Sleep and Epilepsy

Most doctors recommend that persons with epilepsy get adequate sleep. Defining "adequate sleep" is difficult, but a simple definition is a night's sleep that leaves a person feeling refreshed the next day.

It is not only the quantity, but the quality, of sleep that matters. There is a wide range of individual sleep needs. Patients with epilepsy may get insufficient sleep due to circadian rhythm abnormalities, seizure frequency and medication side effects. Their sleep quality may be affected by other sleep disorders that affect the general population, including Obstructive Sleep Apnea and Restless Legs Syndrome. Sleep issues in patients with epilepsy should be addressed by a sleep medicine specialist.

Can sleep deprivation trigger a seizure?

Insufficient sleep or any problems that disrupts sleep can trigger a seizure. Indeed, some people suffer their only seizure in life after doing an "all-nighter" at college or after a prolonged period of poor sleep associated with a major life stressor. For persons with epilepsy, lack of proper sleep can increase their chances of having a seizure, or even increase the intensity and duration of a seizure. Physicians use sleep deprivation, by asking persons with suspected epilepsy to stay up all night before having an EEG, to "activate the brain" and make it more likely that abnormal brain electrical activity will be revealed. Sleep deprivation also makes it more likely that the patient will fall asleep during the EEG, increasing the chances of recording certain electrical abnormalities enhanced by sleep.

We do not know why sleep deprivation provokes seizures. The sleep-wake cycle is associated with prominent changes in brain electrical activity and hormonal activity, so seizures and the sleep-wake cycle are closely related. Some persons have all of their seizures while sleeping. Others have seizures as they are falling asleep or waking up, and still others have seizures randomly spread throughout the day or night. Some specific epilepsy syndromes, especially in children, are very closely related to sleep.

Sleep in Children

Children require more sleep than adults. The sleep medicine specialist can offer guidance on how much sleep the average child requires at different ages, and can offer tips on helping to maintain a regular sleep routine. If a child consistently has more seizures when he or she does not sleep enough, the parents should try to recognize and avoid those things that cause sleep deprivation.

For more information, please contact our sleep medicine specialist at the New York Sleep Institute.

Improving Sleep

For people who have problems falling asleep and staying asleep, some simple measures may be helpful:

  • Make sure the sleeping environment is quiet and dark
  • Use the bed only to sleep
  • Go to bed only when sleepy
  • Get out of bed every day at the same time
  • Do NOT take naps
  • Avoid caffeinated beverages within 6 hours of going to sleep
  • Exercise daily but do not exercise shortly before going to sleep

Sleep Medication

Sleeping pills should be used only under a doctor's supervision. Even with short-term use, certain types of sleeping pills, especially the benzodiazepines such as triazolam (Halcion), clonazepam (Klonopin), and temazepam (Restoril), can trigger seizures in susceptible persons when the dosage is reduced. During periods of tremendous stress, such as loss of a job or a relationship, the judicious use of sleeping pills for several nights can help to prevent a seizure caused by sleep deprivation. There are also new medications on the market that may cause fewer side effects (such as imidazopyridine (Ambien) and eszopiclone (Lunesta).

People who depend on sleeping pills should consult their doctors about getting off them. Gradual reduction of the dosage, possible substitution of non-habit forming medications that promote sleep, and the simple measures just described can be helpful. Diphenhydramine (Benadryl), although non-habit forming and promotes sleep, should generally be avoided since it can also provoke seizures in some individuals with epilepsy. Melatonin is another over-the-counter drug used to promote sleep; it appears to be safe for most people with epilepsy although scientific studies are lacking. All decisions regarding the use of over-the-counter sleep medications should be discussed with your physician.