Epileptic Seizures Occurring During Sleep

Patients with epilepsy are at risk for sleep disorders.

The reason is that seizures or the epileptic state itself may change sleep organization.

Seizures in your sleep have immediate effects resulting in a stage shift to a lighter stage of NREM sleep or to the awaken state.

They also have more delayed effects on REM sleep and other sleep parameters.

The problems with night seizures are:

• Increased wake time after sleep onset
• Decreased total sleep time
• Increased proportion of stage-2 NREM sleep time
• Decreased proportion of REM sleep

If recurrent partial seizures occurred during sleep, the relative proportion of REM sleep time (but not total sleep time) was decreased, suggesting that the REM-suppressing effects of seizures are independent of reductions in total amounts of sleep.

Yet on seizure free nights, people with epilepsy may have more sleep disturbances than those without epilepsy. Those who had at least one seizure a month were the most affected. The majority of the people with epilepsy described feeling mildly tired or very tired on awakening.

The interaction of sleep disorders and epilepsy

Seizures can disturb sleep architecture. Complex partial seizures at night upset normal sleep patterns, decrease REM sleep and increase daytime sleepiness. Daytime complex partial seizures can also reduce subsequent REM sleep, which may contribute to impaired function. Antiepileptic drugs (AEDs) can also disturb normal sleep patterns.

Carbamazepine, given acutely reduces and fragments REM sleep, but these effects are reversed after a month of treatment. The GABAergic drugs can have a profound effect on sleep; phenobarbitone and benzodiazepines extend non-REM sleep and shorten REM sleep, while tiagabine increases slow-wave sleep and sleep effectiveness. Gabapentin and lamotrigine may both increase REM sleep.

Sleep Apnea and Seizures

Certain sleep disorders are more common in patients with epilepsy. People with epilepsy have most commonly obstructive sleep apnea which can worsen seizures. The reasons may be related to increased body weight, use of AEDs, underlying seizure aetiology or the epilepsy syndrome itself.

Patients with obstructive sleep apnea often find that seizure control improves with treatment of the sleep apnea. Topiramate may also be a mainly useful drug in these cases.