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


8 Comments »

  1. I appreciate that you share info with others. I have very mild simple partial seizures and was able to take care of patients while having one. I have a code that lets my husband know. Your article on sleep apnea is not quite correct. I worked in a sleep disorder clinic. For 27 years and retired. Respiratory therapist by degree. I hope you do update your info regarding sleep apnea and the cpap/apap usage. And there are a number of masks. They are made of silicone. The plastic is what the cushion attaches to. And we use apap mode the mode. It measures the obstruction and adjusts the pressure. Not just one constant pressure like cpap. I have used my apap since 2o years, and got to be a guinea pigs for testing. Fun. Sometimes not. Haha. But sleep apnea is a lot more than just 2%. And some of the main side effects are heart attack, stroke, CHF, hypertension, depressing, etc. Again I appreciate your articles, but hope you update this one. 🙂

    Liked by 1 person

    Comment by Frankie Elizabeth Collins Lubin — September 11, 2022 @ 11:14 AM

  2. Frankie thanks for your input, correction and education. All appreciated.

    I think I’ve managed to set things straight — with your help!

    Again Frankie, thanks.

    Like

    Comment by Phylis Feiner Johnson — September 11, 2022 @ 12:46 PM

  3. Write now I take Keppra but it has side effects. Are you satisfied with Lamictal as my daughter thinks I should take it as I am thinking of switching. How much do you take and is it the only medication you take?

    Liked by 1 person

    Comment by Mary Jane — September 12, 2022 @ 7:57 AM

    • I’ve had wonderful success with Lamictal. 250mg in the morning and 250mg in the evening.

      At first, it made me crazy/hyper. But when I settled down and changed my bedtime dose to 6PM, all was well.

      99% seizure free for 10+ years!

      And yes, I supplement it with Klonopin.

      I hope you are as fortunate.

      Like

      Comment by Phylis Feiner Johnson — September 12, 2022 @ 9:08 AM

  4. I use a CPAP machine every night and have regular checkups with my sleep doctor. I found that the nasal cushions
    are very comfortable, more comfortable than nothing at all. The silicone cushions are attached to a soft, elastic strap that goes around the back of my head- keeping them snug in place without any air leakage. Finally, the cushions are attached to the air hose going to the CPAP machine. I tried what I call some of the old-fashioned masks at first but found them much less comfortable. The CPAP machine and nasal cushions enable me to get a good night’s sleep, more oxygen to my brain without interruptions, and close to 0 seizures when added to meds and a Vegas Nerve Stimulator (VNS) implant under the skin on my chest.

    Liked by 1 person

    Comment by Tom Burke — September 12, 2022 @ 12:00 PM

    • We do NOT ever use full face masks since it can increase the pressure when not needed. We use apap (can adjust low and high pressure setting)
      only which can be changed into cpap mode. I personally can only use a nasal mask due to sinus issues. And I have tested all the masks and paps out there for many years. Also the ResMed and Respironcs deliver the pressure differently. More than anything I tried to educate. And congrats on the seizures being taken care of so great!

      Liked by 1 person

      Comment by Frankie Collins Lubin — September 14, 2022 @ 2:41 PM

  5. That’s super Tom! Thanks for the tip.

    Like

    Comment by Phylis Feiner Johnson — September 12, 2022 @ 2:59 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I 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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