Epilepsy and Sleep: Understanding Their Two-Way Relationship

What was studied

This paper was a narrative review of existing research on the two-way relationship between epilepsy and sleep disorders. It did not enroll a new group of participants or test a treatment.

The authors reviewed biological mechanisms, effects of seizures and epileptic activity on sleep, effects of poor sleep on seizure risk, diagnosis of nighttime events, and treatment considerations. They also discussed epilepsy syndromes that are closely linked to sleep.

What they found

The review reports that epileptic activity can reduce total sleep time, sleep efficiency, and REM sleep while increasing wakefulness during the night. In the other direction, sleep disturbances can lower the seizure threshold, and sleep deprivation is described as an independent seizure-precipitating factor. Obstructive sleep apnea may further lower the seizure threshold through repeated low oxygen levels and unstable arousals.

NREM sleep may promote abnormal electrical discharges and seizure spread through increased synchronization of brain networks, while REM sleep may have a protective effect. Antiseizure medicines can affect sleep in different ways, and use of multiple antiseizure medicines was associated with poorer sleep quality. The authors suggest that identifying and addressing sleep problems has the potential to improve seizure control, cognitive function, and quality of life.

Limits of the evidence

This was a narrative review, not a controlled trial or systematic review. The abstract does not report how studies were selected, how many people were represented, or how strong and consistent the evidence was. The review does not establish that improving sleep will directly reduce seizures for every patient. The benefits and risks of specific sleep treatments or antiseizure medication changes were not quantified.

For families and caregivers

Sleep and epilepsy can adversely affect each other, so nighttime symptoms, poor sleep, daytime sleepiness, snoring, or pauses in breathing may be relevant when discussing overall epilepsy care. Some unusual nighttime behaviors can resemble seizures even when they are sleep disorders, making a detailed history important; the review identifies video-polysomnography as the gold-standard test in the diagnostic workup. The review supports including sleep assessment in epilepsy care but does not show that one approach works for everyone.

What to watch next

The authors prioritize wider routine use of systematic sleep-disorder screening, treatment of obstructive sleep apnea, behavioral sleep interventions, and optimization of antiseizure medication timing and selection as part of multidisciplinary epilepsy care.

Terms in this summary

seizure threshold

The level of susceptibility to having a seizure; a lower threshold means a seizure may occur more easily.

NREM sleep

Non-rapid eye movement sleep, which includes light and deep stages of sleep.

REM sleep

Rapid eye movement sleep, a stage associated with vivid dreaming and distinct patterns of brain activity.

interictal epileptiform discharges

Abnormal electrical patterns seen between seizures that can be associated with epilepsy.

sleep architecture

The pattern and organization of sleep stages across the night.

obstructive sleep apnea

A disorder in which the airway repeatedly narrows or closes during sleep, causing interrupted breathing and sleep disruption.

video-polysomnography

An overnight test that records video, brain activity, breathing, movement, heart rhythm, and other sleep-related signals.

polytherapy

The use of more than one medication at the same time, here referring to multiple antiseizure medicines.