Epilepsy Talk

Seizures and Sleep Disorders | October 16, 2012


Sleepless nights. Exhausted afternoons. Confusion. Memory loss. Trouble with concentration, mood swings and of course, seizures. Which may increase in frequency or severity. Or may even contribute to intractable seizures. It seems like an endless cycle.

For people with epilepsy, sleep problems are a double-edged sword; epilepsy disturbs sleep and sleep deprivation aggravates epilepsy. Plus, the drugs used to treat epilepsy may also disturb sleep.

Studies have shown that 10-45% of people with epilepsy have seizures that occur predominantly or exclusively during sleep, whereas 34% have seizures upon awakening and 21% have diffuse seizures (while both awake and asleep).

Sleep activates electrical charges in the brain that result in seizures and seizures are timed according to the sleep-wake cycle. That sleep-wake cycle is associated with prominent changes in brain electrical activity and hormonal activity, so seizures and the sleep-wake cycle are closely related.

For some people, seizures occur exclusively during sleep. Others have seizures as they are falling asleep or waking up, and still others have seizures randomly spread throughout the day or night. This is especially true for Benign Focal Epilepsy or Rolandic Epilepsy.

When seizures occur during sleep, they may cause awakenings that are sometimes confused with insomnia. Epilepsy patients are often unaware of the seizures that occur while they sleep. They may suffer for years from daytime fatigue and concentration problems without ever knowing why.

Conversely, in the case of Juvenile Myoclonic Epilepsy, seizures rarely or never happen when sufficient sleep is obtained.

The way seizures spread through the brain also seems to differ depending on sleep state. Interestingly, frontal lobe seizures begin during sleep more often than temporal lobe seizures. However, temporal lobe seizures are more likely to spread and result in a convulsion when beginning during sleep, while frontal lobe seizures are not. This discovery could have implications for treatment if better understood.

Despite this, many physicians overlook the potential for treatable causes of sleep disruption in patients with epilepsy. And the outcome is that optimal sleep may not be achieved.

Here are some specific epilepsy disorders that are closely related to sleep seizures…

Frontal Lobe Epilepsy

Temporal Lobe Epilepsy

Juvenile Myoclonic Epilepsy

Epilepsy with Generalized Tonic-Clonic seizures on awakening

Rolandic Childhood Epilepsy with centrotemporal spikes

Interestingly, people progress through different stages of sleep. Most sleep seizures begin during the lighter stages, 1 and 2, and usually happen first upon falling asleep, accounting for about half of the total sleep time. These are times during which the electrical activity of the brain is more synchronized (rhythmic), which is why scientists believe that seizures are more likely to begin during these states.

By contrast, few or no seizures begin during REM sleep, (rapid eye movement, when you have the most vivid dreams). Normally, people cycle through all of these stages several times during the night.

On occasions, nocturnal seizures can be misdiagnosed as a sleep disorder and certain sleep disorders can be misdiagnosed as epilepsy. (Video-EEG recordings can assist with the correct diagnosis.)

But, the most troublesome sleep disorder in people with epilepsy is sleep apnea, in which breathing stops briefly during sleep. Sleep apnea affects at least 2% of the general population. But it’s about twice as common for those with poorly controlled epilepsy than in the general population.

As sleep deepens, the airway becomes blocked. The brain recognizes the resulting lack of oxygen, and the person wakes up (usually with a loud snore) and begins to breathe again. Often the person does not remember waking up, but this cycle is repeated all night long and normal sleep is never achieved. Therefore the person is drowsy most of the time and may be at risk of falling asleep during activities like driving.

It’s especially important to recognize and treat sleep apnea if you have epilepsy. Not only can the lack of sleep make your seizures worse, so can the lack of oxygen getting to your brain during sleep.

You may continue to have seizures (particularly during sleep) even if you take seizure medicines that would otherwise be effective. The good news is that both your drowsiness and seizures should improve if the sleep apnea is treated.

Sedating AEDs may benefit epilepsy patients with insomnia, and stimulating AEDs may benefit epilepsy patients with daytime sleepiness.

Phenobarbital and Klonopin can actually be used as sedatives. Lamictal may cause difficulty falling asleep. (It made me crazy hyper!) Felbatol, may cause insomnia. And medications like Dilantin, Phenytek, Tegretol or Carbatrol decrease REM sleep and therefore may contribute to memory problems.

Other seizure medicines, such as Neurontin and Depakote are thought to have little effect on sleep. And the jury is still out on some of the newest medications, like Trileptal, Keppra and Zonegran.

So what about sleeping pills?

Well, it depends upon your body chemistry. (And your state of mind.) Some people tolerate sleeping pills very well. Others become addicted.

The party line is that almost no sleeping pill should be used for more than two or three weeks. Particularly drugs of the benzodiazepine class, such as Xanax, Valium and Ativan, along with Halcion and Restoril.

Although how Restorial can be considered a sleeping pill is beyond me. I threw up all night and got zero sleep. So everyone is different. Which leads back to the merry-go-round of drugs.

To sleep or not to sleep? To seize or not to seize?

I’m tired of this merry-go-round. (I bet you are, too.) I want to get off. And take a nap.

Resources:

http://my.epilepsy.com/EPILEPSY/SLEEP_TYPES_DISORDER

http://www.sleepfoundation.org/article/sleep-related-problems/epilepsy-and-sleep

http://my.epilepsy.com/articles/ar_1062802120

http://my.epilepsy.com/epilepsy/sleep_disorders

http://my.epilepsy.com/epilepsy/provoke_sleepdep

http://sleepdisorders.about.com/od/causesofsleepdisorder1/a/Sleep_Seizures.htm

http://my.epilepsy.com/articles/ar_1063155671

http://community-1.webtv.net/@HH!A3!A6!9DCA6306F44A/MzMinnieMouse/Understanding/page7.html

http://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/nocturnal-seizures-during-sleep

http://epilepsy.med.nyu.edu/living-with-epilepsy/epilepsy-and-lifestyle/sleep-and-epilepsy

http://www.ncbi.nlm.nih.gov/pubmed/12609319


9 Comments »

  1. It seems that Frankinstorm Sandy or some glitch in cyberspace has left us null and void. I apologize for that but enjoy reading your comments everyday.

    Comment by Phylis Feiner Johnson — November 2, 2012 @ 10:18 AM

  2. I have grand mal seizures. Dx with Non-Epilepsy Seizures with possible co-morbid Epilepsy (due to one electrographic seizure observed on eeg during seizure at an ER time in 2012) and further confusing befuddled docs during the time of my intractable seizures in and out of hospital. ….. While in UCSF seizure monitoring unit in July 2013, they obserrved that I spend by far most of my sleeping time in Delta. Unusual, and I still don’t understand this. Was on no AED’s at all at that time of observation. Still having seizures, and with no electrographic correlation then. Have them day and night. A mystery to me and docs. All comments, questions welcome.

    Comment by MaryBeth Alban — September 1, 2013 @ 10:11 AM

    • Stage 2 sleep evolves into “Delta” sleep or “slow wave” sleep in approximately 10-20 minutes and may last 15-30 minutes.

      It is called “slow wave” sleep because brain activity slows down dramatically from the “theta” rhythm of stage 2 to a much slower rhythm of 1 to 2 cycles per second called “delta” and the height or amplitude of the waves increases dramatically.

      In most adults these two stages are completed within the first two 90 minute sleep cycles or within the first three hours of sleep.

      Contrary to popular belief, it is delta sleep that is the “deepest” stage of sleep (not REM) and the most restorative.

      It is delta sleep that a sleep deprived person’s brain craves the first and foremost.

      In children, delta sleep can occupy up to 40% of all sleep time and this is what makes children unwakeable or “dead asleep” during most of the night.

      http://library.thinkquest.org/C005545/english/sleep/stage.htm

      Have you had a Video EEG Monitoring? It allows prolonged simultaneous recording of your behavior and the EEG.

      Seeing EEG and video data at the same time, permits precise correlation between seizure activity in your brain and your behavior during seizures.

      Video-EEG can be vital in the diagnosis of epilepsy and epileptic seizures.

      It allows the doctor to determine: Whether events with unusual features are epileptic seizures, the type of epileptic seizure, and the region of your brain from which the seizures arise.

      Continuous Video EEG Monitoring – studies your brain waves over time.

      This can be accomplished through continuous Video EEG Monitoring, where you stay in a special unit for at least 24 hours.

      Antiepileptic medication is stopped for the duration of this test, since the objective is for seizures to occur so the abnormal brain waves they produce can be recorded.

      A video camera connected to the EEG provides constant monitoring, enabling the medical team to pinpoint the area where a seizure occurs and track your physiological response to the seizure.

      Continuous monitoring can also help distinguish between epilepsy and other conditions.

      It can characterize the seizure type for more precise medication adjustments and locate the originating area of seizures within your brain.

      AEEG (Ambulatory Electroencephalography) –is a relatively recent technology that allows a prolonged EEG recording in the home setting.

      Its ability to record continuously for up to 72 hours increases the recording of an ictal event or interictal discharges.

      An AEEG is a less expensive alternative to in-patient monitoring, with costs that are 51-65 percent lower than a 24 hour inpatient admission for Video-EEG monitoring.

      http://epilepsytalk.com/2010/09/13/beyond-eegs%e2%80%a6diagnostic-tools-for-epilepsy-2/

      One more thing: have you considered a sleep study? It may just be the ticket to your problem.

      Comment by Phylis Feiner Johnson — September 1, 2013 @ 4:16 PM

  3. I been looking at what people say. and I can not believe what there saying. one want,s to give up, because he has no friends,or they stay away from him. His sibings do the same thing. some that are seizure free, for awhile I,m happy for them. I went for 5 years one time, but when they come back, they think it ,s the end of the world.don,t they know it,s part of the epilepsy world, so just go on with your live.

    Comment by Michele Metzger — June 22, 2014 @ 5:59 PM

    • Michelle, please be more tolerant. I understand what you’re saying, but these are people with problems and the purpose of this website is to ask questions, inform, share, and support one another.

      And in this particular thread, I think the questions are quite reasonable.

      Not everyone has the same spirit or attitude as you!

      Comment by Phylis Feiner Johnson — June 23, 2014 @ 6:47 AM

  4. I have deja vu experiences that my neurologist said are seizures. It feels like someone, usually a person I know but haven’t seen in a very long time, is coming into the room I am. This is when I get light headed and can’t control it. I have only blacked out once thank goodness. My husband says I snore loud but I have since I was young. Could this be a form of sleep apnea?

    Comment by Jan — September 25, 2014 @ 6:05 PM

  5. Déjà vu has been firmly associated with temporal lobe epilepsy.

    Reportedly, déjà vu can occur just prior to a temporal-lobe seizure as an aura.

    But you can experience déjà vu during the actual seizure activity or in the moments between seizures.

    Take the neurological circuitry of the hippocampus, a region of the brain where new memories are formed.

    Neuroscientists know memories are actually groups of brain cells linked by especially strong chemical connections; recalling a memory involves finding and activating a specific group.

    It’s also this circuit, the scientists are convinced, that explains déjà vu. Every so often, the circuit misfires, and a new experience that’s merely similar to an older one, seems identical.

    It doesn’t happen very often to most people. But, some people with epilepsy have this experience all the time.

    Jan, I hope this helps…

    Comment by Phylis Feiner Johnson — September 26, 2014 @ 9:27 AM

    • This does help, thank you. I will contact my neurologist and seek his opinion, as well. Wow, I am so glad my daughter found your site. Thank you, again!

      Comment by Jan — September 26, 2014 @ 1:33 PM

  6. Anything I can do to help, just sing out! :-)

    Comment by Phylis Feiner Johnson — September 26, 2014 @ 1:46 PM


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    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I've also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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