Sleep and epilepsy

Introduction

Some people with epilepsy have seizures only when they are awake, some while asleep and some people have a mixture of both.

This information is provided to give you a clear understanding of seizures during sleep and ways in which the sleeping environment can be made a safer place for people who have sleep seizures.

Diagnosis

There are over 40 different types of seizure and some types are more likely to occur in certain stages of sleep. For this reason, it is helpful for doctors to have as much information as possible from eye witnesses about the seizure symptoms and times they occur. This will give them a good idea of the most likely seizure type and will help them to prescribe the best treatment.

Stages of sleep

There are two main states of sleep – non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). These two sleep states are caused by activity which occurs in different parts of the brain. Generally speaking, each person’s sleep pattern follows a cycle in which REM sleep alternates with NREM periods.

In NREM sleep, there is little body movement and breathing is regular. This usually accounts for 75 per cent of a person’s sleeping time. During this type of sleep, generalised seizures are more likely to occur. 

REM sleep is characterised by eye movement, frequent twitching of the face, arms and legs and increased and irregular breathing. This is known as active sleep and is when most dreaming takes place. Periods of REM sleep can last from a few minutes to half an hour. During this stage of sleep, partial seizures are more likely to occur.

Is it epilepsy?

There are a number of different conditions that can be confused with sleep seizures. These include: sleep walking, sleep terrors, bed-wetting, restless-leg syndrome, sleep apnoea and narcolepsy. It is very important to be correctly diagnosed, to ensure that the right treatment is prescribed.

If diagnosis is proving difficult, doctors may carry out an EEG test during sleep, to find out whether epileptic activity is the cause of the symptoms. If the symptoms are present at the time the test is carried out, but the results from this test are clear, then this would indicate that the cause is most probably not epilepsy.

Treatment

The usual way to treat epilepsy is with anti-epileptic drugs (AEDs), which aim to prevent seizures by acting in some way to control the excitability in the brain. It is important to take AEDs exactly as prescribed by your doctor, because missing doses may trigger seizures in some people. You will usually need to take your AEDs at regular intervals throughout the day, to make sure that there is a steady supply in your blood stream.

Some people may notice an increase in seizures in the second half of the night and this may be due to the reduced levels of AEDs in your blood stream. If this happens to you, it is a good idea to talk to your doctor who may suggest adjusting your medication.

First Aid

First aid procedures for seizures are basically the same for both awake and asleep attacks.

There are things you can do to help someone who is having a convulsive seizure.

• Do protect the person from injury - move any sharp or hard objects.
• Do place the person in the recovery position when the convulsive part of the seizure is at an end. This will help their breathing.
• Do be quietly reassuring.
• Do stay with the person until they have regained full consciousness or a normal sleeping pattern is resumed.

There are also things you shouldn’t do.

• Do not try to restrain the person having the seizure.
• Do not put anything in the person’s mouth or force anything between their teeth.
• Do not try to move the person unless they are in danger.
• Do not give the person anything to drink until they have fully regained consciousness.

There are some circumstances when you should call for an ambulance.

• If it is the person’s first seizure.
• If injuries have occurred during the seizure, such as a cut that needs stitching.
• If a generalised seizure shows no sign of stopping after five minutes or lasts two minutes longer than is usual for that person.
• If a second seizure occurs without the person fully regaining consciousness in between.

Safety

There are a number of ways in which you can make your sleep environment safer, to reduce the risks of danger during a sleep seizure.

Sleeping in a low bed, perhaps with protective cushions around it, can help to minimise the risk of injuries if you fall out of bed. A thick carpet or rug would provide a softer landing than hard flooring. Carpets with high wool content are less likely to cause friction burns than those with a high synthetic content.

Keep any sharp objects or pieces of furniture, such as bedside tables, away from your bed. It can also be a good idea to cover any sharp edges around your bed that can’t be moved. Towels, or pieces of foam rubber, which can be purchased from DIY shops, can be handy for this.

There are a number of different types of bed alarm available that pick up unusual sounds or movements during sleep. However, before investing in an alarm, you will want to think about whether you would find it helpful. For example, there must be somebody else available to hear the alarm for it to be useful. Your wish for privacy should also be respected, so you may choose not to be monitored in this way.

For details of companies that supply bed alarms, visit the links to safety alarms section of our website.

Sleep deprivation

Some people find that their seizures are triggered by lack of sleep or changes in their sleep pattern. If this happens to you, it is advisable to try to go to bed and get up at regular hours and to avoid shift work or other causes of disrupted sleep. There is no need to sleep more than usual, as some people may have their seizures triggered by sleeping for longer than they need.

Driving

The driving regulations for people who only ever have seizures during their sleep differ slightly from the regulations for people who have awake attacks. This is because the DVLA recognises that the longer a person continues to have seizures in their sleep only, the less is the risk that they will have one when they are awake.

• Driving regulations

27 April 2007