Epilepsy and sleep: A complex relationship that impacts health and well-being

What is epilepsy, and how does sleep influence it?

Epilepsy is one of the most common neurological conditions, affecting approximately 50 million people worldwide. It can occur at any age and is characterized by repeated, spontaneous seizures caused by abnormal hyperactivity in a group of brain neurons.

Seizures are typically brief and sudden and may involve involuntary movements affecting part of the body (focal seizures) or the entire body (generalized seizures). Some seizures also cause loss of consciousness or, in certain cases, loss of bladder or bowel control. However, experiencing a single seizure is not enough to diagnose epilepsy, it is the recurrence of seizures that defines the condition.

Fortunately, treatments exist to reduce seizure frequency and improve patients’ quality of life. In cases where medications are ineffective (drug-resistant epilepsy), surgery may be considered.

Among the many factors that influence epilepsy, sleep plays a crucial role.

A lack of sleep or poor sleep quality can increase seizure risk, while epilepsy itself can disrupt sleep cycles. This complex relationship deserves special attention, as improving sleep can help stabilize the condition.

Sleep is vital for regulating brain activity. During sleep, the brain strengthens neural connections and releases built-up tension. However, in people with epilepsy, this process is often disrupted. Sleep deprivation or poor-quality sleep increases neuronal excitability, making seizures more likely.

Nocturnal epilepsy illustrates this connection well. Some forms, such as frontal lobe epilepsy, occur exclusively during sleep, causing involuntary movements and sudden awakenings.

What are the most common sleep disorders in people with epilepsy?

The link between epilepsy and sleep is particularly complex and bidirectional. Seizures can disrupt sleep, and poor sleep can, in turn, increase seizure frequency and severity.

For some people, seizures occur only during sleep, while for others, they are more frequent upon waking. Some individuals may even have nocturnal seizures without realizing it, noticing only indirect signs like muscle soreness or tongue bites in the morning.

Certain types of epilepsy, such as juvenile myoclonic epilepsy and wake-up tonic-clonic epilepsy, are especially sensitive to sleep disturbances.

Additionally, many people with epilepsy suffer from sleep disorders that further complicate their condition. The three most common sleep disorders in epilepsy are:

Insomnia

Insomnia is common in people with epilepsy and typically involves difficulty falling asleep or staying asleep. Several factors contribute to this, including anxiety about potential seizures and side effects of anti-epileptic drugs (AEDs), such as restlessness or daytime drowsiness. The fear of having a seizure at night can make falling asleep particularly challenging.

Sleep apnoea

Sleep apnoea is another frequent issue among people with epilepsy. This disorder causes repeated breathing interruptions during sleep, leading to fragmented rest and decreased oxygen supply to the brain. These interruptions can increase neuronal excitability and raise seizure risk.

Individuals with both epilepsy and sleep apnoea often wake up feeling fatigued, even after a full night’s sleep, which can impact their concentration and alertness during the day. Some AEDs may worsen sleep apnoea symptoms, so if you experience loud snoring or persistent morning fatigue, it’s important to consult a doctor.

Restless legs syndrome (RLS)

Restless legs syndrome is characterized by an uncontrollable urge to move the legs, often accompanied by uncomfortable sensations like tingling or itching, especially in the evening. This can make falling asleep difficult and prevent deep, restorative sleep.

All these sleep disturbances create a vicious cycle: poor sleep increases seizure risk, and seizures, in turn, disrupt sleep.

Diagnostic tests like polysomnography (a sleep study with video and EEG recordings) can help identify specific sleep disorders, such as nocturnal epilepsy or parasomnias (e.g., sleepwalking or involuntary movements), which may be linked to epilepsy.

How can you improve your sleep to better manage epilepsy?

Improving sleep quality is especially beneficial for people with nocturnal epilepsy. Establishing a consistent routine is one of the most important steps. Going to bed and waking up at the same time every day helps regulate the body’s biological clock, promoting better sleep and reducing seizure risk by stabilizing brain activity at night.

Here are some strategies to improve sleep while managing epilepsy:

Adjusting medication timing

One way to optimize sleep is to tailor AED schedules to a person’s sleep pattern. A doctor may recommend taking a higher dose before bedtime to promote more stable sleep. However, it is crucial to avoid excessive daytime drowsiness that could interfere with daily activities.

Practicing good bedtime habits

Certain evening routines can improve sleep quality. Taking a warm bath, reading, or listening to calming music before bed can help relax the mind and prepare the body for sleep. If your sleep environment is noisy or bright, using earplugs or a sleep mask can help create a more restful setting.

Avoiding stimulants and practicing relaxation techniques

To improve sleep quality, it’s essential to avoid caffeine and alcohol, especially in the evening, as they can interfere with epilepsy medications and disrupt sleep. Relaxation techniques like deep breathing, meditation, or progressive muscle relaxation can help calm the mind and facilitate better sleep.

Maintaining good sleep hygiene to reduce nocturnal seizure risk

Good sleep hygiene is key to managing epilepsy and regulating brain activity. Consider adopting these habits:

1. Stick to a regular schedule: Go to bed and wake up at the same time daily to support your body's internal clock.
2. Limit screen exposure: Avoid screens before bed, as blue light suppresses melatonin production, making it harder to fall asleep.
3. Optimize the sleep environment: Ensure your bedroom is quiet, comfortable, and dark to promote restful sleep.
4. Get enough sleep: Aim for 7–10 hours per night to allow for optimal recovery and better seizure control.

If sleep disturbances persist, consulting a neurologist or sleep specialist is recommended. Alternative treatments, such as cognitive behavioral therapy (CBT) for insomnia or mindfulness therapies like relaxation, breathing techniques, and mental visualization, may also help improve sleep quality.

Key takeaways

Sleep and epilepsy have a strong, bidirectional relationship—poor sleep can worsen seizures, and epilepsy can disrupt sleep quality.

Common sleep disorders in epilepsy include insomnia, sleep apnoea, and restless legs syndrome, which can contribute to increased seizure frequency.

Improving sleep hygiene through regular sleep schedules, relaxation techniques, and a suitable sleep environment can help reduce seizure risk and improve overall well-being.

If sleep issues persist, consult a doctor or sleep specialist to explore treatment options.

By prioritizing good sleep, people with epilepsy can enhance seizure control and improve their quality of life.

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