Epilepsy and Sleep: Why Rest Is Critical for Seizure Management
- CSMA Team
- May 3
- 5 min read
Epilepsy is a neurological condition that causes unprovoked, recurring seizures—and while many people understand the importance of medication in managing epilepsy, fewer realize how critical sleep is to controlling seizures.
Epilepsy can be caused by a variety of factors, including strokes, brain tumors, head injuries, central nervous system infections, and inherited genetic conditions. While many people have heard of epilepsy—and some even know someone living with it—true understanding of the disorder remains surprisingly limited.
At Comprehensive Sleep Medicine Associates (CSMA), under the leadership and guidance of Triple Board-Certified Jerald H. Simmons, MD, we see firsthand how sleep and seizure activity are deeply intertwined.
While the inner workings of epilepsy and seizures can be complicated, this article aims to provide you with a basic understanding by exploring the powerful relationship between sleep and epilepsy, why rest matters more than you might think, and how patients can improve their sleep to reduce seizure risk.
What Is Epilepsy, and What Triggers Seizures?
Epilepsy affects nearly 3.4 million Americans, according to the CDC. Seizures occur when abnormal electrical activity surges in the brain. For some, seizures are predictable and tied to specific triggers; for others, they may appear without warning.
There are more than 30 different types of seizures, and not all of them are easy to recognize. Some may cause a person to appear confused or to stare blankly into space, while others can lead to sudden falls, shaking, and a complete loss of awareness of their surroundings.
A few of the more common seizure triggers include:
Stress
Bright or flashing lights
Illness or fever
Hormonal changes
Sleep deprivation
That last one—poor sleep—is often overlooked but can be one of the most powerful contributors to seizure activity.
The Science Behind Sleep and Epilepsy
Sleep isn’t just rest—it’s restoration. During sleep, especially during slow-wave sleep (deep sleep) and REM (rapid eye movement) sleep, the brain undergoes essential maintenance. For people with epilepsy, disruptions in these sleep stages can affect brain activity in a way that increases the likelihood of seizures.
Sleep Deprivation and Seizure Risk
Missing even a few hours of sleep can alter brain excitability. Research shows that sleep deprivation lowers the brain’s seizure threshold, making episodes more likely—particularly in those already diagnosed with epilepsy.
Epilepsy can disrupt sleep architecture and quality, leading to sleep disturbances and comorbidities, such as sleep apnea and restless legs syndrome (RLS). It also contributes to excessive daytime sleepiness and fatigue, which the sedating effects of antiseizure medications can compound.
Sleep Stages and Seizure Activity
Certain seizure types tend to occur during specific sleep phases. For example, nocturnal seizures (also known as sleep-related seizures or nocturnal frontal lobe epilepsy) often happen during transitions between sleep stages.
Nocturnal seizures can present in various ways, including:
Awakening for no clear reason: Sudden awakenings from sleep, often without a known cause.
Unusual movements: Jerking, twitching, or violent movements of arms and legs.
Strange vocalizations: Crying out, screaming, or moaning during sleep.
Confused or agitated behavior: Appearing disoriented or acting out of character after waking up.
Tongue biting or bedwetting: These can occur during or after a seizure.
Difficulty waking up: Feeling groggy or having trouble waking up after a seizure.
That’s why improving overall sleep structure and reducing sleep fragmentation can directly reduce seizure frequency.
Common Sleep Challenges in People with Epilepsy
Insomnia and Fragmented Sleep
Difficulty falling asleep or staying asleep is common among people with epilepsy. Waking up frequently during the night may be caused by underlying brain activity—even subtle, subclinical seizures that don’t cause full awareness.
Nocturnal Seizures
Some individuals experience seizures only during sleep, which can go undiagnosed for years if not appropriately evaluated or discovered during a sleep test.
Most nocturnal seizures are tonic-clonic, formerly known as grand mal seizures, and they usually last less than five minutes. During the tonic phase, the person’s muscles suddenly stiffen, which can lead to tongue biting or a loss of bladder or bowel control. This is followed by the clonic phase, where the muscles begin to jerk or twitch rhythmically.
After the seizure ends, the person may be unresponsive and find it difficult to wake for a short time. Additional symptoms may include bedwetting, waking up confused, or extreme fatigue upon waking.
Medication Side Effects
Anti-epileptic drugs (AEDs) are essential for seizure control, but they can sometimes cause drowsiness, insomnia, or disrupt sleep architecture. Balancing medication effectiveness with sleep quality is key—and something your doctor and sleep specialist can work on together.
Tips for Better Sleep Hygiene
Creating a solid foundation for restful sleep can make a big difference in seizure management. Your CSMA sleep team will work with you to develop the right foundation to help you manage your seizures and sleep.
Here are a few strategies:
Stick to a Schedule: Go to bed and wake up simultaneously each day—even on weekends.
Create a Calming Routine: Wind down with relaxing activities (like reading or a warm bath) 30–60 minutes before bed.
Limit Screens and Stimulants: Avoid blue light from devices and reduce caffeine, especially in the afternoon and evening.
Sleep Environment Matters: Keep the bedroom cool, dark, and quiet. Consider blackout curtains, white noise machines, or a weighted blanket if helpful.
Avoid Long Naps: Short naps (20–30 minutes) can be helpful, but long or late-day naps can disrupt nighttime sleep.
When to Seek Professional Help for Epilepsy and Sleep Issues
If you’re having trouble controlling seizures, dealing with ongoing sleep issues, or suspect a sleep disorder may be making your epilepsy worse, it’s time to seek professional help. Talk to your doctor if seizures occur frequently, last longer than five minutes, or involve breathing or heart irregularities.
You should also reach out if you notice unusual movements or sensations during sleep, wake up feeling confused or exhausted, or if poor sleep affects your daily life.
If you or your loved one has epilepsy and:
Has trouble falling or staying asleep
Wakes frequently at night
Experiences daytime drowsiness or brain fog
Suspect seizures occur during sleep
… it may be time for a professional sleep evaluation.
At CSMA, our board-certified sleep specialists can perform in-lab or at-home sleep studies to detect signs of nocturnal seizures, sleep apnea, or other disorders that may impact your health.
Prioritize Sleep, Protect Your Brain
For individuals living with epilepsy, quality sleep isn’t optional—it’s essential. Rest helps stabilize brain activity, supports medication effectiveness, and improves overall well-being. By paying close attention to sleep patterns and creating healthy habits, patients with epilepsy can reduce seizure risk and regain more control over their condition.
📞 Ready to improve your sleep and seizure management? Contact CSMA today to schedule a comprehensive sleep evaluation.
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