Miya Pearson
Sleep is essential for everyone's health and well-being. However, for people with epilepsy, sleep can be a complex issue. The relationship between epilepsy and sleep is bidirectional, with sleep disruptions being a common trigger for seizures, and seizures, in turn, causing sleep disturbances. This can create a cycle where poor sleep leads to more epileptic events, which further disrupt sleep.
People with epilepsy often experience seizures during sleep or immediately after waking up, with certain types of epilepsy, such as self-limited epilepsy with centrotemporal spikes (SeLECTS) and sleep-related hypermotor epilepsy (SHE), predominantly occurring during sleep. Sleep deprivation and irregular sleep patterns can also increase the frequency of epileptic events.
Additionally, people with epilepsy are more likely to have co-morbid sleep disorders, such as obstructive sleep apnea, insomnia, and restless leg syndrome. These sleep disorders can further impact sleep quality and contribute to chronic sleep deprivation.
Given the complex interplay between epilepsy and sleep, it is crucial for people with epilepsy to prioritize healthy sleep habits and maintain good sleep hygiene. This includes practices such as sticking to a consistent sleep schedule, avoiding stimulants and screen time before bed, and creating a relaxing sleep environment. By improving sleep quality, people with epilepsy may be able to better manage their symptoms and enhance their overall quality of life.
| Characteristics | Values |
|---|---|
| Sleep and epilepsy | Complex relationship |
| Sleep deprivation | Can trigger seizures |
| Sleep and seizures | Seizures are very sensitive to sleep patterns |
| Sleep and epilepsy | Lack of sleep can increase epilepsy episodes |
| Sleep and epilepsy | Sleep disorders are common in people with epilepsy |
| Sleep and epilepsy | Sleep disorders can be overlooked in people with epilepsy |
| Sleep and epilepsy | Sleep can be affected by many factors |
| Sleep and epilepsy | Sleep is important for everyone's health and well-being |
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What You'll Learn
Sleep deprivation and epilepsy
Sleep Deprivation and Seizures
Sleep is important for everyone's health and well-being. Sleep helps the brain to work properly and assists in learning, improved problem-solving, memory, and attention. Getting enough good-quality sleep can improve seizure control and general quality of life.
Lack of sleep is a very common seizure trigger for people with epilepsy. Seizures are very sensitive to sleep patterns. Some people have their first and only seizures after an "all-nighter" or after not sleeping well for long periods. If you have epilepsy, a lack of "good sleep" makes most people more likely to have seizures. It can even increase the intensity and length of seizures.
Seizures and Sleep Problems
Having a seizure, whether while awake or asleep, can further disrupt the sleep of a person with epilepsy. After a person has a seizure, their sleep architecture can become disturbed. They may sleep much more than normal that night or for a few nights after. Their sleep may also become more fragmented, even on nights without seizures. They may move through sleep stages more quickly and spend more time awake in bed than usual.
There is a complex relationship between epilepsy and sleep. Seizures are caused by misfiring neurons in the brain. The trouble is that the brain also regulates sleep. Because of this, the same brain activity that causes seizures can also negatively affect sleep quality.
There are three main ways epilepsy and sleep are connected:
- Epileptic events during sleep: A significant amount of people with epilepsy have epileptic events exclusively or occasionally during sleep or soon after they wake up.
- Epileptic events triggered by lack of sleep: Some people with epilepsy experience an increase in epileptic events due to losing sleep or sleeping at irregular times.
- Sleep disorders: It is common for people with epilepsy to experience a sleep disorder.
Sleep Disorders and Epilepsy
Sleep disorders are also a factor that is often overlooked in people with epilepsy. That's because, in some cases, these disorders are similar to the symptoms of an epileptic event. In addition, they can also be easily confused as a side effect of anti-epileptic medication.
People with epilepsy are more likely to also have sleep disorders such as:
- Obstructive sleep apnea (OSA)
- Insomnia
- Restless legs syndrome (RLS)
- Nocturnal panic disorder
- Parasomnias
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Sleep disorders and epilepsy
Sleep is important for everyone's health and well-being. Sleep helps the brain to work properly and assists in learning, improved problem-solving, memory, and attention. Getting enough good-quality sleep can potentially improve seizure control and general quality of life.
The relationship between epilepsy and sleep is complex and bidirectional. People with epilepsy are more likely to have sleep disorders, and certain sleep disorders can trigger seizures.
Sleep Disorders
People with epilepsy are more likely to have sleep disorders such as:
- Obstructive sleep apnea (OSA)
- Insomnia
- Restless legs syndrome (RLS)
- Nocturnal panic disorder
- Parasomnias
Obstructive sleep apnea is one of the most common sleep disorders and people with seizures are more likely to have sleep apnea than the general population. Sleep apnea can be caused by upper airway obstruction, abnormality in breathing regulated by the central nervous system, or a combination of these factors. Episodes of apnea lead to hypoxemia (low blood oxygen) and chronic sleep deprivation due to fragmented sleep. Sleep deprivation and hypoxia may decrease seizure thresholds in people with epilepsy, resulting in poorer seizure control.
Insomnia affects over half of people with epilepsy. It involves daytime tiredness along with trouble falling asleep or staying asleep throughout the night.
Restless legs syndrome causes uncomfortable sensations in the legs, resulting in an urge to move the lower extremities, most often in the evening or while sitting or lying still. In people with epilepsy, RLS is more common and it may contribute to insomnia when a person has trouble falling asleep.
Sleep Disorders and Seizures
Sleep disorders can trigger seizures in people with epilepsy. Lack of sleep is a very common seizure trigger. Seizures are very sensitive to sleep patterns. Some people have their first and only seizures after an "all-nighter" or after not sleeping well for long periods. If you have epilepsy, a lack of "good sleep" makes most people more likely to have seizures. It can even increase the intensity and length of seizures. Some forms of epilepsy are especially prone to sleep problems.
There are three main ways epilepsy and sleep are connected:
- Epileptic events during sleep: A significant amount of people with epilepsy have epileptic events exclusively or occasionally during sleep, or soon after they wake up.
- Epileptic events triggered by a lack of sleep: Some people with epilepsy experience an increase in epileptic events due to losing sleep or sleeping at irregular times.
- Sleep disorders: It is common for people with epilepsy to experience a sleep disorder.
Sleep Disorders and Misdiagnosis
Sleep disorders are often overlooked or misdiagnosed in people with epilepsy because the symptoms of some sleep disorders can appear similar to some seizure types. Doctors may attribute the symptoms and associated tiredness to the effect of anti-seizure medications or poor sleep quality caused by nocturnal seizures, rather than consider the possibility of a co-existing sleep disorder.
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Sleep and epilepsy medication
Sleep and epilepsy are closely related. Sleep deprivation can trigger seizures, and seizures can, in turn, disrupt sleep. Therefore, it is important for people with epilepsy to get good-quality sleep. However, epilepsy medication can sometimes adversely affect sleep.
Benzodiazepines
Benzodiazepines (such as diazepam and lorazepam) are used less commonly for the chronic treatment of seizure disorders, but they have the most convincing evidence for detrimental effects on sleep. They decrease the time it takes to fall asleep but also decrease the amount of REM sleep and slow-wave sleep. Therefore, they can adversely affect sleep quality.
Barbiturates
Barbiturates (such as phenobarbital and primidone) are also used less frequently for the chronic treatment of seizure disorders. Like benzodiazepines, they can decrease the time it takes to fall asleep but also reduce the amount of REM sleep.
Phenytoin
Phenytoin may increase light sleep and decrease sleep efficiency, and studies show decreased REM sleep.
Carbamazepine
Findings for carbamazepine are more variable, but there also seems to be a reduction in sleep, particularly with initial treatment.
Gabapentin
Gabapentin has no detrimental effects on sleep and, in fact, seems to enhance slow-wave sleep in patients with epilepsy and in normal volunteers. It also increases sleep continuity and decreases awakenings. Furthermore, limited studies suggest that gabapentin may be useful in treating restless legs syndrome, a common sleep disorder.
Levetiracetam
Levetiracetam seems to have no detrimental effects on sleep.
Zonisamide, Oxcarbazepine, and Topiramate
The effects of zonisamide, oxcarbazepine, and topiramate on sleep and sleep disorders are not known.
Adjusting Medication
Patients with sleep problems may need to adjust their anticonvulsant dosing or, rarely, change to another drug.
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Sleep and epilepsy in children
Sleep and epilepsy have a complex relationship. Sleep is important for everyone's health and well-being, and it is particularly important for children with epilepsy. Getting enough good-quality sleep can improve seizure control and general quality of life.
Children with epilepsy are more likely to experience sleep troubles than children who do not have the disorder. Epilepsy itself can cause sleep problems, as can medications taken to treat epilepsy. When a child with epilepsy struggles with sleep, they may feel tired during the day, have trouble learning, and experience behavioural problems. Sleep deprivation may also trigger seizures in children with epilepsy, so it is important for them to have healthy sleep habits.
There are three main ways epilepsy and sleep are connected:
- Epileptic events during sleep: Many people with epilepsy have epileptic events exclusively or occasionally during sleep, or soon after they wake up.
- Epileptic events triggered by lack of sleep: Some people with epilepsy experience more epileptic events due to losing sleep or sleeping at irregular times.
- Sleep disorders: It is common for people with epilepsy to experience a sleep disorder.
Sleep disorders
Sleep disorders are a factor that is often overlooked in people with epilepsy. This is because sleep disorders can mimic the symptoms of an epileptic seizure, and they can also be confused for a side effect of anti-epileptic medication. Common sleep disorders among people with epilepsy include:
- Obstructive sleep apnea: A common sleep disorder for people with epilepsy that can lead to chronic sleep deprivation.
- Nocturnal panic disorder: A disorder that commonly co-occurs with panic disorder, causing people to wake suddenly in a state of panic.
- Parasomnias: A disorder associated with general sleep disturbances on a regular basis.
- Restless leg syndrome: A disorder that causes a strong urge to move one's legs or to feel uncomfortable when one's legs are at rest.
Improving sleep
Improving sleep quality can sometimes be as simple as adjusting one's schedule and habits. However, in the case of certain sleep disorders, more substantial treatment methods may be required. This may include things like using melatonin supplements, bright light therapy, or visiting a sleep specialist.
- Follow a sleep schedule: Try to fall asleep and wake up at the same time every day. This will help set your body's internal clock, allowing your mind and body to sleep more easily.
- Make sure you're sleeping long enough: Many people do not get the amount of sleep they need to function at their best. Adults need between about 7 to 9 hours of sleep a night to be fully rested.
- Create a better sleeping environment: Help your brain and body feel comfortable by providing the right environment to sleep in. Keep your room dark and turn off any screens such as a TV or smartphone. Also, be sure to make yourself comfortable.
- Settle in for the night: Try to avoid any strenuous activity before bed and give yourself time to unwind. Also, avoid eating, and consuming caffeine, tobacco, and/or alcohol too close to bedtime. Getting into a relaxed state an hour or so before sleeping is great preparation for a restful night. It may help to develop relaxing habits such as taking a bath or meditating before you go to bed.
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Improving sleep with epilepsy
Sleep is important for everyone's health and well-being. For people with epilepsy, sleep is especially important as it can help improve seizure control and general quality of life. Here are some tips to improve sleep quality for people with epilepsy:
Maintain a consistent sleep schedule: Try to fall asleep and wake up at the same time every day, including on weekends. This helps to keep your body clock synchronised and can make it easier to fall and stay asleep.
Create a sleep-conducive environment: Ensure your bedroom is quiet, cool, and dark. Avoid using electronic devices such as TVs and smartphones before bed, as the blue light emitted by these devices can interfere with your natural sleep cycle.
Avoid stimulants and drugs: Caffeine and nicotine are known stimulants that can disrupt sleep. Avoid consuming caffeinated beverages in the evening and give up smoking if possible. Alcohol consumption can also disrupt your sleep, so it's best to avoid it close to bedtime.
Develop a bedtime routine: Avoid strenuous activity and stimulating activities before bed. Give yourself time to unwind and relax. This may include activities such as taking a bath, meditating, or reading a book.
Exercise regularly: Engage in regular physical exercise, but avoid exercising right before bed as it can stimulate the body and make it difficult to fall asleep.
Manage stress and mood disorders: Anxiety, depression, stress, and other mood disturbances can negatively impact sleep. Seek help from a doctor or mental health professional if you are experiencing these issues.
Review medications: Some medications can cause drowsiness during the day or disrupt sleep at night. Discuss any concerns about your medications with your doctor.
See a sleep specialist: If you experience sleep disorders such as obstructive sleep apnea or restless leg syndrome, consider seeing a sleep specialist for further evaluation and treatment.
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