And other important seizure-related sleep questions for parents raising kids with Epilepsy…
Parents raising kids with epilepsy understand how important anti-epileptic medications (AED’s) are to seizure control. However, they soon discover that SLEEP is equally as important. The amount of time one sleeps and the quality of that sleep plays a significant role in seizure control. When a person with epilepsy is sleep deprived for any reason, they can experience break-through seizures that otherwise may have been avoided.
What Can Cause Sleep Deprivation?
Many things can cause sleep deprivation. Sometimes we miss sleep for the best of reasons such as a family party or social engagement that lasts long after our usual bedtime hour. Sleep deprivation can occur on nights when we can’t seem to fall asleep because we are anxious or worried about something. Other nights, our sleep may be interrupted by a noise. Once we are awake, we can’t seem to fall back asleep, resulting in sleep deprivation. For those prescribed medications for seizure control, sleep deprivation may occur as an unwanted side effect of the medication.
Widely used seizure medications such as Ethosuximide (Zarontin) or Topiramate (Topamax) can cause interruptions in sleep, referred to as “broken sleep”. This is when the individual suddenly wakes up for a prolonged period of time, several times during the night. Other medications prescribed for seizure control can cause insomnia, or difficulty falling asleep: [(Gabapentin (Neurontin), Lamotrigine (Lamictal), Levetiracetam (Keppra), Phenytoin (Dilantin), Pregabalin (Lyrica), Rufinamide (Banzel), Topiramate (Topamax) and Zonisamide (Zonegran)] Sometimes the individual can get to bed at a usual time, but lay there a few hours before falling asleep. Some individuals may fall asleep, but wake up an hour or two later, unable to fall back to sleep.
Can You Have a Seizure During Sleep?
There are different stages of sleep. Some stages are light in nature, referred to as quiet sleep or non-REM sleep and some stages are active in nature such as Rapid eye movement sleep, or REM sleep. REM sleep occurs about 90 minutes after falling asleep. During this stage, your eyes move rapidly while your brain is active and processing information, memories and emotions. Non-REM sleep is restorative sleep and occurs for longer periods then REM. The combination of REM and non-REM sleep throughout the night make up the sleep cycle.
Research studies have demonstrated that seizures occur most often in non-REM sleep compared with REM sleep. REM sleep is found to have strong anti-epileptic effects against spontaneous discharges as well as focus and generalized seizures.
If an individual experiences a seizure during non-REM sleep, the entire night of sleep is affected, decreasing or possibly eliminating the experience of REM sleep. This may cause the person to wake-up, sleep restlessly and/or experience an interruption in their natural states of sleep. By reducing one’s quality of sleep the person’s seizure threshold may decrease, resulting in break-through seizures within the following days.
Can Seizures Cause Bad Dreams (Parasomnias)?
According to recent research, sleep disturbances are more common among children with epilepsy (ranging from 45 to 95%) as compared with typically developing children without the diagnosis of epilepsy (ranging from 25 – 40%) (Zhao, et al.) Children with epilepsy seem to be at higher risk for many sleep disturbances that include restless legs syndrome, narcolepsy, night terrors or obstructive sleep apnea. These conditions are often diagnosed during a sleep study where the person is observed (with heart, respiratory and neurological monitoring) while they are sleeping to identify exactly what the problem may be.
Bad dreams, or parasomnias, are also included in a group of sleep disorders. Parasomnias include nightmares, night terrors, sleepwalking, sleep paralysis and even bed wetting. During a parasomniac episode, the person may experience vivid dreams, fear and anxiety. They may wake up while screaming, sleep-walk or experience a type of paralysis where they feel their limbs are frozen and unable to move while waking up and/or falling asleep. They may also experience bed wetting.
Can Lack of Sleep Trigger a Seizure?
Although there is not a magic number defining how much sleep one should get, the consensus seems to be that people with epilepsy function best with 8 to 10 hours of restorative sleep. However, interruptions to sleep are common among people with epilepsy. Research studies report that, “Adults with epilepsy reported more short or long sleep duration and worse sleep quality than those without epilepsy,” (Tian, Weaton, Zack, Croft & Greenlund, 2021). Lack of sleep can trigger a break through seizure.
People with epilepsy tend to sleep for a long time, or not be able to sleep at all, at times. This inconsistent pattern seems to contribute to fatigue, weakness, overwhelming tiredness and possibly “break-through” seizures.
What Can Improve Sleep?
“Broken sleep”, insomnia and seizures in your sleep can cause significant sleep deprivation. For the person with seizures, sleep reserves are not always available and their brain becomes fatigued. It’s different for people with seizures who can’t easily “push-through” the next day as some people can do. Regular adequate sleep protects the brain from seizures. This is why sleep deprivation that is not carefully monitored can lead to break through seizures in the days after sleep has been deprived.
To improve sleep quality, practical changes to one’s lifestyle and environment may be helpful. Make sure the bedroom is dark and all electronics are shut down so they are not distracting. Inquire with the person about the comfort of the bed. Make sure the bed is comfortable for one’s back and body and that the pillow they use is comfortable for their head and neck. Check to see that the room temperature is cool and if necessary, place a fan in the room to keep air flowing. Encourage sleeping in a calm environment without noise distractions that can wake the individual.
Be mindful of daily routines such as skipping naps, late night eating, drinking alcohol and sedentary lifestyles. If possible, structure daily living to include relaxation routines and increase physical exercise during the day.
If your child is struggling with sleep, consult a healthcare provider.
Early interventions can interrupt sleep difficulties and improve your child’s quality of life. If sleep difficulties continue without intervention, symptoms such as chronic fatigue, irritability, stress, frustration and break through seizures can occur. Behavior and mood can also be greatly affected causing a disruption in school/work performance, social interactions, mental health, general physical health and overall quality of life.
Consulting with a physician or psychologist can greatly improve sleep habits and ways to manage stress to improve one’s ability to achieve quality sleep. To set up a consultation with Dr. Musarra to discuss sleep strategies, contact her at firstname.lastname@example.org or 216-954-5665