Epilepsy and Sleep

Updated on July 22, 2019 While all product recommendations are chosen independently, we may receive compensation for purchases made through our site. Learn more about our affiliate program here.
 

Epilepsy is an increasingly common diagnosis: with 3.4 million Americans currently diagnosed with epilepsy, there are more people dealing with the disorder than ever before. Epilepsy can alter your life in many ways. From having to arrange your everyday activities around the possibility of seizures to experiencing the effects of the seizures themselves, the disorder can have a serious impact on nearly everything you do. However, when we talk about epilepsy, one of the main impacts that is often overlooked is the impact on your sleep.

Epilepsy and sleep affect each other in a cyclical manner: epilepsy can disturb sleep, and sleep disturbances can exacerbate epilepsy. Let’s explore how sleep and epilepsy affect one another, and review ways in which people with epilepsy can improve their sleep and overall well being.

What is Epilepsy?

Epilepsy refers to a group of related neurological disorders that affect the central nervous system. Epileptic disorders cause periods of increased electrical activity in the brain, called seizures. The physical symptoms and severity of seizures vary, and will be explored below, but all seizures are based in the brain.

A person can have seizures without being epileptic. Around 10 percent of people will have a seizure at some point in their lives, caused by factors like brain injuries, tumors, extremely low blood sugar, substance abuse/withdrawal, and other illnesses and conditions. In order to be diagnosed with epilepsy, you need to have had at least two seizures more than 24 hours apart that were not caused by a separate underlying condition.

Approximately 1 in 26 people will develop epilepsy at some point in their lifetime. It is the fourth most common neurological disorder: as of 2015, approximately 3.4 million Americans had active epilepsy. That’s 1.2 percent of the total U.S. population. Though it’s most commonly diagnosed before age 10 and after age 55, a person can develop epilepsy at any age.

Source: CDC

Treatment and History
Epilepsy and its treatment have a long recorded history, dating back at least four thousand years. Historically, seizures were often shrouded in superstition and stigmatized as possession or demonic activity. During the Renaissance and the Enlightenment, there was a push to view epilepsy as a physical illness rather than a moral/religious condition. By the late 19th century, with advances in medical understanding and technology, some seizures were successfully controlled with sedatives and barbiturates. Eventually, non-sedative anticonvulsants like phenytoin were introduced. Since the 1960s, there has been a huge surge of progress in our understanding and treatments of epilepsy. Because of advances in pharmaceutical development and medical imaging technology, seizures can now be specifically located in the brain and categorized, and can be controlled in approximately 70 percent of newly-diagnosed children and adults.
Causes and Complications

Unfortunately, doctors still do not know exactly what causes epilepsy in the majority of cases. For 2 in 3 people with epilepsy, the cause is unknown. Epilepsy with no known cause is called “cryptogenic” or “idiopathic” epilepsy. We do know that it is hereditary, meaning you are at increased risk of developing epilepsy if there are other people with epilepsy in your family. There are also some conditions that affect the brain which have been shown  to cause epilepsy:

  • Stroke
  • Brain tumors
  • Brain infections from parasites (like malaria)
  • Viruses (like the flu or Zika)
  • Traumatic brain injury
  • Lack of oxygen to the brain for an extended period of time
  • Certain genetic disorders (like Down syndrome)
  • Certain neurological diseases (like Alzheimer’s or dementia)

Epilepsy also comes with associated health risks. Seizures can be very dangerous, depending on where a person is and what they are doing when the seizure occurs. Someone experiencing a seizure could fall and break bones or sustain head injuries. If a person has a seizure while swimming, they could drown: people with epilepsy are 15 to 19 times more likely to drown than the general population. Epilepsy increases the risk of car accidents, so much so that many states have epilepsy-related driver’s license restrictions. Pregnancy complications are an issue for people with epilepsy, as seizures during pregnancy pose dangers to both the mother and the fetus, and some anti-epilepsy medications increase the risk of birth defects. Additionally, people with epilepsy are more likely to struggle with depression, anxiety, and suicidal thoughts.

There are also two highly rare, but more severe, complications of epilepsy. Any seizure lasting more than five minutes is referred to as “status epilepticus”. This is a very dangerous condition, and can cause permanent brain damage or death. Even more uncommon and even more severe is sudden unexpected death in epilepsy (SUDEP). People with epilepsy have a small risk of unexpected death. Though doctors are unsure exactly what causes SUDEP, it is suspected that the cause is respiratory or cardiovascular.

Types of Seizures

When most people think about seizures, they think about the sort of seizure they see in movies or on TV, where a person drops to the floor and violently shakes. While some seizures can look like that, there are actually many different types of seizures. They vary depending on what part of the brain they affect, and present with different types of symptoms. In total, there are over 30 different types of seizures, but these are the most common: Generalized Seizures Focal Seizures Generalized Seizures

Generalized Seizures
Focal Seizures
Generalized Seizures

Generalized seizures affect both sides of the brain. They are divided into two main subcategories:

  • Absence (petit mal) seizure: Absence seizures present as rapid blinking or staring into space. They begin and end very quickly, lasting only a few seconds. In fact, they’re so short that they are often mistaken for spacing out or daydreaming. They are more common in children than adults.
  • Tonic-clonic (convulsion) seizures: These are the seizures most people think of when they think of seizures. They can affect both children and adults. Tonic-clonic seizures occur in two parts. The first is the tonic (“stiffening”) phase, during which all the muscles stiffen, and air being forced past the vocal cords causes the person to make a noise (such as a yell, cry, or groan). The person loses consciousness and drops to the ground. Then comes the clonic (“rhythmic jerking”) phase, during which the arms and legs jerk rapidly, eventually slowing and then stopping. Generally, tonic-clonic seizures last 1 to 3 minutes. A tonic-clonic seizure that lasts more than 5 minutes is a potentially dangerous medical emergency.
Focal Seizures

Focal seizures occur in just one area of the brain, though they can become generalized and spread to other areas. They are the most common type of seizure in adults with epilepsy. They are divided into three subcategories:

  • Simple focal seizure: These seizures affect one small area of the brain. They do not cause a person to lose consciousness. Simple focal seizures can cause various symptoms, depending on the location in the brain where the seizure occurs. They include jerking movements in one part of the body, hearing problems, hallucinations, phantom smells or tastes, auras, changes in blood pressure, or sudden feelings of fear, anxiety, or deja vu.
  • Complex focal seizure: These seizures also start in a single lobe of the brain, which is often, though not always, the temporal or frontal lobe. Sometimes, they are preceded by a “warning” (such as an aura), which is actually a separate simple focal seizure. Complex focal seizures can make a person confused and dazed, or cause them to perform involuntary purposeless actions (called “automatisms”), like picking at the air or their clothing, or smacking their lips. People experiencing this sort of seizure stare blankly and are unable to respond if addressed. By in large, complex focal seizures last between 30 seconds and 3 minutes.
  • Secondary generalized seizure: These seizures begin in one part of the brain, but then become “generalized”, spreading to both sides of the brain. They are also referred to as “focal to bilateral tonic-clonic seizures.” They happen in more than 3 out of 10 people with focal epilepsy. This sort of seizure may begin with a simple focus seizure or a complex focal seizure, moving into a tonic-clonic seizure in both parts of the brain. They have all of the symptoms of generalized tonic-clonic seizures.

Generalized seizures affect both sides of the brain. They are divided into two main subcategories:

  • Absence (petit mal) seizure: Absence seizures present as rapid blinking or staring into space. They begin and end very quickly, lasting only a few seconds. In fact, they’re so short that they are often mistaken for spacing out or daydreaming. They are more common in children than adults.
  • Tonic-clonic (convulsion) seizures: These are the seizures most people think of when they think of seizures. They can affect both children and adults. Tonic-clonic seizures occur in two parts. The first is the tonic (“stiffening”) phase, during which all the muscles stiffen, and air being forced past the vocal cords causes the person to make a noise (such as a yell, cry, or groan). The person loses consciousness and drops to the ground. Then comes the clonic (“rhythmic jerking”) phase, during which the arms and legs jerk rapidly, eventually slowing and then stopping. Generally, tonic-clonic seizures last 1 to 3 minutes. A tonic-clonic seizure that lasts more than 5 minutes is a potentially dangerous medical emergency.

Focal Seizures

Focal seizures occur in just one area of the brain, though they can become generalized and spread to other areas. They are the most common type of seizure in adults with epilepsy. They are divided into three subcategories:

  • Simple focal seizure: These seizures affect one small area of the brain. They do not cause a person to lose consciousness. Simple focal seizures can cause various symptoms, depending on the location in the brain where the seizure occurs. They include jerking movements in one part of the body, hearing problems, hallucinations, phantom smells or tastes, auras, changes in blood pressure, or sudden feelings of fear, anxiety, or deja vu.
  • Complex focal seizure: These seizures also start in a single lobe of the brain, which is often, though not always, the temporal or frontal lobe. Sometimes, they are preceded by a “warning” (such as an aura), which is actually a separate simple focal seizure. Complex focal seizures can make a person confused and dazed, or cause them to perform involuntary purposeless actions (called “automatisms”), like picking at the air or their clothing, or smacking their lips. People experiencing this sort of seizure stare blankly and are unable to respond if addressed. By in large, complex focal seizures last between 30 seconds and 3 minutes.
  • Secondary generalized seizure: These seizures begin in one part of the brain, but then become “generalized”, spreading to both sides of the brain. They are also referred to as “focal to bilateral tonic-clonic seizures.” They happen in more than 3 out of 10 people with focal epilepsy. This sort of seizure may begin with a simple focus seizure or a complex focal seizure, moving into a tonic-clonic seizure in both parts of the brain. They have all of the symptoms of generalized tonic-clonic seizures.
 

How Epilepsy Affects Sleep

Regular, restful sleep is important for everyone, but it’s even more important for people with epilepsy. For some epileptic people, not getting enough sleep can trigger and exacerbate the severity of seizures. However, the relationship between epilepsy and sleep is complicated: in some cases, epilepsy and seizures can actually be the cause of sleep loss, creating a vicious cycle of worsening sleep loss and worsening seizures.

Though the interplay between epilepsy and sleep–and the severity of the effects from that interplay–varies from person to person, there are several central ways in which sleep and epilepsy affect one another. They include increased electrical activity in the sleep-wake cycle, the impact of seizures on sleep, underlying sleep disorders, and the additional consideration of epilepsy medication and its potential impact on sleep.

The Sleep-Wake Cycle and Electrical Changes

The sleep-wake cycle refers to the natural sleep stages involved in healthy sleep. During the night, the body cycles through various stages of sleep, which can be roughly categorized into two main sleep states: non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep. Non-rapid eye movement sleep is considered “lighter” sleep, while, rapid eye movement sleep is considered “deeper” sleep. Between consciousness and NREM sleep, the brain produces electrical charges that trigger seizures in some people with epilepsy. In fact, some people exclusively have seizures while they sleep, mostly during that particular part of the sleep cycle.

The Effects of Seizures on Sleep

Seizures can cause awakenings and other disruptions in the sleep cycle which can impact the general quality of sleep. This can cause daytime drowsiness, which is a symptom reported by approximately 70 percent of people with epilepsy. Sleep deprivation can aggravate epilepsy, which in turn may cause more frequent and severe seizures, leading to further sleep disturbances.

Epilepsy and Underlying Sleep Disorders

People with epilepsy are more likely than the general population to suffer from sleep disorders, such as insomnia, narcolepsy, periodic limb movements, and especially obstructive sleep apnea, a potentially serious sleep disorder which causes breathing to repeatedly stop and start during sleep. In fact, obstructive sleep apnea has been diagnosed in approximately 40 percent of people living with epilepsy, regardless of epilepsy type or severity. These sleep disorders are often under-diagnosed, or misdiagnosed as nighttime seizures. They can contribute to sleep disturbances and sleep deprivation.

Impact of Epilepsy Medication on Sleep

Another possible cause of sleep disturbance experienced by people with epilepsy has to do with antiepileptic drugs (AEDs). Though there is still research that needs to be done on this subject, it is possible that some AEDs may contribute to sleep disruption.

 

Sleep Help for People with Epilepsy

The sleep difficulties you can encounter when dealing with epilepsy may seem overwhelming, but there are definitive, proactive steps you can take to improve your sleep. We’ve compiled our top tips for people with epilepsy when it comes to getting a better night’s sleep:

  1. Discuss Specialized Diets with Your Doctor: It is often suggested that people with epilepsy stick to a diet that is higher in fat and lower in carbs, like a ketogenic diet or a modified Atkins diet. This sort of diet has been shown to reduce seizures in some people with epilepsy, and a reduced rate of seizures improves the quality of your sleep. In addition, there are foods and drinks you should avoid several hours before bed, including alcohol, caffeine, chocolate, and heartburn-inducing foods (if you tend to suffer from heartburn). It’s also recommended that smokers stay away from nicotine for around two to three hours before bed. This will make it easier to get to sleep and stay asleep.
  2. Establish a Routine: When it comes to sleep, routine is one concrete step you can take to improve your odds of getting what you need. Our bodies respond well to routine, and putting a nightly series of tasks, activities, and rituals in place will help ease your body into feeling tired at the right time. Brush your teeth, wash your face, put on your pyjamas, and maybe do some nighttime yoga before you hop into bed. Make sure to maintain a regular bedtime, and stick to the same routine every night.
  3. Build a Proper Sleep Environment: Your sleep environment is a major deciding factor in sleep health. Make sure you have a comfortable, appropriately-sized mattress, and high-quality pillows, blankets, and sheets. Do everything possible to make sure your sleep environment is dark, set at a comfortable temperature, and quiet.
  4. Unplug!:Limit screen time right before bed, and make sure that while you’re actually in bed, you access your phone as little as possible–ideally, not at all. Try plugging your phone in across the room, or in another room altogether. If you can, spring for a separate alarm clock so that you’re not depending on your phone to wake you up in the morning.
  5. Try the Tense and Relax Method: The tense and relax method, otherwise known as Progressive Muscle Relaxation or Jacobson’s Relaxation Method, is a relaxation technique commonly utilized to help people get to sleep. It calls for tensing and then relaxing a series of muscle groups in a specific order, while focusing on the sensation of those muscles. Studies have shown that this method is particularly useful in some epileptic people, particularly adolescents.
  6. Get Checked for Sleep Apnea/Comorbid Sleep Disorders. As mentioned above, people with epilepsy develop sleep disorders at a higher rate than the general population. These disorders can sometimes be considered comorbid to epilepsy, meaning they occur alongside epilepsy, and can be treated on their own. Sleep apnea in particular has many different treatments, the most common of which is the use of a CPAP machine, which helps people with sleep apnea breathe more easily and with less obstruction. Consult a sleep specialist and undergo a sleep study if you suspect that you may have apnea or any other sleep disorder.
  7. Avoid Known Seizure Triggers: Each person has their own seizure triggers, and it’s important to be aware of anything that might trigger seizures in you personally. Whenever you have a seizure, try to record everything that happened around that seizure: where you were, what you were doing, anything you might have eaten or drank, and anything you may have been exposed to. There are also things that tend to trigger seizures among many epileptic people. These include emotional and physical stress, certain types of exposure to rapidly flashing lights, nutritional deficiencies, stopping or skipping medication, drugs and alcohol, and, of course, a lack of sleep.
  8. Adjust Your Meds. In some cases, epileptic people experience sleep disturbances from their epilepsy medications. If you feel that this is the case, consult your doctor and let them know that you feel your meds are getting in the way of your sleep. They will be able to tell you if this is a common side effect of that specific medication, and advise work with you to address the issue safely.

Please remember that while our guide is thorough and well-researched, it is not a replacement for medical advice. Always consult your doctor or qualified physician with any questions or concerns you have regarding medical conditions, treatments, and advice.

Frequently Asked Questions About Epilepsy and Sleep

Can Sleep Deprivation Trigger a Seizure?

Yes. In fact, lack of sleep is one of the most frequently reported triggers for seizures. Sleep deprivation can trigger a seizure in someone even if they do not have epilepsy, so it is even more likely to trigger a seizure in an epileptic person. In some people, sleep deprivation can also increase the intensity and the length of seizures. This is because changes in the brain’s electrical and hormonal activity occur during normal sleep-wake cycles. Disturbing your sleep cycles and depriving yourself of sleep can affect that activity, which can trigger seizures.

Can I Use Sleeping Pills if I have Epilepsy?

Most prescription sleep aids are not inherently unsafe to use if you have epilepsy. However, epilepsy is unpredictable, and it’s always possible that a medication may be a seizure trigger for you. In addition, some sleep medications interfere with epilepsy medications, so always consult with your doctor before taking a sleeping aid. This also applies to over the counter sleep aids: some OTC meds taken for sleep, particularly diphenhydramine (the active ingredient in medications like Benadryl) can potentially increase the frequency of seizures in people with epilepsy.

Does Epilepsy Medication Have Side Effects? If So, What Are They?

Some epilepsy medications have side effects. There are many different types of epilepsy medications that work in many different ways. As such, different epilepsy medications may have different side effects. The most common side effects include nausea, sedation, upset stomach, dizziness, irritability, and allergic reactions such as rashes. Dangerous reactions, such as liver problems or a decrease in white blood cells or platelets, are rare, and medications that are more likely to cause these effects require regular blood monitoring. Often, side effects can be addressed by adjusting the dose or how the person takes the medication. It’s important to remember that just because a side effect has been reported in others doesn’t mean it will happen to you.

How Can I Help Someone Who is Having a Seizure?

 If you see someone having any sort of seizure, here are some things you can do to help:

  • Stay with the person until the seizure ends and they are fully awake and aware.
  • Once the person is awake, explain to them what happened in very simple terms, using a calm, comforting, and patient tone.
  • Check to see if the person is wearing a medical bracelet or has emergency information.
  • Offer to call a friend or family member to make sure the person gets home safely.

If someone is having a tonic-clonic seizure (a seizure with muscle tensing and repetitive jerking movements), here is how you can help:

  • Ease the person to the floor, and turn them gently onto one side.
  • Clear the area around the person of anything hard or sharp.
  • Remove anything on the person that might break (like eyeglasses) or restrict breathing (like a necktie).
  • Put something soft, like a folded jacket, under their head.
  • Time the seizure, and immediately call 911 if it lasts longer than 5 minutes.

If someone is having a tonic-clonic seizure, here are some things you should NOT do:

  • Do not hold the person down or try to stop their movements.
  • Do not put anything in the person’s mouth. Contrary to popular belief, this is not helpful. A person cannot swallow their own tongue during a seizure, but placing an object in their mouth can cause injury to the teeth, throat, jaw, and roof of the mouth.
  • Do not try to give CPR. In the vast majority of cases, people start breathing on their own after a seizure.
  • Do not offer the person food or drink, or let them walk off on their own, until they are fully alert.
  • Do not hold the person down or try to stop their movements.
  • Do not put anything in the person’s mouth. Contrary to popular belief, this is not helpful. A person cannot swallow their own tongue during a seizure, but placing an object in their mouth can cause injury to the teeth, throat, jaw, and roof of the mouth.
  • Do not try to give CPR. In the vast majority of cases, people start breathing on their own after a seizure.
  • Do not offer the person food or drink, or let them walk off on their own, until they are fully alert.

Most seizures do not require a 911 call. Only call 911 if:

  • The seizure lasts longer than 5 minutes.
  • The person has another seizure after the first one, especially if they don’t fully gain consciousness between the two.
  • This is the person’s first seizure.
  • The person is having significant difficulty waking up after the seizure.
  • The person has injured themselves and is hurt after the seizure.
  • The person has another health condition, such as diabetes, heart disease, or cancer, or if the person is pregnant.

Can Sleep Deprivation Trigger a Seizure?

Yes. In fact, lack of sleep is one of the most frequently reported triggers for seizures. Sleep deprivation can trigger a seizure in someone even if they do not have epilepsy, so it is even more likely to trigger a seizure in an epileptic person. In some people, sleep deprivation can also increase the intensity and the length of seizures. This is because changes in the brain’s electrical and hormonal activity occur during normal sleep-wake cycles. Disturbing your sleep cycles and depriving yourself of sleep can affect that activity, which can trigger seizures.

Can I Use Sleeping Pills if I have Epilepsy?

Most prescription sleep aids are not inherently unsafe to use if you have epilepsy. However, epilepsy is unpredictable, and it’s always possible that a medication may be a seizure trigger for you. In addition, some sleep medications interfere with epilepsy medications, so always consult with your doctor before taking a sleeping aid. This also applies to over the counter sleep aids: some OTC meds taken for sleep, particularly diphenhydramine (the active ingredient in medications like Benadryl) can potentially increase the frequency of seizures in people with epilepsy.

Does Epilepsy Medication Have Side Effects? If So, What Are They?

Some epilepsy medications have side effects. There are many different types of epilepsy medications that work in many different ways. As such, different epilepsy medications may have different side effects. The most common side effects include nausea, sedation, upset stomach, dizziness, irritability, and allergic reactions such as rashes. Dangerous reactions, such as liver problems or a decrease in white blood cells or platelets, are rare, and medications that are more likely to cause these effects require regular blood monitoring. Often, side effects can be addressed by adjusting the dose or how the person takes the medication. It’s important to remember that just because a side effect has been reported in others doesn’t mean it will happen to you.

How Can I Help Someone Who is Having a Seizure?

 If you see someone having any sort of seizure, here are some things you can do to help:

  • Stay with the person until the seizure ends and they are fully awake and aware.
  • Once the person is awake, explain to them what happened in very simple terms, using a calm, comforting, and patient tone.
  • Check to see if the person is wearing a medical bracelet or has emergency information.
  • Offer to call a friend or family member to make sure the person gets home safely.

If someone is having a tonic-clonic seizure (a seizure with muscle tensing and repetitive jerking movements), here is how you can help:

  • Ease the person to the floor, and turn them gently onto one side.
  • Clear the area around the person of anything hard or sharp.
  • Remove anything on the person that might break (like eyeglasses) or restrict breathing (like a necktie).
  • Put something soft, like a folded jacket, under their head.
  • Time the seizure, and immediately call 911 if it lasts longer than 5 minutes.

If someone is having a tonic-clonic seizure, here are some things you should NOT do:

  • Do not hold the person down or try to stop their movements.
  • Do not put anything in the person’s mouth. Contrary to popular belief, this is not helpful. A person cannot swallow their own tongue during a seizure, but placing an object in their mouth can cause injury to the teeth, throat, jaw, and roof of the mouth.
  • Do not try to give CPR. In the vast majority of cases, people start breathing on their own after a seizure.
  • Do not offer the person food or drink, or let them walk off on their own, until they are fully alert.

Most seizures do not require a 911 call. Only call 911 if:

  • The seizure lasts longer than 5 minutes.
  • The person has another seizure after the first one, especially if they don’t fully gain consciousness between the two.
  • This is the person’s first seizure.
  • The person is having significant difficulty waking up after the seizure.
  • The person has injured themselves and is hurt after the seizure.
  • The person has another health condition, such as diabetes, heart disease, or cancer, or if the person is pregnant.

Reach Out and Learn More

Epilepsy can be a complicated, confusing disorder to face in yourself or in a loved one. Fortunately, the epilepsy support community is active in its outreach and the web is rich with helpful and authoritative resources you can access from home to learn about epilepsy and how to best manage living with it.

  • Epilepsy Leadership Council: A broad network of consumer, governmental, health, and advocacy organizations working with, for, and on behalf of people with epilepsy.
  • CDC Seizure First Aid: What to do when you see someone having a seizure, broken down step-by-step.
  • Epilepsy Foundation: A major source of information, support, and resources for people with epilepsy, their loved ones, and their healthcare providers.
  • For Parents of Children with Epilepsy: A centralized database of resources and information for parents of children with epilepsy.
  • Epilepsy Toolkit: A centralized database of resources, information, and support for parents of teens with epilepsy.
  • Find A Doctor Search Tool: If you’re looking for an epilepsy specialist in your area, use this search tool, which is endorsed and hosted by the American Epilepsy Society.
  • 24/7 Epilepsy Hotline: From practical questions to emotional support, this hotline can help you with your epilepsy-related needs, 24-hours a day.
  • Epilepsy and the Workplace: A Q&A about epilepsy in the workplace, your rights, and the Americans with Disabilities Act (ADA), compiled by the US Equal Employment Opportunity Commission.
  • National Organizations Dedicated to Epilepsy: A CDC list of organizations that advocate and provide resources for people with epilepsy.
  • Your Local Epilepsy Foundation: A search tool that helps people find epilepsy foundations specific to their locations. This tool includes local, national, and international organizations, sorted by location.
 

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