Sleep and epilepsy

This information looks at the links between epilepsy, seizures, epilepsy medicines and sleep disturbance. It also looks briefly at sleep disorders and how they can also affect people with epilepsy.

If your seizures are related to sleep, it also gives hints and tips for how you can sleep better and get better seizure control.

When sleep seizures happen

Sleep seizures can happen any time you’re asleep, whether it’s during the night or a day time nap.

It’s possible to have any type of seizure during your sleep including focal seizures. In focal seizures, epileptic activity starts in just a part of your brain.

Possible effects of seizures on sleep

There are several different stages of sleep including rapid-eye movement (REM) sleep and non-rapid eye movement (non-REM) sleep. REM sleep is important because it’s when your brain processes your emotions, files your memories and relieves your stress. Non-REM sleep (restorative sleep) is important for restoring normal brain functions.

If you have a seizure during your sleep, it affects your sleep for the rest of the night. It makes your sleep lighter, and you wake up more often. Your REM sleep is greatly reduced, and may even disappear. Seizures when you're awake can also reduce your REM sleep the following night. REM sleep happens about 70 - 90 minutes into your sleep cycle. It’s usual to have several periods of this stage of sleep each night

If you have seizures during sleep you will also have less deep non-REM sleep.

Although it's important to get enough REM sleep, it's not clear how to do that, apart from controlling your seizures. If your seizures aren’t controlled, try to catch up on any missed sleep, particularly in the day or two after a seizure. You could also ask your doctor to refer you to an epilepsy specialist for an assessment of your epilepsy and your epilepsy medicine.

Possible effects of epilepsy medicines on sleep

Most people with epilepsy take epilepsy medicines to control their seizures.  Epilepsy medicines can have unwanted side-effects. These include sleep-related side-effects. These are some examples:

Epilepsy medicineSide-effect 

Ethosuximide
Topiramate

Sleep disturbances (broken sleep)
Gabapentin
Lamotrigine
Levetiracetam
Phenytoin
Pregabalin
Rufinamide
Topirimate
Zonisamide
Insomnia (difficulty sleeping)

If you think your epilepsy medicine is causing side-effects, talk to your doctor or epilepsy nurse as they may be able to help.

Epilepsy with sleep disturbance or sleep disorders

People with epilepsy have a higher chance of also having disturbed sleep or a ‘sleep disorder' than people who don't have epilepsy. Sleep disorders include obstructive sleep apnoea, restless legs syndrome, narcolepsy and night terrors. Sleep disorders or disturbances can affect seizures because broken sleep can trigger seizures. So sleep disorders, including the conditions mentioned above can make seizures more likely, as they interfere with sleep.

If there's any possibility that you have a sleep disorder, your doctor might be able to refer you for a sleep study. Sleep studies can take different forms and can help to show exactly what problems you're having while you're asleep. 

Fatigue and epilepsy

Fatigue is a feeling of overwhelming tiredness, weakness or exhaustion that can be mental, physical or both. If you have epilepsy, you are more likely to be affected by fatigue than other people. This might be because your sleep has been disrupted, possibly because of seizures or the effect of epilepsy medicines. Being depressed can also make fatigue worse.

Epilepsy Action has more information about epilepsy and depression and epilepsy and fatigue .

What people tell us about sleep

We all have different ways of getting enough sleep. This is what some people with epilepsy say:

“I used to keep my phone next to me in bed. I looked at social media before I went to sleep and if I woke up in the night. But then I realised I was waking up just to check my phone and I was getting really tired during the day. The crunch came when I started having more seizures. It made good sense to leave my phone in another room, and suddenly I was sleeping much better and not having as many seizures.”

 "If I don't get enough sleep, I'm far more likely to have a seizure next morning. I need about 8 hours, so I always aim to be in bed by 10 pm, so I can read for an hour before going to sleep."

"Sleep is a real problem for me sometimes, especially if I'm feeling stressed, or I've had to work in the evening. I've learned to never go to bed until I'm feeling sleepy – some nights this can be after midnight, if I've been working late. If I haven't fallen asleep within half an hour, I'll get back up and make myself a hot milky drink, then wait until I feel sleepy."

Tips for getting more sleep

There are some things you can do that may help in getting more sleep:

  • Keep regular sleeping hours
  • Avoid caffeine-containing drinks late in the day

Wind down by:

  • Writing a ‘to do’ list
  • Doing relaxation exercises
  • Listening to a relaxation CD
  • Reading a book
  • Listening to the radio

Create the right environment in the bedroom:

  • No TV or electronic devices
  • Dark
  • Quiet
  • Tidy
  • Comfortable temperature
  • Comfortable bed

SUDEP and sleep

Sudden unexpected death in epilepsy (SUDEP) happens when a person with epilepsy dies suddenly and unexpectedly, without any obvious cause. If you have uncontrolled tonic-clonic seizures in your sleep, and sleep alone, you are at increased risk of SUDEP. In tonic-clonic seizures, the epileptic activity affects both sides of your brain.

Epilepsy Action has more information about SUDEP

If you are still having seizures, see our information about getting the right treatment and care for your epilepsy.

Alerting others to your seizures

If you worry about having a seizure and not having anyone to make sure you're safe, you could consider getting a seizure alarm.

There are different kinds of alarm available. The type you need will depend on the type of seizures you have. For example, some alarms are sensitive to movement. So if you have tonic-clonic seizures during sleep, then this type of alarm should detect them. There are other types of alarm available, but alarms will only be useful if there’s someone the alarm could alert, so they can help you.

Epilepsy Action has more information about alarms.

Can I drive if I have sleep seizures?

If your seizures always start when you’re asleep, you may still be able to drive even if you continue having seizures. They don’t need to be at night. A seizure that starts during a daytime nap also counts as a sleep seizure.

Before they allow you to drive, the driving agency would need to be satisfied that:

  • You’ve never had an awake seizure and
  • You’ve been having sleep seizures for at least 12 months. The 12 months applies from the date of your first seizure

 OR

  • If you stop having awake seizures, but still have sleep seizures, you can drive when you’ve been having sleep seizures only for at least 3 years. The 3 years is from the date of your first sleep seizure, after your last awake seizure

Further information

You can get further information about any of the issues discussed here from your family doctor, epilepsy nurse or epilepsy specialist.

If you would like to see this information with references, visit the Advice and Information references section of our website. If you are unable to access the internet, please contact our Epilepsy Action Freephone Helpline on 0808 800 5050.

Code: 
F014.04

Epilepsy Action would like to thank Professor Phil Smith, Consultant Neurologist, University Hospital of Wales, for his help in producing this information.

Professor Smith has declared no conflict of interest.

  • Updated December 2018
    To be reviewed December 2021

Comments: read the 15 comments or add yours

Comments

I am experiencing a strange sleep phenomenon that I think is probably related to sleep epilepsy. It only occurs during sleep or deep drowsiness; never when awake.

Just as I am tipping into sleep (mostly) I snap my jaws shut, occasionally biting my tongue or cheek in the process. It usually wakes me up immediately and I return to full consciousness- I do not endure a typical fit of jerking and shaking. Often I feel a flood of something in my mind afterwards which fades over about 1 minute; that is not painful, but I have the impression that if it has the capacity to become worse and may become painful.

The condition does not seem to affect any other part of my life - I don’t endure temper issues, don’t recognise s pattern of unusual headaches, and sleep is otherwise Just about sufficient. I do occasionally have some difficulty with sleep, but no more than anyone else. Neither does the condition even alert my wife when it occurs.

If it happens during drowsiness / daytime naps, it is often coupled with an instantaneous, singular, and occasionally violent jerk.

Other than the biting the condition does not alarm me, but I am curious to know if this has the capacity to deteriorate? I first noticed this over ten years ago. It now happens almost every night, so there has been a very slow increase in frequency.

49, male, office worker, managerial. Otherwise, general health is pretty good.

Submitted by Gavin

Hi Gavin

The symptoms you describe would be very unusual for epilepsy. I’m wondering if they are a form of sleep disorder, as shown on the NHS Choices website, which mentions jaw clenching. It could be worthwhile asking your GP to refer you for a sleep study, to see if it can be properly diagnosed.

Regards

Kathy

Epilepsy Action Helpline Team

Submitted by Kathy - Epileps...

My husband has experienced complex partial seizures( I think they are called focal seizures now) in his sleep for 29 years and we cope. It is usually in the early hours and by the morning he has slept it off and appears fine ( a little slower to process things maybe to those who know him well). We have our own little routine of assessment questions ( name, where he lives, Prime Minister etc and something harder so it’s not always an automated response). Occasionally he takes longer to recover and is “vague” , stares into space and cannot give correct answers even though the question is answered. This morning, for example, after a seizure at 3.00am he woke up this morning , could tell me his name etc but insisted it was the year 2011 and that he was born in 1900. By lunch time he was functioning normally but it is a worry. Am I right to just see this through and that it is the post ictal stage being prolonged or should I be seeking help? These “vague” sessions are becoming more frequent. His sleep seizures are approximately fortnightly and the vague episodes happen maybe three or four times a year. I would appreciate your advice.Thank you.

Submitted by Jane Meikle

Hi Jane – It can be worrying when you notice changes. People can vary in how long they are confused for after a seizure. And it can take a few days for someone to feel completely recovered.  

But I wonder if your husband has had a review of his epilepsy recently. If he is taking epilepsy medicines and is still experiencing seizures he can ask for a referral to an epilepsy specialist centre for a review of his treatment.

It can be helpful to keep a diary of what you and your husband notice about his seizures and recovery ready for any appointment.

We have some information about epilepsy and memory that you might find helpful as well.

You would be welcome to contact us at the Helpline if we can be of any more help.

Regards

Mags

Epilepsy Action Helpline

Submitted by rich

Focal aware seizures,
I used to get them through the day but they have changed to at night only (while sleeping) is this normal?
Where I used to get one in a blue moon while awake, I can now have 4 or 5 through the night in a 6-8 hour period.

Submitted by Samjd

Hi there – it sounds as though these episodes are disturbing your sleep quite a lot. We know that seizures can change but we don’t always know why. So this can happen. But as this is something different for you it could be worth speaking to your epilepsy doctor about this change. They may be able to look to see if there’s any reason things are different. They may also be able to adjust your medicines to help to stop these episodes happening.

Regards

Mags

Epilepsy Action Helpline Team

Submitted by Mags - Epilepsy...

I have grand mal seizures during my sleep and am on 150 ml Lamotrigine twice a day. I’ve just come out of hospital as I had 4 seizures last Thursday 17/4/20. I have no memory of going to hospital and was tested for meningitis which was clear. My memory has been awful since. I couldn’t even remember who the prime minister was. I also have been having some really mad vivid dreams is this to do with the epilepsy or the medication? The only other medicine I take is 80ml of methadone a day. There is nothing wrong with my brain the doctors have no idea why I developed epilepsy at about 34yrs old. I have to have another scan in 6-8 weeks.
Thank you 🙏

Submitted by Julie Phillips

Hi Julie

Thanks for your message. It sounds like it’s been a difficult week for you.

It’s common for memory to be affected after seizures, and for some people it can take a several days to get back to normal. We have some more information about epilepsy and memory on our website that you may find helpful.

It’s possible that the vivid dreams you have may be related to your epilepsy, your epilepsy medicine or something else.  It would be a good idea to speak to your doctor or your epilepsy nurse (if you have one) about this.

They may be able to review your medication. And if there's any possibility that you have a sleep disorder, they might be able to refer you for a sleep study. Sleep studies can take different forms and can help to show exactly what problems you're having while you're asleep. 

You not alone in not knowing the cause of your seizures. Epilepsy can start at an age and unfortunately, in over half of all people with epilepsy, doctors can’t find a cause.

If we can be of any more help, please feel free to contact the Epilepsy Action Helpline freephone 0808 800 5050. Our helpline is open Monday to Thursday 8.30am until 8.00pm, Friday 8.30am until 4.30pm and Saturday 10.00am until 4.00pm.

 

Regards

Jess

Epilepsy Action Helpline Team

Submitted by Jess - Epilepsy...

Had seizure in bed while asleep. Woke up with stomach ache and needed toilet. Husband told me about seizure. Went rigid and made snorting noise apparently, also bit inside my mouth. Haven't had epilepsy for over 10 years then out of the blue this happens. I don't have a stressful life, just normal everyday things. Now back on medication but why did it happen?

Submitted by Maiisie

Hi Maisie – this must have been really upsetting for you. And it must be frustrating to need to start medicines again. Sometimes it’s difficult to know why a seizure happens even after such a long time. It could be worth checking our information about triggers to see if there’s anything there. If you haven’t had a review of your epilepsy for a while it could be worth asking your doctor about this as well. If you think it would be helpful to talk things through you’d be welcome to call us at the Helpline.

Regards

Mags

Epilepsy Action Helpline

Submitted by Mags - Epilepsy...

Dear Ed

 

Thank you for taking the time to make us aware of this information. I will forward it to our information writing team for them to consider when we review this information.

 

The list of sleep-related side-effects on our website are some examples. These are medicines where the side-effect of sleep problems are more common than others.

 

Regards

 

Diane

Epilepsy Action Helpline Team

Submitted by Diane - Epileps...

Hi was wondering if anyone can help me, my 19month old daughter recently had her 4th seizure, she is now being referred to a specialist for an mri scan, she sleeps awful of a night, constantly fidgets and wakes herself up, also complains of pain in her feet, are these also symptoms of epilepsy?

Submitted by Katie

Hi Katie – you must be worried about your daughter at the moment so I hope you get an appointment soon. It’s possible that some of what’s happening at night could be related to seizure activity but we aren’t medical people so we don’t know for sure. It could be worth getting some video evidence and keeping a diary if you can to show her specialist.

If there’s anything you want to talk through you’d be welcome to call us at the Helpline on 0808 800 5050.

Regards

Mags

Epilepsy Action Helpline Team

Submitted by Mags - Epilepsy...

Hi, I recently have found myself half waking up (stirring or something) during the night to feeling very stiff throughout whole body, my mouth clenched shut and my arms/hands clenched tightly in fists up in front of me which I start shaking a bit. The only way I can describe it is like if you were yawning and stretching while awake only I’m mid sleep during the night. The next thing I know, I’ve woken up to alarm going off for morning. This has happened quite a few times over the past 4-5mths only at night. I’ve tried to wake myself up fully to see what’s going on when I half wake up to it happening but always fall back to sleep suddenly. I’ve never had any seizures ever that I know of or been diagnosed with any kind of seizure disorders. I live alone so don’t have a partner etc who can say if they have noticed anything during night. I don’t know if I’m just “stretching/yawning” kind of thing or if there’s more going on? I know the sensible thing is to see a GP but at same time, I don’t want to waste time if it’s just my body having a good old stretch mid sleep. I’m 39yrs old. I do have problems with sleep due to nightmares (complex ptsd) which I’m on medication for. When depression is bad, I have awful nightmares but depression is well treated and very stable now. It’s scaring me because I’ve never experienced this before. Thank you.

Submitted by Lilibet

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