Sleep, tiredness and fatigue

Can epilepsy make you feel tired?

Fatigue is a feeling of overwhelming tiredness, lack of energy, weakness or exhaustion. Fatigue can be mental, physical or both.

Epilepsy and fatigue are closely connected. People with epilepsy feel fatigued for different reasons and in different ways. Some people with epilepsy may feel tired all the time because of the condition. Other people feel very tired after a seizure.

Being very tired can also trigger a seizure. So it works both ways. Fatigue can trigger a seizure and a seizure can cause fatigue.

How common is fatigue in epilepsy?

Fatigue is common in people with epilepsy. Research has found that almost half of people with epilepsy have fatigue.

Sleep problems can have a huge impact on everyday life. For example, it may interfere with your education, social life, relationships and work.

We have more information about living with epilepsy, including practical advice and support for dealing with epilepsy symptoms such as fatigue:

• Epilepsy and work
• Epilepsy and education
• Epilepsy and relationships

What causes fatigue in epilepsy?

Research has found several reasons why people with epilepsy may feel very tired or fatigued.
These factors can affect each other. For example, tiredness can increase the risk of seizures, and seizures can make tiredness worse.

Fatigue, anxiety and depression

Managing fatigue and other epilepsy symptoms can be challenging. Balancing this with parenting, work or socialising can affect your mental health.

Anxiety and depression are both common in people with epilepsy. These mental health conditions can also cause tiredness and fatigue.

Living with a mental health condition can be difficult. But depression and anxiety can be treated. There are also things you can do to try and help yourself.

Find out more about epilepsy and your wellbeing.

Having seizures during sleep

Some people have seizures during sleep. These may happen while you sleep, as you are falling asleep or when you wake up. Sleep seizures can make your sleep lighter and make you wake up more often. This means that sleep may not help you feel less tired.

Some epilepsy syndromes are particularly associated with sleep problems. These include:

• Lennox-Gastaut syndrome
• Juvenile myoclonic epilepsy
• Landau-Kleffner syndrome

Find out more about sleep seizures.

Epilepsy medicines and fatigue

All epilepsy medicines can cause feelings of fatigue or tiredness. Depending on the dose and the medication used, this can range from a mild feeling of relaxation to deep sleep. This may be after you have taken the medication but it can also be all the time.

Some epilepsy medicines can also cause difficulty sleeping, such as insomnia.

These side effects can be common when starting an epilepsy medicine but usually get better over time.

Talk to your GP, epilepsy specialist or epilepsy specialist nurse if you are having side effects that are bothering you or do not go away. They may be able to give you advice about how to reduce these side effects.

Keep taking your medicine unless you’re advised to stop.

Epileptic seizures and fatigue

A seizure may only last a few minutes, but your brain and body can take much longer to recover. Some people feel exhausted for hours or even several days after a seizure.

The period after a seizure is called the postictal state. We do not fully understand the postictal state and why it happens. But research has shown that many people notice symptoms during this time that include:

• Headache or migraine
• Confusion
• Memory loss
• Depression or anxiety
• Fatigue and tiredness
• Sleep and drowsiness

Each person’s experience in the postictal state is different. Some people may not have any symptoms. For others they may last for a few minutes, hours or even a few days.

One study found that postictal fatigue and depression could carry on for up to 12 days. This means that the postictal state can have a significant impact on everyday life. This includes school, work and relationships.

More research is needed to understand the postictal state, why it happens and how it may be treated. But tell your healthcare professional if you are having symptoms after your seizures. They may be able to help you manage them.

Recovery can take time after a seizure. But call 999 if:

• Their seizure goes on for longer than usual or longer than 5 minutes if you do not know how long they usually last
• They have another seizure without recovering between seizures
• Someone does not regain their usual level of consciousness after their usual postictal phase
• Has breathing problems
• You are concerned that something is seriously wrong

Find out more about first aid for seizures

Epilepsy, exercise levels and fatigue

Many people avoid exercise when they are feeling tired. But being physically inactive can also make fatigue worse.

Exercise can benefit your physical and mental wellbeing. Research suggests that in people with epilepsy exercise may:

• Reduce fatigue
• Reduce sleep problems
• Reduce seizures
• Improve mental and social wellbeing

We have more information about exercising safely with epilepsy.

Lack of vitamin D

Fatigue and tiredness can be a symptom of a vitamin D deficiency. A lack of vitamin D can also weaken bones, which can increase the risk of osteoporosis and bone fractures.

Taking certain epilepsy medicines for a long time can also weaken bones. So it is important to make sure you are getting enough vitamin D.

Good sources of vitamin D can come from:

• Direct sunlight on the skin
• Vitamin D supplements
• Oily fish, red meat and some breakfast cereals

You can also ask your GP to test your blood if you have any concerns about your vitamin D levels or bone health. Find out more about epilepsy and bone health.

Other medical conditions that cause fatigue

If you have epilepsy, it’s easy to assume that is why you’re tired. But fatigue can also be caused by other health conditions, such as:

• Diabetes
• Iron deficiency anaemia
• Overactive or underactive thyroid
• ME (also known as myalgic encephalomyelitis or chronic fatigue syndrome)

Talk to your GP about all the symptoms you are experiencing. For example:

• Noticeable heartbeats (heart palpitations)
• Shortness of breath
• Feeling very thirsty or peeing more than usual
• Weight changes
• Mood changes

You can ask for a blood test to check for other possible causes.

Other causes of tiredness and fatigue that can be unrelated to epilepsy include:

• Not getting enough sleep or finding it hard to get to sleep (insomnia)
• Lifestyle (such as having an unhealthy diet and not getting much exercise)
• Stress, depression and dealing with life challenges, such as bereavement or looking after a new baby
• Hormonal changes (such as during puberty, pregnancy or the menopause)
• Some medical treatments and medicines can cause drowsiness for a while. For example, chemotherapy
• Getting up often during the night to go to the toilet. This is called nocturia, which becomes more common as people get older. Many older people may get up twice a night to wee. But if you find you’re needing to go more often than usual, it could be a sign of a health problem that can be treated.

Epilepsy and sleep disorders

People with epilepsy are more likely to have a sleep disorder than people without epilepsy. These include:

• Excessive daytime sleepiness
• Restless leg syndrome
• Insomnia
• Sleep-disordered breathing, including sleep apnoea

These may be caused by

• Seizures
• Epilepsy medicines
• Sleep seizures

These sleep disorders could also be caused by other medical reasons. But the interrupted sleep can make it more difficult to control your seizures.

Treating sleep disorders

Some sleep disorders may be treated with:

• Lifestyle changes, such as avoiding smoking or alcohol
• Medication
• Using a CPAP machine, which pumps air into a mask you wear over your nose or mouth while you sleep. This can help manage sleep apnoea

Can I use over the counter sleeping aids or use herbal remedies to help sleep if I have epilepsy?

Do not take any over the counter sleep aids before talking to a healthcare professional. Brand names include Nytol Original, Boots Sleepeaze and Histergan. These may contain diphenhydramine, which may trigger seizures.

Herbal remedies and medicines have active ingredients made from plant parts. But being natural does not mean they are safe. Speak to your medical professional before taking any herbal medicine for relaxation.

Find out more about complementary treatments.

What should I do if I’m having sleeping problems with epilepsy?

Talk to your GP, epilepsy specialist or epilepsy specialist nurse about your sleeping problems. It may help to keep a sleep diary to help you explain your symptoms.

There are things they can do to help. This may include:

• Reviewing your epilepsy medicine routine
• Doing tests to identify any other medical reasons for sleep problems, such as blood tests
• Offer specialist referrals. For example, they may refer you to a hospital sleep clinic or to a therapist for cognitive behavioural therapy

The Royal College of Psychiatrists also recommends the following:

• Keep a consistent wake-up time
• Go to bed when you’re actually sleepy
• Cut off caffeine by around 2pm
• Cut down or stop drinking alcohol. Alcohol can also be a seizure trigger
• Have a proper wind-down period before bed
• Keep your bed associated with sleep. Don’t use it for working, studying or watching TV
• Try relaxation techniques, such as mindfulness
• Make your bedroom conducive to sleep. This means making sure your room is calm, quiet and comfortable

When should I speak to a healthcare professional about sleep problems and epilepsy?

Fatigue and tiredness are common in epilepsy. But that does not mean that you should put up with it on your own. You can talk to your GP, epilepsy specialist or epilepsy specialist nurse about these symptoms at any time.

It may be especially important to talk to them if you:

• Have recently started or changed an epilepsy medicine
• Are having more seizures or different seizure symptoms
• Are regularly waking during the night or suspect sleep seizures
• Are sleeping well but still feeling very tired
• Are having other symptoms that could be a sign of another medical condition

Feeling constantly tired can have a big impact on daily life. Support is available, and your healthcare team can help look for possible causes and ways to manage your symptoms.

More information and support

Sleep Apnoea Trust is a patient support charity that provides information about Sleep Apnoea and its treatments.

The Sleep Charity has more information and support for people with sleep problems. This includes a helpline run by a team of specialist advisors.

The British Sleep Society is a registered charity that works to promote education and research into sleep and sleep disorders