Complications – Sleep Disorders

Reviewed by: HU Medical Review Board | Last reviewed: November 2021

Many people with epilepsy find they sleep poorly. Epilepsy and sleep have a complicated relationship. Electrical activity and hormone levels change when we sleep. This means that lack of sleep or poor quality sleep may trigger seizures. In turn, seizures and some anti-seizure drugs may contribute to sleep problems. Two out of 3 people with epilepsy report sleep issues.1

The most common sleep issues linked to epilepsy include:1,2

  • Sleep apnea
  • Restless legs syndrome (RLS)
  • Insomnia

Sleep disorders are especially more common in people with drug-resistant epilepsy. Left untreated, sleep disorders may lead to daytime sleepiness, worse depression, and more seizures.1

Sleep apnea and epilepsy

Sleep apnea is a sleep disorder in which breathing is interrupted 5 or more times per hour during sleep. These periods each last at least 10 seconds. People with sleep apnea tend to snore loudly and make gasping or choking noises in their sleep.1

Sleep apnea is common in people with epilepsy and is found in:2

  • 1 in 10 all adults with epilepsy
  • 2 in 10 children with epilepsy
  • 3 in 10 people with drug-resistant epilepsy

Sleep apnea causes low oxygen levels in the blood and poor, interrupted sleep. Often, people do not enter deep sleep because of these interruptions. Left untreated, it can lead to issues including:3,4

  • Significant daytime sleepiness
  • More seizures
  • High blood pressure
  • Heart disease
  • Diabetes
  • Kidney disease
  • Depression

Using a continuous positive airway pressure (CPAP) machine helps maintain an open airway during sleep to reduce apnea. This leads to more restful sleep, which can lead to better seizure control and a lower risk of other health conditions linked to sleep apnea.3,4

Insomnia and epilepsy

Insomnia means a person has trouble falling asleep or staying asleep. Short-term, or acute, insomnia usually lasts for a few days or weeks. Chronic insomnia occurs at least 3 times a week for 3 months or longer. About half of people with epilepsy also have insomnia.1,5,6

Insomnia may be caused by waking up frequently, having seizures at night, or the anti-seizure drugs taken to control epilepsy.1,5,6

Severe insomnia is more likely in people who also have depression and other illnesses.1,5,6

Restless leg syndrome and periodic limb movement disorder

Restless legs syndrome (RLS) causes unpleasant sensations in the legs. People describe these sensations as aching, throbbing, itching, pulling, or tingling. Twitching, jerking, and the irresistible urge to move the legs also happens and feels better after movement. Between 1 and 3 out of 10 people with epilepsy have RLS.7,8

More than 80 percent of those with RLS also have periodic limb movement disorder (PLMD). In general, RLS happens when the person is awake, while PLMD happens during sleep. RLS can be felt by the person but not seen by others. With PLMD, the legs and sometimes arms twitch or jerk periodically, as the name suggests, sometimes all night. PLMD is also common in epilepsy.7-9

Treating sleep disorders in people with epilepsy

It is important to talk with your doctor about any sleep problems you may have. Sleep disorders are treatable.

There are many options to treat sleep disorders. The treatment will depend on the type of sleep issues you have. For instance, sleep apnea is usually treated with a CPAP machine. RLS may be treated with certain drugs such as dopamine agonists or iron supplements.

However, one of the most effective and helpful treatments requires no machines or pills. It is called sleep hygiene. This is simply a series of lifestyle habits that make it easier to get good-quality sleep.3

If you are struggling with sleep, talk to your neurologist. They can change the timing or type of anti-seizure drugs you take at night to help improve your sleep.

In addition to sleep disorders, other complications may also occur with epilepsy. These include:

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