Epilepsy and Sleep: Causes and Treatments

Epilepsy is a neurological disorder with spontaneous recurrence of unprovoked seizures as the main symptom. The relationship between epilepsy and sleep is enigmatic and has profound implications on the quality of life of affected people.

Learning about epilepsy can help you understand its impact on sleep and how to manage them.

Epilepsy & the Human Brain

Epilepsy is characterized by unprovoked seizures, which are the result of sudden, excessive electrical discharge in a group of brain cells. It is the

fourth most common

neurological disorder,

which has affected around 1 in 26 Americans.

These electrical discharges can happen in different parts of the brain leading to various types of
seizures.

These electrical discharges travel throughout the body via neurotransmitters.

Studies have found that, during a seizure,
many neurons

send signals simultaneously, much faster than normal. Due to these impulses, the person suffers from involuntary movements, sensations, emotions, and behaviors.

How Does Epilepsy Impacts Sleep?

Sleep is a multifaceted process governed by the brain. During sleep, the brain cycles between REM (Rapid Eye Movement) sleep and the non-REM sleep stages.

Epilepsy and
sleep

are bidirectional — sleep can influence the occurrence and pattern of seizures, while epileptic activity can disrupt normal sleep architecture.

Studies in Epilepsy Current

have found that seizures frequently occur during non-REM sleep, and frontal lobe seizures are most likely to occur.

Epileptic activity during sleep can cause disruptions and fragmentation, leading to insufficient, broken sleep.

A
research article

from Neuropsychiatric Disease and Treatment has mentioned that epilepsy patients have significantly lower efficiency of sleep, have more N2 non-rapid eye movement sleep, and have less rapid eye movement (REM) sleep.

Thus, epileptic patients are prone to disrupted sleep, which also further affects their symptoms negatively.

Epileptic Seizures While Sleeping

Epileptic seizures during sleep or nocturnal frontal lobe epilepsy seizures can intervene with the body’s
natural rest cycle.

Though these seizures predominantly occur during the non-REM stage, the exact triggers can vary.

However, the common factors of
nocturnal seizures

include sleep deprivation, certain sleep disorders like obstructive sleep apnea, and fluctuations in medication levels during nighttime.

Studies have found

that around 20% of people with epilepsy only have nighttime seizures, while 40% experience seizures while awake, and in 35% of people, seizures occur regardless of the state.

These seizures come with profound implications. They can disrupt the sleep cycle, cause an increase in daytime drowsiness, and elevate the risk of complications, including
SUDEO

(Sudden Unexpected Death in Epilepsy).

How Sleep Deprivation Affects Epilepsy

Sleep plays a pivotal role in the overall health of an individual. However, epilepsy makes it hard to get enough quality sleep.

Lack of adequate rest or sleep deprivation
can affect

the frequency, severity, and nature of epileptic seizures.
Sleep deprivation

can act as a potent trigger for seizures in many people.

What happens when the brain is deprived of rest? It undergoes changes in its electrical activity and neurotransmitter balance. This altered state caused by sleep deprivation can make the brain more susceptible to erratic electrical discharge, which is the starting point of epileptic seizures.

The lack of sleep also becomes the root cause of stress, which exacerbates seizures and symptoms of epilepsy. Stress can also worsen sleep, creating a vicious cycle.

Epilepsy & Sleep Disorders

Inefficient sleep causes several degenerative effects in normal individuals. In patients with epilepsy, sleep disorders are commonly diagnosed. Several sleep disorders are linked to epilepsy, such as

• Nocturnal Seizures: Epilepsy can cause sleep disturbances due to seizures that occur during sleep. These frequent seizures can fragment the sleep cycle and cause frequent waking-ups. Even without seizures, abnormal electrical activity in the brain can disrupt sleep stages.
• Sleep Apnea: This condition is associated with periodic interruptions in breathing sleep, which can also trigger seizures. Factors like brief awakening and fluctuations in oxygen levels can provoke seizures, which is why sleep apnea is prevalent among epileptic patients.
• Restless Leg Syndrome (RSL): In epileptic patients, restless leg syndrome has been observed with increased frequency. In normal individuals, RSL can lead to sleep deprivation. In patients with epilepsy, the intense electrical activity and the strong urge to move their legs can prevent restful sleep.
• Insomnia: Insomnia is a common sleep disorder that involves difficulty falling asleep, staying asleep, or waking up too early. In individuals with epilepsy, insomnia can be a side effect of medications or drugs or a result of anxiety about having seizures. Insomnia can lead to chronic sleep deprivation, which can increase the risk of seizures.

Treatments and Interventions

Treating epilepsy in the context of sleep disorders requires a unique approach. Addressing both conditions simultaneously is crucial to ensure the overall well-being of the patient.

Here are some treatment options.

• Antiepileptic Drugs (AEDs): These drugs are most commonly used in the treatment of epilepsy. The choice of AED will depend on the type and frequency of the seizures, the patient’s age, associated health conditions, and potential drug interactions. Some
  AEDs
  
  can have sleep-related side effects, which require healthcare professionals to monitor and adjust dosage accordingly.
• Vagus Nerve Stimulation (VNS): This
  treatment method
  
  is being used for people who don’t respond to AEDs. This method involves implanting a device under the skin on the chest which sends electrical impulses to the brain through the vagus nerve. Studies have found this method as one of the most effective ones, as approximately
  50% of patients
  
  experience at least 50% reduced seizure frequency.
• Responsive Neurostimulation (RNS): This treatment method
  involves
  
  the implantation of a device within the skull connected to electrodes placed in the area of the brain where seizures start. This device detects any abnormal electrical activity that starts in the brain and sends impulses to normalize it.
• Dietary Therapies: A diet low in carbohydrates and high in fat, like a ketogenic diet,
  has been
  
  
  found effective
  
  in treating epilepsy, especially in children. The key is low glycemic index foods containing a diet that keeps sugar spikes to a minimum.

Aside from these treatment options, your healthcare professional might suggest you undergo
surgery

depending on the intensity & frequency of seizures.

Surgical options can also help with related conditions that affect sleep, such as surgery for sleep apnea.

One example is

that removing soft palate tissue has been found to decrease OSA symptoms and seizures. The effectiveness of each treatment depends on the individual case and severity.

Tips to Improve Sleep for Epilepsy Patients

For epilepsy patients, achieving restful sleep is not just a matter of comfort. Sleep plays a crucial role in managing their condition. Here are some tips you can follow to achieve quality sleep hygiene with epilepsy.

• Consistent Sleep Schedule: Follow a consistent sleep schedule by waking up and going to bed at the same time every day. It helps regulate the internal clock of your body and improves sleep quality.
• Create a Restful Environment: Ensure that your bedroom environment is supportive for deep sleep. Keep your bedroom dark, quiet, and maintained at an optimal temperature and humidity.
• Limit Screen Time: Epilepsy makes it hard to fall into a deep sleep, and the use of screens and technology before bed can exacerbate your symptoms. Light
• Make a Wind-Down Routine: Follow a nighttime routine that can help your body wind down before bed and help you fall asleep. Turn off electronics, dim the lights, block out noise in the bedroom, and engage in relaxing activities to help you fall asleep with a calm mind.
• Address Medicinal Side Effects: It is important to know if the antiepileptic medicine that you are using is working and if there are any unexpected side effects to the
  medicine.
  
  You should discuss the potential
  side effects
  
  of the medicine with your doctor and inform any unusual side effects you are experiencing.
• Open Up about Stress and Anxiety: Epilepsy can be emotionally and physically draining and can transform a person’s life completely. Though it is normal to feel a variety of emotions, if you are feeling constantly anxious and stressed, you should consult with your doctor. Seeking support from a support group or talking to a counselor about your feeling can also help.

By keeping a check on your sleep hygiene and working with the best healthcare professionals, you can manage to get some hours of quality sleep.

FAQs

How do you know if you have sleep epilepsy?

Sleep epilepsy involves seizures that occur during sleep, especially in light sleep. The symptoms of sleep epilepsy include waking up confused, experiencing unusual movements at night, or finding new injuries upon waking up. If you have such symptoms, your healthcare professional should do an overnight EEG to monitor your brain activity during sleep.

What foods should epileptics avoid?

There are certain foods that cause hyperactivity in the brains of neurotypical human beings. The same foods might trigger seizures in epileptic patients, such as excessive caffeine, and high sugary foods.

Some patients might also be sensitive to artificial sweeteners, MSG, or gluten. What foods trigger seizures in your body requires you to be attentive toward their effects on your body.

Can epilepsy medication affect sleep?

Some epilepsy medications can cause drowsiness, while others might become a reason for insomnia. Antiepileptic medications can have different effects on your sleep cycle. It is better to discuss potential side effects with a doctor and keep track of your sleep patterns.

What medications make epilepsy worse?

Certain medications that are not designed to treat epilepsy specifically can lower the seizure threshold and exacerbate the symptoms of epilepsy. For example, some antidepressants, antipsychotics, and certain stimulant medications can worsen epilepsy. We suggest consulting with your doctor about the synergistic effects of these medicines.

What are the mental side effects of epilepsy?

Epilepsy can bring a spectrum of side effects on mental health, such as mood disorders like depression, anxiety, memory and cognitive challenges, and difficulty with concentration. Managing a chronic condition comes with an emotional toll and disorientation. Some antiepileptic drugs can also contribute to these mental health challenges.

Can I take melatonin supplements with epilepsy?

Melatonin can potentially interfere with seizure medications due to its interaction with enzymes in the liver that metabolize drugs. These enzymes are responsible for breaking down various substances, including certain epilepsy medications. When melatonin is introduced, it might affect the efficiency of these enzymes, leading to altered levels of seizure medications in the bloodstream. This could result in reduced efficacy or increased side effects.

Conclusion

Epilepsy is a complex neurological disorder that affects various aspects of an individual’s life, including circadian rhythms for sleep cycle & patterns, dietary choices, and mental well-being.

If you are feeling unusual symptoms or side effects, pay attention to your routine and medicines. Consult with your healthcare professional for better outcomes.

By adapting to a healthy sleep routine and taking the medicines that suit you, you can improve your quality of life.