Epilepsy Talk

Sleep apnea — it’s not just what you think it is | September 11, 2022

It’s not just snoring. It’s much more dangerous than that. Even deadly.

The estimated prevalence in North America is approximately 15 to 30 percent in males and 10 to 15 percent in females, But, as much as 40 percent of epilepsy patients suffer with undiagnosed sleep apnea. Especially those with refractory epilepsy.

As you already know, sleep apnea is characterized by abnormal pauses in breathing. Or instances of abnormally low breathing during sleep.

Each pause in breathing is called an apnea which can last from at least ten seconds to minutes. And it may occur 5 to 30 times or more an hour, causing partial airway obstruction.

As sleep deepens, your airway becomes blocked.

If these pauses last too long, they can reduce the oxygen in your blood to a life-threatening level. In addition, during a convulsive seizure, your airway may sometimes get covered or obstructed, leading to suffocation.

When your brain recognizes the resulting lack of oxygen, you suddenly awaken and then begin to breathe again.

Other than loud snoring, here are some common signs and symptoms:

Gasping for air while you’re asleep

Waking up with a dry mouth

A morning headache

Difficulty staying asleep (insomnia)

Excessive daytime sleepiness (hypersomnia)

Difficulty paying attention while you’re awake

Irritability

Memory deficits

Erectile dysfunction

And here are some dangerous results:

Hypertension

Stroke

Arrhythmias

Cardiomyopathy (enlargement of the muscle tissue of the heart)

Heart failure

Diabetes

Heart attacks

It’s really scary. Especially since it’s so benign as occasionally waking up in the middle of the night.

Often you don’t remember waking up — although I’m sure your partner remembers — but this cycle is repeated all night long and there’s really no high quality sleep.

Not surprisingly, a Norwegian study of 794 patients with epilepsy concluded that the most common triggers for seizures were emotional stress, sleep deprivation and tiredness. For people with epilepsy, healthy sleep is essential for effective control of seizures.

And for those with epilepsy, sleep problems are a double-edged sword.

Epilepsy disturbs sleep and sleep deprivation aggravates epilepsy.

The immediate effects of sleep apnea on your body depends on how long the failure to breathe endures.

Drops in blood oxygen can trigger seizures, even in the absence of epilepsy.

And if you do have epilepsy, the inadequate oxygen caused by apnea may trigger seizures that had previously been well controlled by medications. And some antiepileptic drugs, may adversely affect the continuity of your sleep.

It’s an endless cycle.

“Any disorder that fragments, or disrupts, sleep can change the overall excitability, and irritability, of the brain,” says Beth Malow, M.D., M.S., an assistant professor of neurology at the U-M Health System.

“In a person with epilepsy, the sleep disruption may facilitate a seizure.”

If sleep apnea is suspected, or your sleep is just so fragmented that you’re having seizures and difficulties during the day, a sleep study is highly recommended.

Sleep studies (Polysomnography) with expanded EEG aids can indicate the difference between seizures and parasomnias — a different kind sleep disorder — and diagnosis if the condition is truly sleep apnea, which can exacerbate seizures.

Treating sleep apnea may lead to improved seizure control. Which makes this diagnosis especially important in terms of sleep quality and treating epilepsy.

Treatment options include continuous positive airway pressure (CPAP), oral appliances for repositioning of the airway, surgery (reducing the tissue in the throat and improving airflow), and conservative treatments like sleep positioning and weight loss.

A randomized, controlled trial showed that approximately one third of people who received continuous positive airway pressure (CPAP) treatment had a 50% or greater reduction in seizure frequency, compared with only 15% of subjects who improved on a CPAP placebo.

“We did observe a significant trend toward improvement in seizure frequency among patients who received CPAP — a result that rivals that of an antiepileptic drug,” principal investigator Dr. Beth Ann Malow said.

Although CPAP therapy is extremely effective in reducing apneas and less expensive than other treatments, some people find it extremely uncomfortable.

In fact, lots of people refuse to continue the therapy or fail to use their CPAP machines on a nightly basis, especially in the long term.

But more comfortable CPAP face masks are available.

CPAP masks come in different shapes, sizes and materials to ensure effective treatment for obstructive sleep apnea.

It’s more a matter of pursuing the mask that best fits you.

And breathing easy. With a better night’s sleep. And hopefully, seizure relief.

(An article of interest may be: For Sleep Apnea — Three Revolutionary New Types of CPAP)

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Resources:

https://health.usnews.com/health-care/for-better/articles/2018-02-21/treating-sleep-apnea-in-epilepsy-reduces-seizures

https://www.webmd.com/connect-to-care/sleep-apnea/can-sleep-apnea-cause-seizures

https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-obstructive-sleep-apnea-in-adults

https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea

https://www.sleepfoundation.org/articles/epilepsy-and-sleep

https://www.epilepsy.com/article/2018/3/relationship-between-sleep-apnea-and-seizures

http://www.sciencedaily.com/releases/2000/10/001012074517.htm

https://www.healio.com/internal-medicine/neurology/news/online/%7Bbca18658-76d5-441d-bbb3-d31d392cdf07%7D/treating-sleep-apnea-decreases-risk-of-epileptic-seizures

https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741277/

https://www.cdc.gov/epilepsy/about/sudep/index.htm

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