Epilepsy and Sleep

Epilepsy is a neurological disorder involving recurrent seizures. A seizure, also called convulsion, is a sudden change in behavior caused by increased electrical activity in the brain. The increase in electrical activity may result in unconsciousness and violent body shakes or simply a staring spell that may go unnoticed. There is no known exact cause for epilepsy but a number of factors may be at work. It can be brought on by anything that affects the brain, including tumors and strokes. Sometimes epilepsy is inherited. Often, no cause can be found.

Epilepsy is just one of many conditions that may cause seizures. Others include head injuries, infections in the brain, low blood sugar, drug use, and alcohol withdrawal. On the other hand, seizures are just the tip of the iceberg for people with epilepsy. In addition to working to prevent seizures, people with epilepsy typically face an array of other challenges including cognitive, social and medical problems. The good news is that epilepsy is not considered a degenerative disorder. That is, it can be controlled without getting worse and most epilepsy patients lead full and long lives.

There is an inherent relationship between sleep and epilepsy. Sleep activates the electrical charges in the brain that result in seizures and seizures are timed according to the sleep wake cycle. For some people, seizures occur exclusively during sleep. This is especially true for a particular type of epilepsy known as benign focal epilepsy of childhood, also known as Rolandic epilepsy. When seizures occur during sleep, they may cause awakenings that are sometimes confused with insomnia. Epilepsy patients are often unaware of the seizures that occur while they sleep. They may suffer for years from daytime fatigue and concentration problems without ever knowing why.

For people with epilepsy, sleep problems are a double-edged sword; epilepsy disturbs sleep and sleep deprivation aggravates epilepsy. The drugs used to treat epilepsy may also disturb sleep. Because lack of sleep is a trigger for seizures, achieving healthy sleep on a nightly basis is essential for people with epilepsy.

People with epilepsy also have a high incidence of sleep apnea. In fact, a University of Michigan study found that as many as one third of epilepsy patients also has sleep apnea. The University of Michigan researchers also found that epilepsy patients who have sleep apnea were more likely to have seizures at night than epilepsy patients without sleep apnea. These results highlight the need for further investigation into whether receiving treatment for sleep apnea lessens the frequency and severity of epileptic seizures.

Children with epilepsy must cope with a variety of problems as a result of their disorder that goes beyond seizure control. Sleep problems are among the most critical. A team of researchers from the University of Calgary in Alberta, Canada recently conducted a study of the sleep patterns of children with epilepsy and the sleep patterns of their siblings without epilepsy. The results indicate that epileptic children had a significantly higher rate of sleep disturbance and that their disturbed sleep is associated with greater social and attention problems and a reduced quality of life. They also have a higher rate of attention deficit hyperactivity syndrome and other learning, emotional and behavioral difficulties compared to children without epilepsy. The results of this study support the idea that healthy sleep is essential for children with epilepsy.

If you are the parent of a child with epilepsy, it is very important that you make healthy sleep a priority for yourself as well. A recent study done by researchers at West Virginia University looked at the sleep habits of 50 parents of children under the age of 5 with epilepsy. They found that these parents slept 4 hours per night on average and that they woke up an average of 3 times per night to check on their children. A secondary finding in this study showed a correlation between nighttime awakenings and reports of decreased marital satisfaction and maternal health. If your child has epilepsy, pay careful attention to your sleep habits. If you or your spouse is having trouble sleeping, talk to your doctor about ways in which to address the problem.

According to the National Institutes of Health, between 1.5% and 5.0% of Americans have a seizure at some point in their lives and about 0.5% have epilepsy. For most people, epilepsy is a lifelong condition. However, the majority of people with epilepsy are able to prevent seizures with medication and lead normal lives. In some cases, the need for medication may be reduced or eliminated over time or once a patient enters adulthood. On the other hand, it is very important that people with epilepsy take proper precautions to avoid accidents as a result of their condition. Serious injuries can result if seizures occur while driving or operating machinery.

Symptoms

Epilepsy affects people in varying degrees. Epileptic seizures range from simple staring spells to loss of consciousness and violent convulsions. The type of seizure a person has depends on a number of factors, such as what triggered the seizure and where in the brain it originates. Most seizures only last a minute or two and are accompanied by an aura or euphoric sensation that occurs prior to the event and may last for several minutes after the event.

Different types of seizures include:

• Petit mal seizure – symptoms of petit mal seizures include a brief loss of consciousness, little or no movement, and a blank stare. They occur most often in children and may be mistaken for a learning disability.
• Grand mal seizure – symptoms of grand mal seizures include violent body contractions, loss of consciousness, a pause in breathing, urinary incontinence, tongue or cheek biting, and confusion and weakness following the event.
• Partial seizures - symptoms include muscle contractions or jerking movements in certain parts of the body, sensations such as numbness or tingling, nausea, sweating and dilated pupils. Partial seizures affect only a portion of the brain and consciousness is maintained.
• Partial complex seizures – symptoms of partial complex seizures include a blank stare, unresponsiveness, automated non-purposeful movements, inappropriate emotions, strange smell or taste hallucinations, and loss of consciousness.

Treatment

Any plan for the treatment of epilepsy will include a physician-prescribed drug regimen for the control of seizures. However, it is important that physicians also take into consideration the particular concerns of each epilepsy patient. Each antiepileptic drug has a particular effectiveness profile. Some have side effects that include cognitive impairments, sleep disturbance and other adverse effects. If you or your child has epilepsy, discuss your primary concerns about side effects with your doctor in order to develop a treatment plan that allows you or your child to live as normally as possible. Also, keep in mind that therapy and strong social support are likely to play a critical role in achieving this goal.

In addition to drug treatment, there are several alternative therapies for people with epilepsy. They include:

• Vagus Nerve Stimulation – surgical implantation of a generator into the chest that stimulates the vagus nerve in the neck and thus reduces seizure activity (side effects may include cough, sore throat, voice alteration and sleep apnea)
• Surgery – for some epilepsy patients, it is possible to have surgery to remove the seizure producing areas of the brain. Surgery may be done on children or adults when medicines fail to effectively prevent seizures.
• Alternative/complementary medicines – these are therapeutic approaches that have not been studied and tested using the rigorous methods of modern medical science, but that have been known to help some people. Some examples are herbal remedies and vitamin therapies. Before beginning any alternative therapy, talk to your doctor about possible side effects or negative interactions with your current treatment regimen.

Epilepsy is often associated with other health problems. Evidence from recent clinical investigations indicates that epilepsy may raise a person's risk of developing other disorders such as depression, anxiety, migraine headaches, and obesity. In some cases, the presence of one or more of these other conditions may impact a person's health more than their incidence of seizures. If you experience symptoms related to other medical conditions, talk to your doctor about managing them while maintaining your treatment for epilepsy.

Coping

In addition to the treatment options described above, acknowledging and avoiding seizure triggers may improve seizure control for many epilepsy patients. A Norwegian study of 794 patients with epilepsy concluded that the most common triggers for seizures were emotional stress, sleep deprivation and tiredness. For people with epilepsy, healthy sleep is essential for effective control of seizures.

If you have epilepsy, always take your medication as prescribed and wear a medical alert bracelet.

When a seizure does occur, there are things people can do to keep the person having the seizure from injuring himself or herself. If you or your child has epilepsy, be sure that your family, friends, co-workers, and classmates are aware of the condition and know how to help in the event of a seizure.

Here are some tips for what to do if someone is having a seizure:

• Lay the person down on his or her side in an area free of sharp objects
• Cushion the person's head
• Loosen clothing, especially around the neck
• Check for a medical ID bracelet that gives instructions on what to do
• Monitor the person's vital signs
• Stay with the person until the episode is over or medical personnel arrive

Here are some tips for what NOT to do if someone is having a seizure:

• Do not restrain the person
• Do not put anything in the person's mouth during the episode
• Do not move the person unless he or she is in danger

If someone is having a seizure, call 911 if:

• This is the first time the person has had a seizure
• The seizure lasts more than 2-5 minutes
• The person does not awaken or have normal behavior after the seizure
• Another seizure starts soon after a seizure ends
• The person had a seizure in water
• The person is pregnant, injured, or has diabetes
• The person does not have a medical ID bracelet
• There is anything different about this seizure compared to the person's usual seizures

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