Everyone needs sleep to perform at their best, but that’s especially true if you or your child have been diagnosed with epilepsy, the condition that causes seizures.
“It’s a two-way relationship: Sleep affects epilepsy, and epilepsy affects sleep,” says UNC Health neurologist Lynn Liu, MD. “It can cause a vicious cycle in which sleep disruption can increase seizures, and then your medications to control seizures disrupt your sleep routine.”
It is possible to break that cycle, though. Dr. Liu explains what you need to know.
How Sleep Affects Epilepsy
You may notice triggers for your seizures—maybe they’re common when you’re stressed, dehydrated or at certain parts of your menstrual cycle. If you’re not getting the quantity or quality of sleep you need, you may have more seizures.
“A lot of people who have epilepsy say that being sleep-deprived is a trigger for their seizures,” Dr. Liu says. “They learn that they have to pay a lot of attention to their sleep hygiene.”
That means sticking to the same sleep schedule each night and making sure your bedroom is quiet, cool and dark. Have a soothing wind-down routine that doesn’t involve looking at your phone or a screen. Avoid stimulants, such as caffeine, smoking or exercise close to bedtime, as well as alcohol, which can affect the quality of your sleep.
If you find yourself lying awake without sleeping, get up and do a quiet activity somewhere else, so that you don’t associate your bed with tossing and turning. If you struggle with insomnia, talk to your doctor.
If you’re an adult with epilepsy, an afternoon nap might affect your ability to fall asleep at night, so you may need to resist that urge. Children, however, are an exception.
“If a very young child is napping during the day, they should still do so until they outgrow it,” Dr. Liu says. “Children should keep their nap as long as it’s developmentally appropriate.”
Teenagers tend to go to sleep and wake up later than many adults, particularly during breaks from school, which Dr. Liu says isn’t a problem when they can get enough sleep each night, but be mindful about adjusting their sleep schedule back to normal slowly before school begins again.
How Epilepsy Affects Sleep
Naps, particularly late in the day, can affect your ability to fall asleep at night. However, there are times when they are necessary for a person with epilepsy.
“After a seizure, in the postictal phase, people do need to rest or sometimes nap,” Dr. Liu says. “You can’t control that sleep, because the brain is exhausted by seizure activity and needs rest.”
That can present a problem: If the seizure is in the afternoon, then you nap for a few hours, you won’t be tired when it’s time for bed, and your sleep cycle will be disrupted.
Seizure medications also can affect sleep.
“The medication is meant to calm down an irritated brain, but the medication can’t tell the difference between irritable nerve cells and healthy nerve cells, so all of the brain’s cells get calmed down,” Dr. Liu says. “As a result, the meds make people feel tired during the day.”
That may make it hard to resist that nap, which will affect your nighttime sleep. Being tired day after day also can make it harder to eat right and exercise, and if you gain weight as a result, you’re at higher risk for obstructive sleep apnea, which affects the quality of your sleep.
That’s why it’s important to talk to your doctor about any side effects you notice with your medication.
“We all metabolize medications differently, so if you’re excessively sleepy, we might order labs to check the levels of medication in your blood and adjust the medication so you’re not so tired,” Dr. Liu says. “For some medications, we might recommend that you take your biggest dose at night, when you’ll be asleep anyway and when it might help you sleep better.”
Some Types of Epilepsy Are Especially Sensitive to Sleep
Some people with epilepsy are more likely to have seizures while they are asleep or just before or just after they wake.
With juvenile myoclonic epilepsy, you tend to have seizures in the hours after you wake, often as a result of sleep deprivation.
“Juvenile myoclonic epilepsy is often first diagnosed when students go to college,” Dr. Liu says. “They might stay up all night studying for an exam and then end up in the emergency department because they have convulsions for the first time.”
People with frontal lobe epilepsy tend to have the majority of their seizures at night, because the frontal lobe is involved in the transition in and out of sleep.
When a person who has nocturnal seizures wakes, they may or may not be aware that they had a seizure. They may wake up confused, tired or sore; they may have lost control of their bladder. A parent, roommate or partner is sometimes the one who notices the nighttime seizures.
“A nocturnal seizure might start with a vocalization, and then it’s followed by stiffening or shaking,” Dr. Liu says. “Turn the person on their side, so that saliva falls out of their mouth. There’s an old wives’ tale that people having a seizure will swallow their tongue, and that won’t happen, but they could bite their tongue and it could obstruct their airway while they’re on their back.”
If a nocturnal seizure lasts longer than five minutes, or if the person seems to be having trouble breathing, call 911.
Having one convulsion during the night doesn’t necessarily mean that a person has epilepsy, but it’s important to talk to your doctor so they can consider possible reasons for the seizure.
“It’s really important to consider both epilepsy and sleep disorders called parasomnias, like sleepwalking, when this happens,” Dr. Liu says. “We can do a sleep study to determine whether movements are related to sleep or to epilepsy.”
If you’re having trouble sleeping, talk to your doctor. If you need a doctor, find one near you