Have you ever woken up with a headache, with some bruises on your body, or on the bedroom floor? If the answer to any of these is yes, it’s time to seek medical help. You may be one of the people whose sleep isn’t disturbed by nightmares, but by seizures that occur while you are asleep.
Our brain cells communicate with nerves, muscles, and other parts of the brain and body through electrical signals. However, there are times when the electrical signals can get out of control, meaning they can send too many or not enough messages. When this happens, an individual may experience a seizure. These seizures are sometimes associated with a medical condition known as epilepsy.
To answer our titular question, first we’ll define what nocturnal seizures are and then we’ll go over what causes them. Next, we’ll explain the process of diagnosing nocturnal seizures and what treatment options are currently offered.
Let’s get started!
What Are Nocturnal Seizures?
The seizures that occur while an individual is sleeping are known as nocturnal seizures. These seizures can cause unusual nighttime behavior, like waking up without a particular reason, the body shaking, or even urinating during sleep.
Nocturnal seizures are quite rare and they mostly occur in individuals that have epilepsy. Various chemicals stimulate electrical activity that has an important role in a person’s movements, speaking, cognitive faculties, and other types of brain activities. When an individual experiences a seizure, a sudden rush of unusual electrical activity is causing them to lose control over some of the brain’s functions.
How Can You Know If You Have a Seizure During Sleep?
Without having a person around who can witness a nocturnal seizure, it’s quite difficult to know whether you’ve had one or not. However, there are some indicators that can help you figure out if you (or someone else in your household) have had a seizure the previous night. Check whether any of the following have occured:
- The bed sheets are wet;
- You feel like you’ve bitten your tongue;
- You’ve fallen out of bed;
- There are bruises on your body;
- You’ve woken up without any reason;
- Your arms and legs feel really stiff;
- You feel sleepy throughout the next day;
- You have problems with memory and concentration;
- You experience severe headaches;
- You have daytime seizures due to lack of sleep.
It’s quite challenging to differentiate nocturnal seizures from nightmares and sleepwalking, so it’s better to consult a neurologist in order to establish whether you have nocturnal seizures, or you’re just a sleepwalker, or you’re just having nightmares.
Causes for Nocturnal Seizures
The causes of nocturnal seizures are usually unknown, however, nocturnal seizures are associated with epilepsy. Epilepsy is a medical term that refers to various types of seizure disorders. Even if we know that an individual has epilepsy, we couldn’t possibly know the particular cause of it. An individual is diagnosed with epilepsy if they have experienced more than two seizures that aren’t a result of something else, like drug/alcohol withdrawal or fever.
Epilepsy seizures are roughly divided into two types: partial seizures and generalized seizures. Generalized seizures occur after an abnormal electrical activity in the part of the brain known as the cerebral cortex. On the other hand, partial (localized) seizures are restricted to one brain’s hemisphere.
Here are some types of epilepsy that can cause nocturnal epileptic seizures:
- Tonic-clonic seizures after waking (grand mal);
- Juvenile myoclonic epilepsy;
- Childhood benign focal epilepsy, also known as Benign Rolandic;
- Electrical status epilepticus;
- Landau-Kleffner epilepsy syndrome;
- Frontal lobe epilepsy.
The following conditions may be potential causes for seizures:
- Infections in the brain, such as meningitis or encephalitis;
- Serious head trauma;
- Brain stroke or tumor;
- Reduced oxygen to the brain.
Nocturnal seizures can be related to the risk of sudden unexpected death from epilepsy.
Epilepsy and Sleep Disorders
Regular, high-quality sleep is crucial for an individual’s physical and mental health. However, sleep disorders are often found in people that have some form of epilepsy. Here are some of the sleeping disorders that are associated with epilepsy:
- Insomnia. Certain forms of epilepsy have correlation to sleep disorders, like childhood benign focal epilepsy, also known as Benign Rolandic. Insomnia in individuals that are diagnosed with some forms of epilepsy can be caused by a few factors. For instance, it may be caused by the side effects of some medications, depression or anxiety, or seizures during sleep.
- Obstructive sleep apnea (OSA). Sleep apnea is a respiratory disorder that involves the partial or total collapse of the top airway while a person is asleep. It affects around 30% of individuals diagnosed with epilepsy, and this is twice more than the number of affected individuals in the general population. This sleep disorder can make a person snore, wake up frequently, or not get enough sleep.
- Parasomnia. Parasomnia is a sleep disorder that involves uncommon behaviors that may happen before sleeping, during sleep, and when a person wakes up. Parasomnia can be divided into three categories: REM related, NREM related, and other types of parasomnia. Neurologists are still trying to solve the complex connection between epilepsy and parasomnia. Many types of epilepsy are quite difficult to differentiate from parasomnia and most individuals that are diagnosed with epilepsy are diagnosed with parasomnia as well.
Epilepsy and Sleep Deprivation
Can lack of sleep be considered as a seizure trigger? The answer is yes. The frequency of seizures is affected by the amount of sleep a person gets at night, especially in a person that is diagnosed with epilepsy. A good night’s sleep is the best friend of individuals with epilepsy, because without it, the seizures can increase in intensity and length.
Sleeping can have different effects on seizures, i.e. their occurrence and frequency. During the normal sleep-wake cycles, some shifts occur in the hormonal and brain activity, and these changes may become abnormal and result in seizures. These shifts are accountable for why some experience more seizures while sleeping than others, and the reason why sleep deprivation may lead to seizures.
Diagnosing Nocturnal Seizures
Nocturnal seizures are really hard to diagnose due to the fact that they happen while we are asleep. Seizures during sleep are often confused with some sleep disorders like sleepwalking, restless leg/arm syndrome, etc. In order to determine the type of epilepsy that a patient might have, a neurologist will take into consideration and assess several factors, such as:
- The seizure type that the patient experiences;
- The age when the person first started experiencing seizures;
- Medical and family history.
Afterward, to diagnose whether you have epilepsy or not, the neurologist may use any of the following methods:
- Electroencephalogram (EEG). EEG is the most useful method in diagnosing epilepsy. It makes a record of the electrical activity in your brain, which means that the EEG records any uncommon waves or spikes in the regular pattern of the electrical activities in the brain.
- Computed Tomography (CT) and Magnetic resonance imaging (MRI). CT and MRI scans can show the neurologist in which part of the brain the seizures are occurring.
- Data of the seizure activity. The doctor may ask a witness to describe the seizure or keep you overnight for a sleep study.
Treatment Options for Nocturnal Seizures
Unfortunately, seizures aren’t fully curable. However, with the right treatment, they can be reduced or prevented. A neurologist will decide on the treatment for your seizures during sleep based on the following factors:
- Seizure frequency;
- The seizure type;
- Any underlying conditions;
- How serious are the nocturnal seizures?;
- How old is the patient?;
- The general health of the patient;
- Any other medical conditions in the patient.
There are two treatment options:
- Anti-epileptic drugs. Anti-seizure drugs can be quite useful, though it may take several attempts to find the correct drug and dosage.
- Surgery. This is the last option, and the neurologist will recommend it in case the anti-epileptic drug cannot control the seizures. The surgery includes implementing a vagus nerve stimulator, a.k.a. VNS, under the skin of the chest. This stimulator sends regular, mild pulses of electricity to the brain through the vagus nerve that prevent or decrease the seizures. This treatment is usually combined with anti-seizure drugs in order to decrease the occurrence of seizures.
You can also try some lifestyle changes to reduce the effects of seizures, like:
- Changing your diet by implementing a low-carb, high-fat diet, also known as the keto diet;
- Trying to get enough sleep;
- Avoiding seizure triggers, like sleep deprivation.
Tips for Preventing Injuries From Seizures During Sleep
The right treatment for seizures can help you to reduce or even prevent nocturnal seizures. A neurologist will prescribe the treatment based on the type of the seizure, the cause of the seizure, and the individual characteristics of the patient.
However, you can help yourself by taking some preventive measurements in order to decrease any potential injuries from seizures during sleep, such as:
- Select a bed with lower bed frame – this way, you won’t injure yourself in case you fall off the bed;
- Don’t use a bedside table, or in case you want to use it, place it further away from the bed;
- Keep the environment around the bed free from hard or sharp objects;
- Use a nighttime seizure or epilepsy monitor that informs other members of your household when you’re experiencing a nocturnal seizure;
- Put a mattress or a carpet on the floor next to your bed.
Seizures during sleep are potentially dangerous due to the fact that you may injure yourself in the middle of one. For individuals that have no earlier medical history of seizures, this might be the first symptom of epilepsy. Regardless of the number of seizures you experience during sleep or what anti-epileptic drug you use, it’s crucial to see a neurologist for any symptoms of nocturnal seizures immediately. Getting nocturnal seizures under control will significantly lower the risk of epilepsy complications.