Epilepsy and Sleep

Epilepsy is an increasingly common diagnosis: with 3.4 million Americans currently diagnosed with epilepsy, there are more people dealing with the disorder than ever before. Epilepsy can alter your life in many ways. From having to arrange your everyday activities around the possibility of seizures to experiencing the effects of the seizures themselves, the disorder can have a serious impact on nearly everything you do. However, when we talk about epilepsy, one of the main impacts that is often overlooked is the impact on your sleep.

Epilepsy and sleep affect each other in a cyclical manner: epilepsy can disturb sleep, and sleep disturbances can exacerbate epilepsy. Let's explore how sleep and epilepsy affect one another, and review ways in which people with epilepsy can improve their sleep and overall well being.

What is Epilepsy?

Epilepsy refers to a group of related neurological disorders that affect the central nervous system. Epileptic disorders cause periods of increased electrical activity in the brain, called seizures. The physical symptoms and severity of seizures vary, and will be explored below, but all seizures are based in the brain.

A person can have seizures without being epileptic. Around 10 percent of people will have a seizure at some point in their lives, caused by factors like brain injuries, tumors, extremely low blood sugar, substance abuse/withdrawal, and other illnesses and conditions. In order to be diagnosed with epilepsy, you need to have had at least two seizures more than 24 hours apart that were not caused by a separate underlying condition.

Approximately 1 in 26 people will develop epilepsy at some point in their lifetime. It is the fourth most common neurological disorder: as of 2015, approximately 3.4 million Americans had active epilepsy. That’s 1.2 percent of the total U.S. population. Though it’s most commonly diagnosed before age 10 and after age 55, a person can develop epilepsy at any age.

Active Epilepsy Prevalence, by State

Source: CDC

Types of Seizures

When most people think about seizures, they think about the sort of seizure they see in movies or on TV, where a person drops to the floor and violently shakes. While some seizures can look like that, there are actually many different types of seizures. They vary depending on what part of the brain they affect, and present with different types of symptoms. In total, there are over 30 different types of seizures, but these are the most common:

Generalized Seizures

Generalized seizures affect both sides of the brain. They are divided into two main subcategories:

  • Absence (petit mal) seizure: Absence seizures present as rapid blinking or staring into space. They begin and end very quickly, lasting only a few seconds. In fact, they’re so short that they are often mistaken for spacing out or daydreaming. They are more common in children than adults.
  • Tonic-clonic (convulsion) seizures: These are the seizures most people think of when they think of seizures. They can affect both children and adults. Tonic-clonic seizures occur in two parts. The first is the tonic (“stiffening”) phase, during which all the muscles stiffen, and air being forced past the vocal cords causes the person to make a noise (such as a yell, cry, or groan). The person loses consciousness and drops to the ground. Then comes the clonic (“rhythmic jerking”) phase, during which the arms and legs jerk rapidly, eventually slowing and then stopping. Generally, tonic-clonic seizures last 1 to 3 minutes. A tonic-clonic seizure that lasts more than 5 minutes is a potentially dangerous medical emergency.
Focal Seizures

How Epilepsy Affects Sleep

Regular, restful sleep is important for everyone, but it’s even more important for people with epilepsy. For some epileptic people, not getting enough sleep can trigger and exacerbate the severity of seizures. However, the relationship between epilepsy and sleep is complicated: in some cases, epilepsy and seizures can actually be the cause of sleep loss, creating a vicious cycle of worsening sleep loss and worsening seizures.

Though the interplay between epilepsy and sleep--and the severity of the effects from that interplay--varies from person to person, there are several central ways in which sleep and epilepsy affect one another. They include increased electrical activity in the sleep-wake cycle, the impact of seizures on sleep, underlying sleep disorders, and the additional consideration of epilepsy medication and its potential impact on sleep.

Sleep Help for People with Epilepsy

The sleep difficulties you can encounter when dealing with epilepsy may seem overwhelming, but there are definitive, proactive steps you can take to improve your sleep. We've compiled our top tips for people with epilepsy when it comes to getting a better night’s sleep:

  1. Discuss Specialized Diets with Your Doctor: It is often suggested that people with epilepsy stick to a diet that is higher in fat and lower in carbs, like a ketogenic diet or a modified Atkins diet. This sort of diet has been shown to reduce seizures in some people with epilepsy, and a reduced rate of seizures improves the quality of your sleep. In addition, there are foods and drinks you should avoid several hours before bed, including alcohol, caffeine, chocolate, and heartburn-inducing foods (if you tend to suffer from heartburn). It’s also recommended that smokers stay away from nicotine for around two to three hours before bed. This will make it easier to get to sleep and stay asleep.
  2. Establish a Routine: When it comes to sleep, routine is one concrete step you can take to improve your odds of getting what you need. Our bodies respond well to routine, and putting a nightly series of tasks, activities, and rituals in place will help ease your body into feeling tired at the right time. Brush your teeth, wash your face, put on your pyjamas, and maybe do some nighttime yoga before you hop into bed. Make sure to maintain a regular bedtime, and stick to the same routine every night.
  3. Build a Proper Sleep Environment: Your sleep environment is a major deciding factor in sleep health. Make sure you have a comfortable, appropriately-sized mattress, and high-quality pillows, blankets, and sheets. Do everything possible to make sure your sleep environment is dark, set at a comfortable temperature, and quiet.
  4. Unplug!:Limit screen time right before bed, and make sure that while you’re actually in bed, you access your phone as little as possible--ideally, not at all. Try plugging your phone in across the room, or in another room altogether. If you can, spring for a separate alarm clock so that you’re not depending on your phone to wake you up in the morning.
  5. Try the Tense and Relax Method: The tense and relax method, otherwise known as Progressive Muscle Relaxation or Jacobson’s Relaxation Method, is a relaxation technique commonly utilized to help people get to sleep. It calls for tensing and then relaxing a series of muscle groups in a specific order, while focusing on the sensation of those muscles. Studies have shown that this method is particularly useful in some epileptic people, particularly adolescents.
  6. Get Checked for Sleep Apnea/Comorbid Sleep Disorders. As mentioned above, people with epilepsy develop sleep disorders at a higher rate than the general population. These disorders can sometimes be considered comorbid to epilepsy, meaning they occur alongside epilepsy, and can be treated on their own. Sleep apnea in particular has many different treatments, the most common of which is the use of a CPAP machine, which helps people with sleep apnea breathe more easily and with less obstruction. Consult a sleep specialist and undergo a sleep study if you suspect that you may have apnea or any other sleep disorder.
  7. Avoid Known Seizure Triggers: Each person has their own seizure triggers, and it’s important to be aware of anything that might trigger seizures in you personally. Whenever you have a seizure, try to record everything that happened around that seizure: where you were, what you were doing, anything you might have eaten or drank, and anything you may have been exposed to. There are also things that tend to trigger seizures among many epileptic people. These include emotional and physical stress, certain types of exposure to rapidly flashing lights, nutritional deficiencies, stopping or skipping medication, drugs and alcohol, and, of course, a lack of sleep.
  8. Adjust Your Meds. In some cases, epileptic people experience sleep disturbances from their epilepsy medications. If you feel that this is the case, consult your doctor and let them know that you feel your meds are getting in the way of your sleep. They will be able to tell you if this is a common side effect of that specific medication, and advise work with you to address the issue safely.

Frequently Asked Questions About Epilepsy and Sleep

Reach Out and Learn More

Epilepsy can be a complicated, confusing disorder to face in yourself or in a loved one. Fortunately, the epilepsy support community is active in its outreach and the web is rich with helpful and authoritative resources you can access from home to learn about epilepsy and how to best manage living with it.

  • Epilepsy Leadership Council: A broad network of consumer, governmental, health, and advocacy organizations working with, for, and on behalf of people with epilepsy.
  • CDC Seizure First Aid: What to do when you see someone having a seizure, broken down step-by-step.
  • Epilepsy Foundation: A major source of information, support, and resources for people with epilepsy, their loved ones, and their healthcare providers.
  • For Parents of Children with Epilepsy: A centralized database of resources and information for parents of children with epilepsy.
  • Epilepsy Toolkit: A centralized database of resources, information, and support for parents of teens with epilepsy.
  • Find A Doctor Search Tool: If you’re looking for an epilepsy specialist in your area, use this search tool, which is endorsed and hosted by the American Epilepsy Society.
  • 24/7 Epilepsy Hotline: From practical questions to emotional support, this hotline can help you with your epilepsy-related needs, 24-hours a day.
  • Epilepsy and the Workplace: A Q&A about epilepsy in the workplace, your rights, and the Americans with Disabilities Act (ADA), compiled by the US Equal Employment Opportunity Commission.
  • National Organizations Dedicated to Epilepsy: A CDC list of organizations that advocate and provide resources for people with epilepsy.
  • Your Local Epilepsy Foundation: A search tool that helps people find epilepsy foundations specific to their locations. This tool includes local, national, and international organizations, sorted by location.

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