Relationship between sleep and seizures

The relationship between epilepsy and sleep is complex. There are some epilepsy syndromes where seizures only occur during sleep or when waking, which can have an impact on a person’s quality of sleep.

Seizures are also much more likely to occur if you are tired or sleep deprived. Lack of sleep is a very common seizure trigger for people with epilepsy. The symptoms of some sleep disorders can appear similar to some seizure types. Because of this sleep disorders may be missed in people with epilepsy or misdiagnosed.

Being mindful of sleep and ensuring regular, good quality sleep is essential for people living with epilepsy. Making sure that your environment, and the things you do, can support a good night’s sleep is a big part of this. It is called maintaining good sleep hygiene. Identifying what may be preventing good quality sleep is also important. If you experience sleep problems, have a chat with your neurologist or GP for guidance.

Things that affect sleep

Sleep can be affected by many factors. Recognising what factors might be impacting on your sleep is important. You may like to start a sleep diary to identify what affects your sleep.

Common factors that affect sleep include:

  • Stimulants found in coffee, soft-drinks and nicotine
  • Use of electronic devices such as TVs and smartphones. These can emit a blue light which can interfere with your circadian rhythms (your natural wake/sleep cycle). Be aware of this when choosing to wear a sleep tracking device, such as a Fitbit
  • Mood, stress, anxiety and depression can all impact on your quality of sleep and ability to fall and stay asleep
  • Anti-epileptic drugs (ASMs) can have effects on sleep. Although some may improve sleep, some may cause insomnia or disrupted sleep
  • The body is synchronised to night and day by a part of the brain known as the circadian clock. A person’s work schedule can affect this, in particular shift work, and in turn impact on sleep quality.

Sleep disorders

Sleep disorders are conditions that cause problems with sleep on a regular basis. This can affect anyone, not just people who live with epilepsy. Examples include obstructive sleep apnoea, sleepwalking, nocturnal panic disorder, restless leg syndrome, and parasomnias. Most sleep disorders will impact on the quantity and quality of a person’s sleep.

Sleep disorders can sometimes be overlooked in people with epilepsy. This may be because some sleep disorders mimic the symptoms of an epileptic seizure. Doctors may attribute the symptoms and associated tiredness to the effect of ASMs or poor sleep quality caused by nocturnal seizures, rather than consider the possibility of a co-existing sleep disorder.

Obstructive sleep apnoea

Obstructive sleep apnoea is one of the most common sleep disorders and people with seizures are more likely to have sleep apnoea than the general population.

Epilepsy and sleep apnoea frequently co-occur and may negatively influence each other. Sleep apnoea, a disorder of abnormal respiration during sleep, can be caused by upper airway obstruction, abnormality in breathing regulated by the central nervous system or a combination of these factors.

Episodes of apnoea lead to hypoxemia (low blood oxygen) and to chronic sleep deprivation due to fragmented sleep. Sleep deprivation and hypoxia may decrease seizure thresholds in people with epilepsy, resulting in poorer seizure control.

There is some evidence which suggests that ASMs exacerbate sleep apnoea by inhibiting respiratory drive centres and relaxing upper respiratory muscle tone, decreasing deep sleep cycles, or via medication related side effects such as weight gain.

Some evidence suggests that treatment of sleep apnoea may contribute to better seizure control. Treatment of sleep apnoea can include weight loss, maintaining oxygen flow through using continuous positive airway pressure (CPAP), oral appliances such as mouth guards, medications or surgery.

Healthy sleep tips

Many sleep problems are due to bad habits built up over a long period of time. You won’t fix sleeping problems in one night – persevere with good sleep hygiene and sleep should improve. You may need to experiment with different strategies to find out what works for you. Above all don’t obsess about your sleep problems.

Get enough sleep

The amount of sleep needed varies across ages. The National Sleep Foundation recently published new sleep guidelines suggesting that adults between the ages of 25 and 63 require seven to nine hours of sleep each night, while those over 65 require seven to eight hours of sleep.   

Listen to your body clock

  • Understand your sleep needs. Although the guidelines have recommendations, your actual sleep needs may be more or less.
  • Try to spend some daytime outdoors. This helps the body produce melatonin which is important in promoting sleep.
  • If you aren’t sleepy – don’t go to bed. Don’t stay in bed if you are awake and can’t fall asleep. If you can’t fall asleep within 20-30 minutes get up, leave the room and do a boring activity.

Build your perfect sleep environment

  • Evaluate your bedroom to ensure the ideal set up. Consider temperature, sounds, lights and the comfort of your bed. Ideally, your bedroom should be quiet, cool and dark.
  • Only use your bed for sleep. This builds an association of sleep with your bed which can help with falling and remaining asleep.

Avoid stimulants and drugs

  • Don’t drink beverages with caffeine in the evening.  Common caffeinated beverages include coffee, tea, soft drinks and energy drinks. Check the label to see if there is caffeine in what you are drinking and eating.
  • Give up smoking. Nicotine in cigarettes has been shown to be a stimulant that contributes to sleep loss.

Develop a going to bed sleep routine

  • Wake up and go to bed at the same time each day. This helps to keep your body clock synchronised. Stick to your bed routine and try to go to bed and wake up at the same times, even on the weekend.
  • Settle your body and mind before bed. Don’t engage in stimulating activities before bed.
  • Limit the use of electronic devices such as TV and smartphones. Try to switch off any devices an hour before sleep.
  • Be as relaxed as possible before going to sleep.

General lifestyle tips for good sleep

  • Get regular exercise but don’t exercise right before bed as this stimulates the body and makes it difficult to fall asleep.
  • People with epilepsy may need to avoid working night shifts as the significant loss or disruption to sleep can trigger seizures.
  • If you are affected by insomnia or another sleep disorder, ask your doctor for advice because improved sleep could make a difference to seizure control.
  • If you know you are going to have a late night compensate by having a nap earlier in the day and be aware sleeping later than usual may put you at a higher risk of seizures.
  • Mood disorders and stress can interfere with sleep so, if this applies in your case you should seek help from your doctor.

Other resources

The Australasian Sleep Association and the National Sleep Foundation have great tips about improving your sleep.

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