Rem Sleep And Seizures: A Complex Connection

Sleep and epilepsy have a complex relationship. Sleep deprivation can trigger seizures, and seizures can disrupt sleep. Seizures are very sensitive to sleep patterns, and some people have their first seizures after a period of sleep deprivation. Sleep disorders, such as insomnia and sleep apnea, can also affect epilepsy.

REM sleep, in particular, has been observed to have a strong antiepileptic effect. Studies have shown that the occurrence of seizures during REM sleep is extremely rare, with a strikingly low proportion of around 1% or less. This stage of sleep is the most protective against focal and generalized seizures.

However, the links between epilepsy and sleep are complex and vary from person to person. While some people may have seizures triggered by a lack of sleep, others may have seizures that occur during sleep or during REM sleep.

Seizures are very sensitive to sleep patterns

Sleep and epilepsy are closely linked. Seizures are very sensitive to sleep patterns. Sleep deprivation can trigger seizures, and the lack of "good sleep" makes most people with epilepsy more likely to have seizures. It can even increase the intensity and length of seizures. Some people have their first and only seizures after a prolonged period of not sleeping well.

During normal sleep-wake cycles, changes in the brain's electrical and hormonal activity occur. These changes can be related to why some people have more seizures during sleep than others, and why not getting enough sleep can trigger seizures. Some people have all of their seizures while sleeping, when falling asleep, or waking up. Sleep disorders such as insomnia and sleep apnea can affect epilepsy, and epilepsy can also affect sleep disorders.

The different stages of sleep can also play a role in seizure activity. During the second stage of non-rapid eye movement (NREM) sleep, seizures can be more likely to happen for some people with epilepsy as they transition to the third stage of deep sleep. This is because during the second stage, heart rate and breathing slow down, and during the third stage, the brain begins to produce 'delta waves', which are associated with deep sleep.

Additionally, research suggests that reduced REM sleep could be a potential biomarker for epilepsy. Individuals with epilepsy have been found to have a significantly lower percentage of REM sleep compared to those without epilepsy.

It is important to note that the links between epilepsy and sleep are complex, and the effects of sleep deprivation on seizures can vary from person to person. However, maintaining good sleep hygiene and getting adequate, quality sleep is generally important for managing epilepsy and reducing the risk of seizures.

Sleep deprivation can trigger seizures

Sleep deprivation is a common trigger for seizures, especially for those with epilepsy. The links between epilepsy and sleep are complex, and vary from person to person. For some, a lack of sleep can make seizures more likely to happen, while for others, seizures at night can cause tiredness during the day.

The brain is active during sleep, processing information and strengthening memories. Changes in the brain's electrical and hormonal activity during sleep-wake cycles can be related to why some people have more seizures during sleep than others, and why not getting enough sleep can trigger seizures.

There is a well-documented correlation between epilepsy and sleep deprivation. Preclinical and clinical studies have shown that sleep deprivation can lead to an increased risk of epileptic seizures. Sleep deprivation has even been used as a diagnostic tool for epilepsy, by triggering epileptiform activity.

Some people have their first and only seizures after a period of sleep deprivation, such as an "all-nighter". Sleep deprivation can also increase the intensity and length of seizures. Sleep plays an important role in mental and physical health, quality of life, and safety.

Sleep deprivation can cause impaired cognitive functioning, decreased mood, and impaired motor performance. It can also change EEG waveforms, with delta wave activity in the frontal and parietal lobes of sleep-deprived patients. As delta waves are synchronous and constitute a seizure risk in epilepsy, this may be a mechanism for how sleep deprivation lowers the seizure threshold.

In addition, sleep disorders such as insomnia and sleep apnea can affect epilepsy, and vice versa. Sleep disorders can leave a person chronically sleep-deprived and tired, which can increase the likelihood of seizures.

REM sleep is a potential biomarker for epilepsy

Sleep and epilepsy are closely linked. Research has shown that a lack of sleep can make seizures more likely to occur, and having seizures at night can cause tiredness during the day. Sleep disorders such as insomnia and obstructive sleep apnea (OSA) can also affect epilepsy.

The links between epilepsy and sleep are complex and multifaceted. Sleep occurs in an alternating pattern of non-rapid eye movement (NREM) sleep, which includes light and deep sleep, and rapid eye movement (REM) sleep. During REM sleep, the brain attempts to organise information from the day, which may be important for creating meaning from experiences and strengthening memories.

A study by Ufuk Sadak and colleagues published in the journal *Seizure* in 2022 investigated the potential of REM sleep as a biomarker for epilepsy. The study included 128 individuals, 64 of whom had been diagnosed with epilepsy, and the remaining 64 with a differential diagnosis. The researchers found that the percentage of REM sleep (REM%) was significantly lower in the epilepsy group compared to the control group (12.2% vs. 17.2%, p<0.001). This difference was not influenced by sex, age, anti-seizure medication, or other medications. The study concluded that reduced REM% could be a valuable supplementary biomarker for epilepsy, especially in challenging diagnostic settings where interictal epileptic discharges (IEDs) or seizures are not detectable.

The study by Sadak et al. adds to the growing body of research on the complex relationship between sleep and epilepsy. While the exact mechanisms are not yet fully understood, these findings suggest that assessing REM% could improve diagnostic accuracy for epilepsy, particularly in ambiguous cases. Further research and prospective multicentric trials are needed to evaluate the potential of REM% as a biomarker for epilepsy.

Seizures are rare during REM sleep

Sleep and epilepsy have a complex relationship. Sleep deprivation can trigger seizures, and seizures can disrupt sleep. However, seizures are rare during REM sleep.

During REM sleep, the brain processes information and tries to make sense of the day's experiences, emotions, and memories. This stage of sleep is characterised by low voltage fast activity on the electroencephalogram (EEG), rapid eye movements, and muscle atonia. The low voltage fast activity on the EEG is due to the depolarisation of the thalamus by cholinergic neurons, which allows for the transmission of information to the cortex.

Multiple studies have confirmed that there is a strikingly low proportion of seizures (around 1% or less) during REM sleep. This stage of sleep has been found to be the most protective against focal seizures, generalised seizures, and focal interictal discharges. REM sleep has been shown to have an additional protective effect compared to wakefulness, with significantly fewer seizures occurring during this stage.

The reduced occurrence of seizures during REM sleep may be due to the desynchronised EEG pattern observed during this stage of sleep. The desynchronisation of the EEG reflects important connectivity differences unique to REM sleep. The reduced synchrony during REM sleep may decrease the likelihood of spatial and temporal summation of aberrant spontaneous depolarisations, which are thought to be a mechanism underlying seizures.

While seizures are rare during REM sleep, they are more common during non-REM sleep, particularly during the second stage of non-REM sleep. Sleep can affect seizures in various ways, and the links between epilepsy and sleep are complex.

Nocturnal seizures often go unnoticed

Nocturnal seizures, or seizures during sleep, often go unnoticed as they occur when a person is sleeping. They are most common right after falling asleep, just before waking up, or soon after waking up. Nocturnal seizures can cause unusual nighttime behaviour, such as waking for no reason, involuntary muscle movements, bed wetting, tongue biting, and jerking and shaking of the body.

These seizures are challenging to diagnose due to their occurrence during sleep. They can be mistaken for parasomnias, or sleep disorders, such as sleepwalking or night terrors. Distinguishing nocturnal seizures from other sleep behaviours can be particularly difficult. People who live alone may not realise they are having seizures and may simply attribute their daytime sleepiness to a poor night's rest.

However, there are some signs that may suggest a person is experiencing nocturnal seizures. These include interrupted sleep, difficulty concentrating, waking suddenly for unknown reasons, and an increase in daytime seizures triggered by a lack of sleep. Involuntary muscle movements linked to seizures can include jerking body movements.

If a person notices these symptoms, it is important to consult a doctor. A diagnosis of epilepsy is typically made when a person has two or more unprovoked seizures at least 24 hours apart, not caused by another medical condition. Doctors usually diagnose epilepsy using an electroencephalogram (EEG) to measure electrical activity in the brain. In some cases, they may also recommend MRI or CT scans to check for brain injuries or tumours.

Nocturnal seizures can be dangerous, increasing the risk of dying from epilepsy. They can also make a person more prone to injuries. Therefore, it is crucial to seek medical help if you or someone you know experiences nocturnal seizures.

Frequently asked questions