Epilepsy and seizures during sleep

For some people, sleep is disturbed not by dreams but by seizures. You can have a seizure with any form of epilepsy while you sleep. 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 another medical condition, you may have epilepsy.

There are different kinds of epilepsy, and the condition is common. About 2.9 million Americans have epilepsy. You can get it at any time. But new cases are most likely diagnosed in 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 your 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.

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 to 45 percent of people who have epilepsy have seizures mostly during sleep.

People with nocturnal-only seizures can develop seizures while awake. One study from 2007 showed that about one-third of people with sleep-only seizures can develop seizures while awake even after being seizure-free for many years.

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

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

  • juvenile myoclonic epilepsy
  • tonic-clonic seizures upon waking
  • benign rolandic, also called benign focal epilepsy of childhood
  • electrical status epilepticus of sleep
  • Landau-Kleffner syndrome
  • frontal onset seizures

Nocturnal seizures disrupt sleep. They also affect concentration and performance at work or school. Nocturnal seizures are also associated with an increased risk for Sudden Unexpected Death in Epilepsy, which is a rare cause of death in people with epilepsy. Lack of sleep is also one of the most common triggers for seizures. Other triggers include stress and fever.

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.

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.

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:

To determine which form of epilepsy you may have, you doctor will evaluate a number of factors, 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, your doctor may use:

  • images of electrical activity in your brain recorded by an EEG
  • the structure of your brain as shown in a CT scan or MRI
  • a record 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

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’re 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. With proper diagnosis and treatment, most cases of epilepsy can be controlled with medications.