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Sleep and epilepsy

Most people have more energy, think more clearly and react more quickly after a good night’s sleep. 

For some people with epilepsy, sleep is specially important. This is because disturbed sleep patterns, or not having enough good quality sleep, can make seizures more likely.

There are also some types of epilepsy, where seizures have a particular connection to sleep.

Contents

Links between epilepsy and sleep

There are many different types of epilepsy. And some seem to be particularly related to sleep. Three of the more common are epilepsy grand mal on awakening, juvenile myoclonic epilepsy and benign rolandic epilepsy.

Epilepsy grand mal on awakening

In this type of epilepsy, you have tonic-clonic seizures either just before, or just after, you wake. This may be in the morning, after a night’s sleep, or during the day after a nap. Tonic-clonic seizures used to be called grand mal. They are the ones most of us think of when we imagine someone having an epileptic seizure. They are sometimes referred to as convulsions.

Epilepsy Action has more information about tonic-clonic seizures.

Juvenile myoclonic epilepsy (JME)

In juvenile myoclonic epilepsy, seizures may happen shortly after waking. Or they may happen at other times, but when you are very tired. You may find that not having enough sleep could make your seizures more likely.

In JME, you have three different kinds of seizure.

  • Absence seizures: you appear to be daydreaming, staring or blinking.
  • Myoclonic seizures: you have brief jerking movements of different parts of your body.
  • Tonic-clonic seizures: you have stiffening, then jerking of the whole of your body.

Epilepsy Action has more information about juvenile myoclonic epilepsy, absences seizures, myoclonic seizures and tonic-clonic seizures

Benign rolandic epilepsy (BRE)

If you have this kind of epilepsy, you will have focal (partial) seizures, in your sleep. Occasionally, you might have seizures when you are awake.

Focal seizures affect just a part of your body. In BRE they affect your mouth and you might dribble a lot of saliva. Sometimes they cause your arms and legs to jerk. Some people with Benign rolandic epilepsy also have tonic-clonic seizures. BRE affects almost one in five of all children with epilepsy.

Epilepsy Action has more information about focal seizurestonic-clonic seizures, and benign rolandic epilepsy.

Stages of sleep

For some people, seizures are related to different stages of sleep. There are five stages of sleep with different brain activity in each.

1. Drowsiness - this stage lasts five or 10 minutes. Your eyes move slowly under your eyelids, your muscles begin to relax and you are easy to wake up.

2. Light sleep - your eye movements stop, your heart rate slows, and your body cools down.

3. and 4. Deep sleep - it’s not easy to wake you during these stages of sleep. If you do wake, you will be groggy and not quite with it for a few minutes. This kind of sleep allows your brain to rest and restores your energy. Your immune system is helped by deep sleep.

5. Rapid eye movement (REM) sleep - about 70 to 90 minutes into your sleep cycle, you enter REM sleep. You usually have three to five episodes of REM sleep each night. This stage is associated with processing your emotions, filing your memories and relieving your stress.

The effects of having seizures on your sleep

If you have a seizure during your sleep, it affects your sleep patterns for the rest of the night. Your sleep becomes lighter, and you wake up more often. The most serious effects are on REM sleep. REM sleep is greatly reduced, and may even disappear.

Seizures when you’re awake can also reduce your REM sleep the following night.

Although it’s important to get enough REM sleep, it’s not clear how to get enough, apart from by controlling your seizures. If your seizures aren’t fully controlled, your doctor should refer you to an epilepsy specialist for an assessment of your epilepsy and your epilepsy medicine.

If it’s not possible to control all your seizures, you should try to catch up on missed sleep, particularly in the day or two after a seizure.

The effects of epilepsy treatment on sleep

Most people with epilepsy take epilepsy medicine to control their seizures. Like all types of medicine, epilepsy medicines can have unwanted side-effects. The following epilepsy medicines may have sleep-related side-effects.

Epilepsy medicine

Side-effect 

Ethosuximide sleep disturbances, night terrors
Lamotrigine insomnia (difficulty sleeping), sleep disturbance
Pregabalin insomnia, abnormal dreams
Topiramate sleep disturbance
Gabapentin
Levetiracetam
Phenytoin
Rufinamide
Topirimate
Zonisamide
insomnia

If you are concerned that your epilepsy medicine is causing side-effects, speak with your doctor. They may be able to help.

Lack of sleep as a trigger for seizures

For many years, it has been thought that not having enough sleep makes a person with epilepsy more likely to have seizures. This seems to be the case for some people, but not everyone. Instead, it could be lack of sleep, combined with things such as stress, alcohol or going without food that is more likely to trigger seizures.

Epilepsy with other sleep disorders

Some people with epilepsy also have ‘sleep disorders’. These include sleep apnoea, restless leg syndrome, narcolepsy and night terrors. Further information about these disorders is available from NHS Direct: 
Tel: 0845 4647
 

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. What type you would need would depend on the kind of seizures you have. For example, some alarms are sensitive to movement. So if you have tonic-clonic seizures (grand mal, convulsions) then this type of alarm will detect them. There are other types of alarm available.

Alarms would only be suitable if there was someone the alarm could alert, so that they could help you.

For information about alarms and manufacturers, you can contact Disabled Living Foundation’s equipment helpline. They provide information about suppliers of specialist equipment to help with everyday living.

Tel: 0300 999 0004 (calls charged at local rate)
Textphone: 020 7432 8009 (calls charged at standard rate)
Email: advice@dlf.org.uk

The Disabled Living Foundation's website is called Living made Easy.

Telecare (alarms linked to a help centre)
Website: livingmadeeasy.org.uk/telecare 

Bed alarms
Website: livingmadeeasy.org.uk/bedroom

 How to get a good night’s sleep

If you have problems getting a good night’s sleep, Ann Jacoby and Gus Baker from Liverpool University, UK, offer the following tips.

  • Have a regular bedtime and getting-up time.
  • Avoid taking naps during the day.
  • Make sure your bedroom is at a comfortable temperature.
  • Make sure the bedroom is dark and free of noise.
  • Avoid stressful activities or situations before bed.
  • Avoid stimulants, such as alcohol, caffeine and exercise in the late evening.

Conclusion

  • Some seizures seem to be connected to sleep.
  • Lack of sleep can trigger seizures for some people.
  • Seizures and epilepsy medicines can affect sleep.
  • Some people with epilepsy also have sleep disorders.
  • If sleep disorders are treated, epilepsy may become better controlled.

Further information

You can get further information about any of the issues discussed here from your own doctor.

Read more about research into epilepsy and sleep [PDF file], featured in our members' magazine Epilepsy Today.

If you would like to see this information with references, visit the Advice and Information references section of our website. See Sleep and epilepsy.

Pay it forward

This resource is freely available as part of Epilepsy Action’s commitment to improving life for all those affected by epilepsy.

On average it costs £414 to produce an advice and information page – if you have valued using this resource, please text FUTURE to 70500 to donate £3 towards the cost of our future work. Terms and conditions. Thank you

Code: 
F014.02

Epilepsy Action would like to thank Dr Henry Smithson, Academic Unit of Primary Medical Care, Sheffield, UK, for reviewing this information. 

Dr Henry Smithson has no conflict of interest to declare.

This information has been produced under the terms of The Information Standard.

  • Updated August 2012
    To be reviewed August 2014

Comments: read the 17 comments or add yours

Comments

I am currently experiencing bouts were I am awake next I am unintendedly falling asleep. in a deep heavy sleep snoring and and partner moving round the room I don't hear anything. When I do wake I am very dazed and confused.
Am I asleep or is it something else ?

Submitted by Debs on

Hi Debs

You didn’t say if you’ve already had a diagnosis of epilepsy or if you’ve been searching the internet for some answer and come across our website. Whatever the case, you might want to get this checked out.

As your question has come from the sleep and epilepsy section of our website, you’ll see that some people can have seizures while they are asleep. Although some people do sleep after a seizure is over, no matter what time of day the seizure happens. This is when the body is recovering. Some people with epilepsy also feel dazed and confused, during a seizure or after a seizure is over. However, it’s important to talk to your doctor to get your symptoms sorted out. This is because they could be epilepsy related, but the symptoms of epilepsy can be similar to many other medical conditions.

It might help you to read another section of our website called Epileptic seizures explained and Diagnosing epilepsy.   

Rosanna
Advice and Information Team

Submitted by Rosanna@Epileps... on

Hi I am 37 and have had epilepsy since 2007 the medication I am on has links with insomnia if I were to change medication what would be the risks involved and how long would the change over take as I don,t want to be at risk of another fit forgot to add I have had my sleep patterns changed to early starts twice aweek and now I am lucky if I get 3 hours of Natural sleep each night throughout the week including days off.

Submitted by marc on

Hi Marc 

Lack of sleep is such a terrible thing to experience.

It’s advisable to discuss your insomnia with your neurologist. The neurologist will discuss the possible reason for this to be happening. If they think it’s your epilepsy medicine, they may see if your medication dosage or the type of medication you are taking, needs altering. If you are not under a neurologist, you will need to ask your GP to refer you. Preferably to someone with a specialist interest in epilepsy, as there are many neurological conditions. Here is our information on changing from one epilepsy medicine to another.

I hope things improve for you very soon.

Regards

Diane Wallace
Advice and Information Team

Submitted by Diane@Epilepsy ... on

I have had epilepsy since i was 17 (now 22), and was told i had jme and it would go by the time i was 19. That couldnt of been more wrong, my seizures had calmed down to about 1-2 every month which was fine, but my fits would only happen when i am sleeping, i would wake up out of my sleep, with a thumping heart beat and sweat pouring from me ( a panic attack). Then i would start having jerks, i would then feel the need to go to the toilet but this would only make my jerks worse as my heart is still going 90. Then after that i would go into bed again and try calm myself down and fall asleep which is usually when i have my fit and wake up without a clue. These fits have been happening more and more now for no reason and it scares me as i don't know when it's going to happen, so it effects my sleep plus my daily living as it's hard to find a job with having epilepsy. I also can't take ANY anti-depressants or sleeping tablets as they dont mix with my meds (1000mg epilim 2x a day).

Submitted by Adam mc lean on

I am currently going through partial complex seizure issues, and they started couple of months after I turned 30. My wife decided to tell me that I was having seizures after she started noticing them them 3+ months before I knew about them. She notified me that I was having them when I woke up one morning and noticed that bit my toung. Before having those issue, I was having breathing attacking in my sleep for 2+ years and she didn't notify me of those till I started having breathing attacks in the day time. I started to having night time breathing sleep issues 2+ months after my son's birth.

Truthfully I'm a little frustrated because I got kicked out of the military due to the these seizures, my wife called the police and asked me to separate for a short time, when she ment forever and eventually a divorce (never done anything to her). When throughout that whole time, she neglicted to inform me of my issues until it became so bad that I needed medical help through the military vetrans services.

Anyone know what I can do? I take 750mg of Keppra (Levetiracetam) two times a day, and I take 1 mg clonazepam before I go to bed. They are under control for the most part but I think my wife should be questioned. We are going to court right now for custody of our kids and soon we will have to go through divorce court.

Is there anything I can do?

Submitted by Steve on

Dear Steve

Thank you for your comment.

I can’t comment on your situation with your wife.  But I can give you some facts about epilepsy which I hope will help answer your questions.

Complex Partial seizures (CPS) can be very difficult for people to recognise unless they know what they are looking for. We often hear people who are recently diagnosed with CPS say, on reflection, they were probably having them for years.

Some parents undergoing divorce or separation may worry that their epilepsy could affect their opportunity of having access to or residency of their children.  In the UK, parents are not denied access or residency of their children purely because of their epilepsy.

I’m pleased your epilepsy is under control most of the time. But make sure you see your epilepsy specialist regularly, so they can review your treatment and look at other possible reasons for your seizures to still be happening. They may suggest trying a different epilepsy medicine.  If you have tried various types of epilepsy medicines, it may be the specialist could look into other treatment options for you.

If you are in the UK, and you are not under a specialist, you will need to ask your family doctor to refer you. This would usually be to a neurologist. The ideal would be to someone with a specialist interest in epilepsy, as there are many different neurological conditions, and neurologists tend to specialise in different ones. 

If you are not in the UK, for information on treatment in your country please contact a local epilepsy organisation.

Do you think it may help you to talk to others with epilepsy? From our experience, in most case people find it helpful to talk to or contact people who understand what they are experiencing. If you think this could help, you may find some of our services helpful. Such as our local groups and online community – Forum4e

I hope this has helped. If we can be of any more help, please feel free to contact us again, either by email or if you are in the UK, phone the Epilepsy Helpline freephone 0808 800 5050. 

Regards

Diane Wallace

Advice and Information Team

Submitted by Diane on

I used to suffer from tonic-clonic seizures upon awakening - this was always from sleep and I was always in bed. Since 2009 when I was put on Keppra my seizures have changed - the closest I can describe them is a clonic seizure - I wake up, my heart racing in complete panic, my muscles jerk and contract - the top of my body both sides including my head. The only control I have is my breathing - I hold my breath until it stops and i don't lose conciousness.

I have described this situation numerous times to GPs who have always told me they were panic attacks but I recently had an EEG and saw a neurologist who was able to diagnose this as epilepsy. After increasing my dosage of Keppra (i am now on 1000mg x2 a day) my siezures seem to be increasing.

After doing internet research, i am finding that clonic seizures seem to be quite rare - i feel quite isolated as I feel nobody understands what I am going through as I can't even find a term to describe what I experience. I am also scared to go to sleep which is one of the reasons I am writing this at 4.20am.

I

Submitted by Kizzie on

Hi Kizzie.

It sounds like you have been having a pretty tough time. I wonder if you have discussed with your doctor about how your seizures are increasing at the same time as your dosage of Keppra is increasing? They might want to consider reducing the level of it to see if that helps. It may be that the Keppra just really doesn’t suit you.

I do hope things improve for you soon.

Cherry

Advice and Information Team

Submitted by Cherry on

Hi,
I am suffering with epilepsy since I was 17 now I am 25.On an avg have 2 seizures/ year.Earlier I was on keppra 500*2X now on lamictal 350mg/day. its time for my marriage dont know when I will get rid of the same. These are horrible and affecting my parents and ny job.
How much time it will take to get rid of such a complex considering my profile.
Thanks,
Gaurav

Submitted by Gaurav Pruthi on

Hi Gaurav

Thank you for your message.

It sounds like you are finding it difficult to come to terms with your diagnosis. You might find it helpful to contact our freephone helpline number 0808 800 50 50 (UK only) to talk things through with an Advice and Information Officer. You may also be interested in our online community, forum4e. This is for people with epilepsy and carers of people with epilepsy. Hopefully, you will be able to talk to others in a similar situation.

There are many types of epilepsy. Some types last for a short time and other types can last for the whole of your life. Lots of people with epilepsy find that when they have the right epilepsy medicine, they have fewer or no seizures. In the UK 70 per cent (seven out of ten) of people with epilepsy could be seizure free with the right treatment.

If we can be of any more help please feel free to contact us again.

Kind regards

Vicky Morris

Advice & Information Team

Submitted by Vicky on

Hi , In the last two year I started having seizures.... which only happen once a month and always in my sleep!! I had my first seizure by myself but was not sure what it was I just woke up and had bit my tounge and wet myself, I had a newborn at the time that was very sick in the hospital so I had not been resting well so just tought I slept to hard. Then the next month I had one and have had one every.month since. Up until this month I have had two ( not the normal) I am currently not taking any meds due to the fact the I recently had another baby. The doctors seem to think it had something to do with the pregnancy. But my child is now 7 weeks old and ive had 3 since he was born. Anyways I feel like they are getting worse not better any advice or have you ever heard of this? Thanks so much in advance!!

Submitted by Nikki on

Hi

As your seizures are getting worse, it would be advisable to talk to your doctor again. They can review your seizures and look at other possible reasons for your seizures to still be happening. If it is epilepsy, they may suggest you now try treatment which is usually epilepsy medicine. Epilepsy can develop at any time, and it might have been coincidence that it happened when you was under a lot of stress with your first baby. However, it may well be that your seizures are related to hormonal change/sleep deprivation/stress -  very common when you have a newborn

If you are not under a doctor that is a specialist in epilepsy, you will need to ask your doctor to refer you. This would usually be to a neurologist. The ideal would be to someone with a specialist interest in epilepsy, as there are many different neurological conditions, and neurologists tend to specialise in different ones.

You may also wish to keep a seizure diary.  The seizure diary can be a helpful record of what’s been happening with your seizure and can be helpful for your doctor or epilepsy specialist. 

Regards

Diane Wallace

Advice and Information Team

Submitted by Diane on

Hello,

My sister suffers from epilepsy seizures for the last 2 years, which despite the medication are getting more and more often. She had brain surgerywhen she was one for brain tumor and the doctors and the doctors' opinions are divided on whether or not it is related 15 years after the surgery (her MRI is clear). At first, she got the seizures during the first 2 hours after she fell asleep at night and because she went back to sleep immediately afterwards, she remembered nothing in the morning, though she had headache and pain in her muscles and was often sleepy. Lately though they happen even after 4 hr of sleep, and she seems to remember more and more about it, as if she woke up right before it started. Is it a bad sign that the time she gets it has changed? I'm afraid that they will soon start happening during the day, and because of the very jerky movements she might get hurt.

As fas as the frequency is concerned, the first time she got it she was 16 and the next time was 3 months later. The third time was again months later and against the doctor's order we didn't start her on medication, believing it was because of the stress and workload of high school. The first medicine she got was Depakine Chrono every night, and almost a year later the doctor switched her to Trileptal and the to zebinix, all of which failed to control the seizures which started becoming monthly and are now weekly. They all made her sleepy and affected her concentration. Is it normal that none of the medicine have managed to at least reduse the number of seizures (on the contrary they have increased dramatically)?

Thank you in advance for your help,
Sofia

Submitted by Sofia on

Dear Sofia

It sounds like your sister has been having a really rough time.

That‘s a lot of different epilepsy medicines to have tried. We are not medically trained. So I am definitely not able to offer a diagnosis. Some people do just have a type of epilepsy which means they don’t respond to any of the epilepsy medicines on offer. And sometimes epilepsy medicines can make things worse.

But I am hoping your sister is in touch with a neurologist who is monitoring her situation. If she doesn’t already do so, she may find it useful to keep a seizure diary.  She may also benefit from asking for a second opinion.

I do hope this information is of some use to you. But if we can be of any more help, please feel free to contact us again, either by email or the Epilepsy Helpline freephone 0808 800 5050. 

Cherry Lander

Advice and Information Team

Submitted by Cherry on

I have just been diagnosed with epilepsy after having a second tonic clonic seizure (the last one was 25 years ago and I am now 56). For the last year I have been biting my tongue in my sleep (usually when I was just dropping off - my jaw would just snap shut for a second and of course the pain would wake me up!) and when I mentioned this to my dentist he suggested it was probably stress and suggested some relaxation techniques. Also I often 'jump' just as I am dropping off to sleep but I have done that all my life. Could I have been having seizures all this time without realising it? I have been diagnosed with photosensitive epilepsy and my warning both times was the feeling like I had just got off a roundabout!

Submitted by Cathie Palmer on

Hi Cathie

With the Personal Independent Payment the money will be paid to you for you to use as you need. You can use this money in anyway to help with your quality of live. It doesn’t matter if it’s your daughter that takes you shopping or helps with your daily care. 

The following information is taken form the Disability Rights UK PIP factsheet.

‘PIP is for you, not for a carer. You can qualify for PIP whether or not you have someone helping you. What matters is the effect your disability or health condition has on you and the help you need, not whether you actually get that help. You can spend your PIP on anything you like. PIP acts as a ‘passport’ for other types of help, such as the Motability Scheme (see Other ways PIP can help you).’ Here’s a link to this factsheet. If you haven’t already completed your application for PIP, you may wish to get help with completing the form one of the helpful organisations listed on our PIP webpage.

Many people experience a jumping movement in their sleep but I’ve not heard of many people who actually bite their tongue in their sleep. If you haven’t already, you could mention your night time symptoms to your epilepsy consultant. They may arrange for further tests such as a sleep EEG. Or they may suggest you wait and see if your epilepsy medicine helps with the night time tongue biting.

Regards

Diane Wallace

Advice and Information Team

Submitted by Diane on

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