Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures caused by sudden bursts of abnormal electrical activity in the brain. The quality and quantity of sleep a person receives is fundamentally linked to the stability of this electrical activity. For individuals with epilepsy, the seizure threshold—the point at which the brain’s electrical system becomes overexcited—is profoundly influenced by sleep health. This strong, bidirectional relationship means that poor sleep increases seizure risk, and seizures themselves can disrupt the sleep cycle.
Sleep Deprivation as a Seizure Trigger
A lack of sufficient sleep is one of the most common triggers for seizures in people with epilepsy. Acute sleep loss significantly lowers the brain’s seizure threshold, making it more susceptible to abnormal discharges. This effect is particularly pronounced in certain types of epilepsy, such as juvenile myoclonic epilepsy.
Sleep deprivation is so effective at inducing brain excitability that it has historically been used as a diagnostic tool. Neurologists may request a sleep-deprived electroencephalogram (EEG) to uncover epileptiform activity not visible during a normal waking state. Sleep deprivation increases cortical excitability, a state where nerve cells are more easily activated, which correlates with a higher risk of seizure occurrence.
Research has suggested that a decrease in the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) is observed in both epilepsy and states of sleep deprivation. GABA acts like the brain’s braking system, calming excessive electrical signaling. A reduction in this inhibitory action due to poor sleep removes a natural defense against the hypersynchronization of neurons that leads to a seizure.
The Protective Role of Sleep in Brain Stability
Adequate, restorative sleep is a major factor in stabilizing the brain against sudden electrical discharges. The brain’s electrical activity changes dramatically across the two main sleep phases: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. Understanding these phases helps explain why good sleep is so important for seizure control.
NREM sleep, especially the lighter stages, tends to facilitate epileptic activity and interictal epileptiform discharges (abnormal brain waves between seizures). This stage is characterized by increased neural synchronization, which can foster the hypersynchronization of brain cells.
In contrast, REM sleep, the phase associated with dreaming, often acts as a natural suppressor of epileptic activity. During REM sleep, the brain’s neurochemical environment shifts, and electrical activity becomes more desynchronized, which appears to inhibit the spread of abnormal electrical signals. Therefore, a full, uninterrupted sleep cycle that includes sufficient REM sleep is necessary to help regulate and stabilize the brain’s overall electrical environment.
Addressing Sleep Disorders and Improving Sleep Hygiene
The relationship between sleep and epilepsy is often compounded by coexisting sleep disorders, which are more common in people with epilepsy. Insomnia, characterized by difficulty falling or staying asleep, is frequently reported and can exacerbate seizure activity. These disturbances can result from nighttime seizures, side effects of anti-seizure medications, or the co-occurrence of anxiety and depression.
Obstructive sleep apnea (OSA), a condition where breathing stops briefly and repeatedly during sleep, is another frequent comorbidity. OSA causes chronic sleep fragmentation and low blood oxygen levels, which can significantly increase seizure risk. Treating underlying sleep disorders like OSA, often with a continuous positive airway pressure (CPAP) machine, has been shown to improve seizure control.
A proactive approach to sleep health, known as sleep hygiene, is a non-pharmacological strategy for epilepsy management. Following these practices helps regulate the body’s internal clock and stabilize brain function:
- Maintaining a consistent sleep and wake schedule, even on weekends.
- Creating a relaxing bedtime routine and ensuring the bedroom is dark, quiet, and cool.
- Avoiding stimulating substances like caffeine and nicotine late in the day.
- Limiting screen time from electronics before bed to facilitate the natural release of sleep-promoting hormones.