Epilepsy Talk

Epilepsy and sleep apnea — a dangerous duo | January 10, 2023

Almost a third of people with epilepsy may suffer with undiagnosed sleep apnea, a sleep disorder which is dangerous because of  the possible serious consequences.

Basically (as you probably already know), sleep apnea is characterized by abnormal pauses in breathing or instances of abnormally low breathing during sleep.

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

As sleep deepens, your airway becomes blocked.

Your brain recognizes the resulting lack of oxygen, and you wake up — usually with a loud snore and then begin to breathe again.

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.

That’s because synchronized non-rapid eye movement (NREM) sleep tends to facilitate seizures.

While desynchronized rapid eye movement (REM) sleep discourages seizure occurrence.

The most common complaints of sleep apnea are excessive daytime sleepiness and frequent awakenings.

There can also be symptoms like grinding your teeth, a dry mouth, morning headaches, erectile dysfunction, memory deficits, and snoring.

But most importantly, this sleep deprivation provokes seizures and epileptiform discharges in some people with epilepsy.

30% thirty per cent of those with medically refractory epilepsy are likely to have seizures caused by sleep apnea.

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.

It’s an endless cycle.

But there’s more to sleep apnea than what meets the eye. (No pun intended.)

There are actually three forms of sleep apnea: central (CSA), obstructive (OSA), and complex or mixed sleep apnea (a combination of central and obstructive) constituting 0.4%, 84% and 15% of cases respectively.

In CSA, your breathing is interrupted by a lack of respiratory effort.

In OSA, your breathing is interrupted by a physical block to airflow — despite respiratory effort — and snoring is common.

During central apneas, your central respiratory drive is absent, and your brain does not respond to changing blood levels of the respiratory gases.

No breath is taken, despite the normal signals to inhale.

The immediate effects of central 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.

Conversely, some antiepileptic drugs (AEDs) adversely affect the continuity of sleep.

“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.

The CPAP machine generates the required air pressure to keep your airways open during sleep.

Involved is a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.

Advanced models may warm or humidify the air and monitor your breathing to ensure proper treatment.

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 of matter of pursuing the mask that best fits you.

With that, you’ll be on your way to a better night’s sleep and hopefully, seizure relief.

An article which may be of interest to you: For Sleep Apnea — Three Revolutionary New Types of CPAP https://epilepsytalk.com/2014/11/08/for-sleep-apnea-three-revolutionary-new-types-of-cpap/

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Resources:

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

https://jaxsleepcenter.com/can-sleep-apnea-cause-seizures/

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

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

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