Epilepsy and Sleep

Mary the AuthorMary Sweeney RN, BSN, CEN, ONN-CG
Updated: April 11, 2020

What is Epilepsy?

Epilepsy is the fourth most common neurological disorder and can affect people regardless of age, sex or gender. This disorder is characterized by recurrent, unpredictable seizures that do not have a root cause. While some seizures can be caused by low blood sugar, a traumatic brain injury or alcohol withdrawal, an epileptic seizure happens with no clear explanation why (source).

People that are diagnosed with epilepsy may have varying degrees of symptoms, as the condition can affect people differently. Within those different groups of people, there are different kinds of seizures that can be experienced by epileptics. We’ll take a closer look at those below.

Types of Seizures

There are three main types of seizures: generalized onset, focal onset, and unknown onset seizures. Here’s a breakdown of each one:

Generalized onset seizures affect both sides of the brain and can encompass several different subtypes of seizures. Seizures within this group include:

Tonic-clonic: A seizure that has two phases, this type is the most commonly known one. During the tonic phase, a person loses consciousness and all of their muscles become stiff. At this time, the person may bite their tongue. During the clonic phase, the person’s body begins to move uncontrollably, with jerky movements in all extremities. This type of seizure usually lasts one to three minutes, followed by a period of time called the postictal period. After the seizure in the postictal time, the person may be groggy, confused and disoriented.

Absence: An absence seizure is where a person may be “staring into space” or “blanking out” for a small period of time. During this type of seizure, the person is conscious and is having a brief interruption in normal electrical activity in their brain. They are conscious and there is no postictal period after this type of seizure.

Atonic: This type of seizure causes part or all of a person’s body to become limp. Usually, the person is not aware of their surroundings with atonic seizures. 

The above seizure types do not include all of the types of generalized seizures, it’s just a snapshot. For more information on this group of seizures, visit the Epilepsy Foundation website.

Focal onset seizures can be further divided into two groups:

Focal onset aware seizures: This type of seizure is when a person is awake and aware during a seizure. It usually begins on one side of the brain, lasts less than two minutes and is the most common type of seizure in people with epilepsy.

Focal onset impaired awareness: In this type of seizure (also known as a partial seizure), signs may include lip smacking, repetitive picking at clothes, loss of awareness of surroundings and wandering around. These last one to two minutes.

Causes and Risk Factors

As mentioned earlier, often there is no clear explanation for why epilepsy develops. It can affect anyone at any age but is more common in younger children and older people. According to the Epilepsy Foundation, about 1 in 100 people in the United States has had a single, unprovoked seizure or has been diagnosed with epilepsy. Furthermore, 1 in 26 people will develop epilepsy in their lifetime. To put those numbers in perspective, about 48 out of 100,000 people will develop epilepsy each year. Those are staggering statistics!

So, what are the risk factors? According to the Epilepsy Foundation, here are some of the common ones:

  • Prematurely born infants
  • Babies who have had a seizure in the first month of life
  • Brain tumors
  • Lack of oxygen to the brain
  • Traumatic brain injury
  • Meningitis or other brain infections
  • Autism spectrum disorder
  • Alzheimer’s disease (late stages)
  • Illegal drug use
  • Concussions
  • Febrile seizures that last longer than usual
  • Mild head injuries (concussions)

Signs and Symptoms

The signs and symptoms of a seizure can vary based on what kind of seizure a person is having. However, here are some common signs and symptoms:

Pre-seizure:

  • Heightened sense of smell, taste, or sounds
  • Blurry vision
  • Nausea
  • Lightheadedness
  • Loss of awareness
  • Headache
  • Numbness/tingling to arms or legs

During a seizure:

  • Possible loss of consciousness
  • Confusion
  • Lack of movement or lack of control over movements
  • Tremors or twitching
  • Spastic movements of arms or legs
  • Racing heart
  • Inability to control bowel or bladder

Post-seizure:

  • Confusion, grogginess
  • Nausea, vomiting
  • Disoriented
  • Thirsty

Diagnosis and Treatment

Epilepsy can be difficult to diagnose. There are many factors that can cause seizures, and the first step is making an accurate diagnosis. Often, healthcare providers will better be able to diagnose a seizure disorder if the patient provides detailed information about frequency of seizures, type of seizures, and what happens before and after the onset of seizures.

Generally, a doctor will order the following tests to diagnose epilepsy:

  • Electroencephalogram (EEG), which is a test that measures brain waves. This can identify changes or abnormalities in electrical patterns in the brain.
  • Blood tests to rule out other medical conditions that may be causing the seizures
  • Imaging tests like a CT scan or MRI to look for things like a tumor, infection, or area with decreased blood flow that may be causing the seizures
  • Sleep study to evaluate what happens during periods of sleep
  • Lumbar puncture to test spinal fluid for infection or other abnormalities

These tests can help to rule out other medical conditions that may be causing seizures. If they come back normal, that doesn’t necessarily mean that epilepsy has been ruled out, it just means that they have ruled out other conditions.

Treatments for epilepsy can include:

  • Medications: There are several different types of medications to treat seizures. Many can have debilitating side effects, so the treatment with medication will vary from person to person and can also vary based on the type of seizure disorder a person has been diagnosed with.
  • Surgery: If doctors can isolate the area of the brain that is causing seizures, surgery may be an option. This is typically considered after the person has failed several different types of medication treatment.
  • Diet changes: There has been recent evidence that eating a ketogenic diet may help with seizure disorders. A ketogenic diet consists of low-carbohydrate, high-fat foods and may help to reduce the frequency of seizures in some disorders.
  • Vagus nerve stimulation: This involves the placement of a nerve stimulator in the chest to reduce the frequency of seizures. This comes with side effects like cough, sore throat, and sleep apnea. Again, this is usually only considered when treatment with medications has failed.

Usually, doctors will start with medications to treat epilepsy. If medications fail, they will explore other options based on underlying health conditions, medical history, and type of epilepsy (source).

How Epilepsy Affects Sleep

The relationship between epilepsy and sleep is complicated – epilepsy can affect sleep, and sleep can affect epilepsy. The medications that are used to treat epilepsy can often cause sleep disturbances. For example, the medication Keppra (used to treat seizures) can cause fatigue but has to be taken at certain time intervals throughout the day for it to be effective. This may cause the person to nap frequently, thus disturbing the quality of sleep they get at night.

People that are diagnosed with epilepsy often suffer from sleep apnea. This is a condition in which a person may go for a period of several seconds without breathing while sleeping. When this happens, the brain sends a message to the body to wake up and breathe, which causes many interruptions in sleep throughout the course of a night. Side effects of sleep apnea include headache, fatigue, and trouble concentrating. Sound familiar? Those are also precursors to seizures.

According to a study of children with epilepsy and their siblings that did not have epilepsy, conducted through the University of Calgary in Alberta, Canada, “The results indicate that epileptic children had a significantly higher rate of sleep disturbance and that their disturbed sleep is associated with greater social and attention problems and a reduced quality of life. They also have a higher rate of attention deficit hyperactivity syndrome and other learning, emotional and behavioral difficulties compared to children without epilepsy” (source). This can present a huge challenge in children and adolescents with learning and socialization.

In summary, epilepsy is an extremely common condition that can occur at any age. There are instances where epilepsy can occur during childhood and then resolve completely at the onset of adulthood, and yet other instances where epilepsy presents during adulthood and persists for the duration of the person’s life. Epilepsy is a treatable condition with medications, surgery, and other treatments. 

If you are suffering from seizures or suspect you may have epilepsy, contact a healthcare professional as soon as possible to rule out any life-threatening medical conditions. For more information on epilepsy, its treatment or other topics, see the helpful links below.

References and Continued Reading