Insufficient Sleep Syndrome
Sleep deprivation, or lack of restorative sleep, can trigger a seizure. Some people suffer a single seizure for the only time in their life after an “all-nighter” at college or during a prolonged period of poor sleep with a major life stress. Lack of proper sleep can increase their chances of a seizure or increase the intensity and duration of a seizure.
Doctors take advantage of this phenomenon by asking persons with known or suspected epilepsy to stay up very late before an electroencephalogram to "activate the brain" and record abnormal epilepsy waves. Sleep deprivation also makes it more likely that the electroencephalogram will record sleep, increasing the chances of epilepsy waves in some people. Similarly, epilepsy centers use sleep deprivation during video-EEG recordings to help provoke a seizure.
We don't know why sleep deprivation provokes seizures. The sleep-wake cycle is associated with prominent changes in brain electrical, chemical, and hormonal activities. Seizures and the sleep-wake cycle are often related. Some people have all of their seizures in sleep or while awake, some have seizures transitioning into or out of sleep, and still others have seizures randomly spread throughout the day or night.
People with epilepsy should get adequate sleep - enough to feel refreshed the next day. In general, adults should try for at least 7-8 hours a night. Going to bed late (for example, 3 a.m. instead of 11 p.m.) can be compensated for by sleeping late (10 a.m. instead of 6 a.m.) and thereby avoiding sleep deprivation. However, for some, the disruption of the circadian rhythm may make seizures more likely even if they total sleep time is the same. Are you sleep-deprived? One good measure is the alarm clock - if you need one to wake up every morning, you are probably sleep deprived! Many people with epilepsy (and retired people) get into a different sleep rhythm, where they may sleep 4-5 hours at night but nap once or twice for an additional 2-4 hours during the day. Although they may feel as if they are not getting enough sleep, a log will often show that they are getting 7-8 hours per day.
For persons who have problems falling asleep and staying asleep, some simple measures can help: the sleeping environment should be quiet and dark, and they should avoid caffeinated beverages or foods within 6 hours of going to sleep, avoid alcohol, exercise daily but not within a few hours of going to sleep, and go to bed only when sleepy (not to read or watch TV).
Sleeping pills should be used only under a doctor's supervision and almost never for more than 2 or 3 weeks. During periods of tremendous stress, however, such as loss of a job or a relationship, the judicious use of sleeping pills for several nights can help to prevent a seizure caused by sleep deprivation. Even with short-term use, they must be handled carefully, because stopping certain types of sleeping pills, especially the benzodiazepines such as triazolam (Halcion), clonazepam (Klonopin), and temazepam(Restoril), can trigger seizures in susceptible persons. Other drugs also work at the benzodiazepinereceptor but are not benzodiazepines, such as zolpiderm (Ambien), eszopiclone (Lunesta), and zaleplon(Sonesta). These drugs have less tendency to become habit-forming or cause seizures if suddenly discontinued after regular use. Ramelteon (Rozerem) targets melatonin receptors and has no potential to be habit-forming or cause withdrawal seizures; it is the only sleep medicine approved for long-term use. Melatonin is an over-the-counter drug that promotes sleep and can help regulate the sleep-wake cycle; it appears safe for most people with epilepsy. For sleep, 2-3 mg a half hour before bedtime is recommended.Diphenhydramine (Benadryl; also in over-the-counter sleep drugs such as Sominex) is not habit-forming, but, like other antihistamines, it can lower the seizure threshold and should generally be avoided by people with epilepsy.
Persons who become dependent on sleeping pills should consult their doctors about getting off of them. Gradual reduction of the dosage, possible substitution of non-habit-forming medications that promote sleep, and improved sleep hygiene can help.
Sleep disorders are common in the general population as well as in people with epilepsy. Sleep disorders include insomnia (trouble falling asleep, staying asleep, waking up too early), tiredness during the day, sleep apnea, and restless legs syndrome. Snoring can be a sign of sleep apnea. In children, snoring every night is abnormal. Sleep disorders impair restorative sleep and can therefore make seizures more likely to occur in both children and adults. If a sleep disorder is suspected, consider an evaluation by a sleep specialist.