsy affects 3 million Americans. Epilepsy begins in the brain, the same part of your body that controls your sleep.

In addition to frequent seizures, people with epilepsy often experience sleep disorders that often interrupt their everyday lives, including nocturnal seizures, insomnia, sleep apnea, and daytime exhaustion.

Keep reading to learn all about the relationship between epilepsy and sleep, common sleep disorders affecting people with epilepsy, and how to get better sleep and relieve seizures.

What is epilepsy?

Repeated seizures are a hallmark symptom of epilepsy, but a person can have seizures without being epileptic. While just over 1% of Americans have epilepsy, up to 10% of people will experience a seizure at some point during their lives.

What is a seizure? Technically, seizures are described by abrupt behavioural changes due to elevated electrical activity in the brain. People may become unconscious, shake violently, or stare. The seizure usually lasts for only a couple of minutes. Physical signs of seizures can differ, but they all come from the brain. Seizures are disruptive and potentially dangerous to the person experiencing one, depending on when they occur and what the person is doing at the time.

In order to be diagnosed with epilepsy, a person must experience two unprovoked seizures at least 24 hours apart that have not been caused by another explainable trigger, such as very low blood sugar. Besides epilepsy, seizures can also be caused by:

  • Head and brain injuries or infections, tumors or strokes
  • Substance abuse or withdrawal
  • Alcohol withdrawal
  • Extremely low blood sugar

Epilepsy can develop at any point in a person’s life, but it is most commonly diagnosed before age 10 and after age 55. Unfortunately, doctors don’t know what causes epilepsy or associated seizures, although they have observed it can run in families. People with epilepsy are also at increased risk for migraines, depression and anxiety disorders, and obesity.

Epilepsy and sleep problems

Your brain controls your sleep-wake cycle, when you get sleepy, when you fall asleep, and how much time you spend in every stage of sleep. The electrical charges that develop into seizures also begin in the brain. Since both seizures and sleep occur in the brain, it makes sense that they are related.

Sleep disorders and epilepsy share a dynamic relationship where each has an effect on the other. Thus one analysis summarised: 

  • Electrical brain activity during light sleep may spur seizures.
  • Daytime seizures and antiepileptic drugs (AEDs) like anticonvulsant can contribute to fragmented sleep and reduced sleep efficiency.
  • Comorbid sleep disorders further disrupt sleep, exacerbate symptoms of epilepsy, and impair overall quality of life.
  • Some symptoms of the sleep disorders themselves mimic seizures, which can prevent individuals from receiving a proper diagnosis and effective treatment afterwards.

The most common sleep problems affecting individuals with epilepsy include nocturnal seizures and insomnia, sleep deprivation and daytime fatigue, and sleep apnea.

Nocturnal seizures and insomnia

Some people have seizures only during sleep, known as nocturnal seizures or sleep-related epilepsy. Between 7.5 to 45% of people with epilepsy experience these sleep seizures. They’re most common during child, affecting up to 60% of children with epilepsy.

Since they’re unconscious when a seizure happens, it’s not rare for people not to know that what they’re waking up is really a seizure – and then, incorrectly, self-diagnosis with insomnia. As a result, their problem will continue as they never get root-related treatment: night seizures.

Signs you experienced a nocturnal seizure include waking up confused, feeling pain from biting your tongue or grinding your teeth, or discovering you were incontinent. Others, such as a sleeping partner or a parent, might observe you making involuntary movements.

However, these symptoms can also stem from another sleep disorder like sleep bruxism or periodic limb movement disorder, which is why it’s important to get properly diagnosed. Your doctor can prescribe a night sleep test in a laboratory called a polysomnogram, where sleep technicians will monitor your brain waves and more to detect nocturnal seizures.

Nocturnal seizures usually occur during stage 1 or 2 of light sleep, thus interrupting sleep and preventing the person from reaching slow-wave sleep and REM sleep.

The end result is overall reduced sleep efficiency.

Seizures and Sleep

People with epilepsy have poorer sleep efficiency than the general population, but the effect is heightened when they have nocturnal seizures (indicated by NTSZ in the chart below). The study behind this chart found that even when one experiences seizures during the day, it can worsen sleep the following night.

Epilepsy Sleep Efficiency
Seizure REM Sleep

Sleep deprivation

A nocturnal seizure breaks the sleep cycle of a person by waking them up. As a result, they may spend a shorter amount of time asleep each night than is ideal.

Plus, each time they fall back asleep, their sleep cycle begins anew, so they don’t get enough deep and REM sleep, which are concentrated in the letter half of the night. Both of these stages are critical for muscle repair and recovery, memory consolidation, and more essential functions.

When we don’t get enough sleep, we become sleep deprived. We’re more on edge during the day, less able to focus, and in the long run it compromises our immune system to the extent that we’re at risk for cardiovascular disease and hypertension.

Problematically, sleep deprivation itself can trigger seizures. Sleep deprivation, along with emotional stress and exhaustion (two symptoms of sleep deprivation) are the top three causes for seizures, according to one major study from Norway.

Sleep apnea

Researchers report that one-third of people with epilepsy had undiagnosed sleep apnea, according to a study by the University of Michigan. They also found a correlation between sleep apnea and the probability of having nocturnal seizures.

Obesity is another risk factor for sleep apnea, and weight gain is a side effect of many AEDs individuals take to manage their seizures.

Obstructive sleep apnea (OSA) occurs when the airways are compressed, resulting in suspended breathing during sleep and reduced levels of oxygen in the blood. OSA can cause sleep-deprivation, which in turn can aggravate seizures. OSA is a treatable condition, but if people are not aware they have it, their sleep problems will continue.

One 2008 study sought out to see whether CPAP treatment could be effective for people with epilepsy. The lower line in the graph below, shows that after using CPAP, individuals indeed experienced a significant reduction in apneic episodes.

Baseline and Titration Study

As they age, older adults are at increased risk of developing OSA. Unfortunately, for older adults with epilepsy, they’re also more prone to experience more disruptive seizures. Researchers from a 2007 study confirmed that OSA is linked with seizure exacerbation for older adults with epilepsy, and recommended treating the underlying OSA to improve seizure control.

Daytime fatigue

All of the sleep problems described above result in daytime fatigue. Fatigue interferes with quality of life. This may explain the results of one study of patients with partial epilepsy. The researchers found people with partial epilepsy are twice as likely to experience disturbed sleep, and they experience poorer quality of life as a result.

Fatigue Graph
Fatigue Graph

Fatigue is common independently in both epilepsy and depression, and people with epilepsy are at increased risk for both fatigue and associated depression. Fatigue can also be a side effect of AEDs. Between 44 to 50% of people with epilepsy experience fatigue.

However, often times the cause behind excessive daytime sleepiness in people with epilepsy is an undiagnosed sleep disorder, which can be changed by treating that sleep disorder.

Children and epilepsy

For children with epilepsy, the effects of sleep disorders are even more severe. Children who suffer insomnia or sleep loss due to seizures are far more likely to experience school-based challenges, social or behavioural issues, impaired cognitive growth, and have an increased risk for attention-deficit/hyperactivity disorder (ADHD).

When children with epilepsy can’t sleep, neither can their parents. According to one study, parents of children with epilepsy have just 4 hours of sleep a night (which is much lower than the recommended minimum of 7 hours for adults). and experience higher levels of stress and decreased marital satisfaction.

Tips for getting better sleep with epilepsy

Sleeping well on a regular basis is important for everyone, but it’s especially important for anyone with epilepsy hoping to reduce the number and frequency of seizures they experience.

1. Get regular sleep.

Opt a daily bedtime and wake-up time, and set aside enough time to get 7 hours of sleep realistically.

If your child has epilepsy, they need more sleep depending on their age. Check how much sleep is recommended for your child here.

Try not to nap too much, as this would only make it harder for you to fall asleep at night. If you are too tired, limit it to a single power nap of 30 minutes or less.

2. Exercise and eat well.

Caffeine and alcohol both interfere with sleep. One makes it difficult to fall asleep (caffeine), while the other wakes you up too early (alcohol). Avoid these in large doses, especially in the evening.

Eating too much at night, especially if it’s overly sugary or fatty, can also make it tough to fall asleep.

3. Review your medication.

Speak with your doctor to rule out any anti-seizure medication you’re taking as the cause of your sleep problems. If sleep issues are a common side effect, see if there’s an alternative medication you can switch to, or if there’s a way you can adjust your dosing schedule to improve sleep.

4. Reduce pre-sleep stress with a calming bedtime routine.

Stress is a trigger for seizures, so create a routine that relaxes your mind and body before bed.

Take a warm shower or bath – as your body cools down, so will your mind, signaling to your brain that it’s time to sleep. Try aromatherapy (but double-check with your doctor first to ensure the essential oils won’t interfere with your medication). Practice meditation, deep breathing, or progressive muscle relaxation exercises. Stop using electronics and checking your phone or email.

The idea is to follow the same set of activities each night to train your brain into recognizing it’s bedtime.

5. Make your bedroom safe and comfortable to avoid injury.

Invest in a padded headboard. Get floor mats and pads to surround your bed, and get a low base for your bed in case you fall out during a night seizure. Remove sharp furniture or delicate items from the bed.

All of these precautions will help you rest assured (pun intended) that if you do have a seizure, you won’t get hurt, which may relieve some anxiety around falling asleep in the first place.

6. Treat your sleep apnea.

If you’re concerned you have sleep apnea, speak to your doctor. There are many ways to treat sleep apnea.

CPAP therapy has been shown to be successful for individuals with comorbid epilepsy, as can more severe approaches such as tracheostomy or other surgery. One study of obese pediatric patients found that sleep apnea surgery decreased frequency of seizures or eliminated them altogether (a happy outcome that occured in one-third of patients).

While consistent CPAP therapy is the best way to reduce symptoms of sleep apnea, it can be uncomfortable. A less invasive, although less effective approach, is a mandibular advancement device. This is an appliance molded to your teeth that pushes your tongue forward while you sleep, freeing any obstruction from your throat.

Behavioral approaches to treating sleep apnea include changing from sleeping on your back to your side, and losing weight if you’re obese.

Additional resources

Related reading

  • Our guide to sleep products for people with disabilities provides recommendations on mattresses, bedding, and bedroom accessories for people with neurological disorders like epilepsy.
  • The Cleveland Clinic lists books about epilepsy, helpfully divided by target audience of parents or children. The Epilepsy Foundation also lists books for children and parents, as well as books for adults living with epilepsy.

Advocacy organizations

  • The Epilepsy Foundation, is the leading advocacy group for individuals living with epilepsy. The site provides educational resources for parents, healthcare professionals, and older adults, including a downloadable pamphlet “Seizures & Sleep.” They also have a local provider directory and a 24/7 toll-free helpline (800-332-1000).
  • The American Epilepsy Society is a professional membership organization for researchers and healthcare professionals who treat seizure disorders.
  • The International League Against Epilepsy is a worldwide association of researchers and healthcare professionals working in epilepsy. The site publishes the latest news and findings in epilepsy research.

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