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Identifying and Treating Nocturnal Seizures

Epilepsy and seizures during sleep

For some people, sleep is disturbed not by dreams but by seizures. You can have a seizure while you sleep with any form of epilepsy. But with certain types of epilepsy, seizures only occur during sleep.

The cells in your brain communicate to your muscles, nerves, and other areas of your brain via electrical signals. Sometimes, these signals go haywire, sending too many or too few messages. When that happens, the result is a seizure. If you have two or more seizures at least 24 hours apart, and they weren’t caused by a medical condition, you may have epilepsy.

There are many different kinds of epilepsy, and the condition is common. About 2.9 million Americans have epilepsy. You can get it at any time in life. But new cases are most likely diagnosed in infants and children under the age of 10, and adults over the age of 55.

As with epilepsy, there are many different kinds of seizures. But they fall roughly into two categories: generalized seizures and partial seizures.

Generalized seizures

A generalized seizure happens when abnormal electrical activity occurs in all areas of the cerebral cortex. This is the top layer of the brain associated with movement, thought, reasoning, and memory. Included in this category are:

Tonic-clonic seizures: Formerly known as grand mal, these seizures include a stiffening of the body, jerking motions, and usually loss of consciousness.

Absence seizures: Formerly known as petit mal, these seizures are characterized by brief periods of staring, blinking eyes, and small movements in the hands and arms.

Partial seizures

Partial seizures, also called focal or localized seizures, are limited to one hemisphere of the brain. When they occur, you may remain conscious but don’t know the seizure is happening. Partial seizures can affect behavior, consciousness, and responsiveness. They also can include involuntary movements. 

Seizures that occur while sleeping

According to an article in the Journal of Neurology, Neurosurgery & Psychiatry, if more than 90 percent of your seizures occur while you slumber, you likely have nocturnal seizures. The report also noted that an estimated 7.5 percent to 45 percent of people who have epilepsy have some form of sleep seizures.

It’s believed that sleep seizures are triggered by changes in the electrical activity in your brain during certain stages of sleeping and awakening. Most nocturnal seizures occur in stage 1 and stage 2, which are moments of lighter sleep. Nocturnal seizures can also occur upon waking. Most often, nocturnal seizures are partial seizures.  

Nocturnal seizures are associated with certain types of epilepsy, including:

  • juvenile myoclonic
  • awakening grand mal
  • benign rolandic, also called benign focal epilepsy of childhood
  • electrical status epilepticus of sleep
  • Landau-Kleffner syndrome (LKS)
  • frontal onset seizures 

Nocturnal seizures disrupt sleep. They also affect concentration and performance at work or school. Lack of sleep is also one of the most common triggers for seizures. Other triggers include stress and fever.

Nocturnal seizures in infants and young children

Seizures and epilepsy are more common in infants and children than any other age group. However, children who have epilepsy often stop having seizures by the time they reach adulthood.

Parents of new infants sometimes confuse a condition called benign neonatal sleep myoclonus with epilepsy. Infants experiencing myoclonus have involuntary jerking that often looks like a seizure. But an electroencephalogram (EEG) won’t likely show changes in the brain that are consistent with epilepsy. Plus, myoclonus is rarely serious. For example, hiccups and jerking in sleep are forms of myoclonus.

Diagnosing nocturnal seizures

It can be tricky to diagnose nocturnal seizures because of when they occur. Sleep seizures can also be confused with parasomnia, an umbrella term for a group of sleep disorders. These disorders include sleepwalking, teeth grinding, and restless leg syndrome.

Doctors will evaluate a number of factors to determine which form of epilepsy you may have including:

  • the type of seizures you have
  • the age when you began having seizures
  • family history of epilepsy
  • other medical conditions you may have 

To diagnose epilepsy, doctors may use:

  • images of electrical activity in your brain recorded by an EEG
  • the structure of your brain as shown in a computed tomography (CT) scan or magnetic resonance imaging (MRI)
  • a record or diary of your seizure activity 

If you suspect that your infant or child is having nighttime seizures, consult with your doctor. You can monitor your child by:

  • using a baby monitor so you can hear and see if a seizure occurs
  • watching for signs in the morning, such as unusual sleepiness, headache, and signs of drooling, vomiting, or bed-wetting
  • using a seizure monitor, which has features like a motion, noise, and moisture sensors

You asked, we answered

  • Along with following your doctor’s prescribed treatment plan, what steps can you take in your bedroom to protect yourself during nighttime seizures?
  • If you do have nighttime seizures, take certain precautions to protect yourself. Remove sharp or dangerous objects near the bed. A low bed with rugs or pads placed around the bed can be helpful if a seizure occurs and you fall out. Try not to sleep on your stomach and limit the number of pillows in your bed. If possible, have someone sleep in the same room or nearby to help if you have a seizure. You can also use a seizure detection device that alerts someone for help if a seizure occurs.

    - William Morrison, MD

Outlook for epilepsy

Talk to your doctor if you believe that you or your child is experiencing seizures while sleeping. They can order tests that will confirm if you are experiencing seizures. Medication is the first-line treatment for epilepsy. Your doctor will help find the treatment that works best for you or your child.

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