Nocturnal Seizures

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Nocturnal seizures are a type of seizure that happens while you sleep or as you wake up. They can disrupt your rest. And that can set off a cycle of sleeplessness that may make your seizures worse.

Even though these seizures are called "nocturnal," meaning related to the night, they can also happen as you nap during the day.1

What causes nocturnal seizures?

When you are awake, brain waves are steady. They become more active as you sleep. Experts think changes in your brain's electrical activity trigger nocturnal seizures. These changes happen as you go through different sleep stages.1

Nocturnal seizures affect more than your sleep. They can also cause:1

  • Sleepiness during the day
  • A lack of focus
  • Problems with:
  • Diminished quality of life

At which stage of sleep do nocturnal seizures happen?

There are 5 stages of sleep. The first 2 are fairly light sleep. During the other 3, you sleep more deeply. The deeper stages of sleep are called REM (rapid eye movement) sleep.1

Nocturnal seizures are more likely to happen during the first 2 stages of sleep. These are the lighter, non-REM stages. They happen during the first 2 hours after you fall asleep. You may also experience seizures:1

  • As you wake up
  • Up to 1 hour after waking
  • As you stir during the night

Who is most likely to have nocturnal seizures?

Around 12 percent of people with epilepsy have nocturnal seizures. But anyone who has epilepsy is at risk. These seizures are more likely to happen with specific forms of epilepsy, including:1

  • Juvenile myoclonic epilepsy
  • Epilepsy with generalized tonic-clonic seizures alone
  • Childhood epilepsy with centro-temporal spikes (Benign rolandic epilepsy of childhood)
  • Electrical status epilepticus of sleep
  • Landau-Kleffner syndrome
  • Frontal onset seizures (such as nocturnal frontal lobe epilepsy)

How do doctors diagnose nocturnal seizures?

Since nocturnal seizures happen when you sleep, you may not even know you have them. You or your doctor could also mistake seizures for a sleep disorder.1

If possible, it is best to have another person witness your seizure to confirm they are happening. This could be a family member or a medical professional. Your doctor could recommend a video EEG (electroencephalograph). Video EEG is a test that records your brain waves and video of what is going on with the outside of your body at the same time. You may be asked to take the test after going without sleep for a while.1,2

How can I manage this type of epilepsy?

Undiagnosed and uncontrolled nocturnal seizures can cause a pattern of problems. Seizures cause you to lose sleep. And a lack of sleep is a trigger for more seizures.1

Your doctor will probably suggest treatments similar to those for daytime seizures. These include:1,3,4

  • MedicineAnti-seizure drugs help reduce or completely stop seizures. Nocturnal seizures may require a higher dose than daytime seizures. Your doctor will prescribe one or more drugs based on things like:
    • Your condition
    • How often you have seizures
    • Your age
  • Surgery – If medicine does not work to control your seizures, your doctor may suggest surgery. The surgery involves removing the part of your brain that triggers seizures. You may still need anti-seizure drugs after the surgery. But you should be able to take a lower dose, less often than you would have without the surgery.
  • Ketogenic diet – A diet that is high in fat and low in carbs or carbohydrates has been shown to relieve seizures in some children. Before starting a ketogenic diet, talk to your doctor to ensure your child gets the proper nutrients.
  • Vagal nerve stimulation – In this therapy, a doctor implants a device like a pacemaker in your chest beneath the skin. Wires from the device are attached to the vagus nerve, in your neck. The device sends electrical signals through the vagus nerve to your brain, curbing seizures.

Sleep disorders like sleep apnea may also make nocturnal seizures worse. Treating the sleep disorder can ease seizures and help you get a better night's sleep.3

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