Seizures describe jerky movements of different body parts due to irregular electrical activity in the brain. While most people experience this activity during the day, some may get develop them during sleep. Also known as sleep seizures or nocturnal seizures, they can easily disrupt sleep or interfere with its quality. Sometimes, sleep seizures may injure people or even cause death. Learning more about sleep seizures, their symptoms, causes, diagnosis, and treatment can help people understand what to do if they or someone they love experiences this activity during sleep.
What are Sleep Seizures: An Outline
Also known as nocturnal seizures, sleep seizures describe a jerky or shaky activity that occurs during sleep. For some, these seizures may disrupt sleep, causing poor quality, excessive fatigue, and daytime sleepiness. While some people may experience these seizures once or twice in their life, others continue developing them time and again as a part of their ongoing epilepsy. Note that epilepsy describes a medical disorder in which an individual experiences at least two or more seizures 24 hours apart without any known cause.
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Epilepsy and seizures are not uncommon as sources suggest that one in every ten people experience it at least once in their lifetime. In the United States alone, over 2 million adults and more than half a million children have been diagnosed with epilepsy. Out of these diagnosed cases, up to 15% of people have sleep seizures. Hence, it is worth understanding its symptoms, causes, and treatment to avoid grave damage.
Symptoms of Sleep Seizures
Many people who experience sleep seizures do not realize that they have them. The symptoms are quite hard to identify since a person experiencing them is asleep. This is in contrast to epileptic seizures, which can occur at any time regardless of whether a person is asleep or awake. Research indicates that 20 percent of people with epilepsy experience seizures during sleep whereas 40 percent only develop them while they are awake. Approximately 35 percent of these diagnosed epileptic cases develop seizures both during daytime and nighttime.
For most people, sleep seizures occur during the following times:
- Immediately before waking up
- Immediately after waking up
- Immediately before falling asleep
Following are some common signs indicating that a person has experienced seizures in their sleep:
- Loss of bladder control or bedwetting
- Tongue biting
- Bruises or headaches upon waking up
Some people may also experience involuntary movements during sleep seizures, causing the following symptoms:
- Body jerks
- Leg stiffness
- Falling out of bed
- Stiff arms
- Making unusual noises
Some people may be very hard to wake up following a seizure. Others may appear sleepy or confused the following day.
What Causes Sleep Seizures?
In general, a seizure indicates an abnormal electrical activity in the brain. There can be several possible reasons why a person experiences seizures at night. The specific cause often depends on a person’s age and past medical history but for most people, there is no clear explanation.
The following are the most likely causes of general seizures in a person:
- High fever
- Brain tumors
- Head trauma
- Infections, such as meningitis or encephalitis
- Unusual brain development
- Alzheimer’s disease
- Congenital conditions, including Down’s syndrome
Although the cause behind nocturnal seizures remains unknown, some seizure-causing conditions are more likely to hit a person as they are asleep. These may include the following:
- Frontal lobe epilepsy: This form of epilepsy occurs when the brain cells forming the frontal lobe start sending abnormal impulses.
- Benign Rolandic epilepsy: This seizure disorder affects adolescents and young children.
- Juvenile myoclonic epilepsy: These seizures begin during childhood and include unintended, sudden muscle contractions.
- Landau-Kleffner syndrome: This rare seizure disorder affects young children, affecting their language, speech, learning, and behavior.
- Awakening tonic-clonic seizures: This type of seizure occurs when a person wakes up from sleep, causing uncontrolled stiffness and jerkiness of the legs, arms, and the rest of the body.
Diagnosing Sleep Seizures: What Parameters Are Used?
Doctors often perform multiple tests to diagnose sleep seizures and their underlying causes. Because their symptoms are similar to other issues, like night terrors, sleepwalking, and parasomnias, it is imperative to make the right diagnosis and provide the most appropriate treatment.
History and Physical Examination
A doctor usually begins the process of diagnosis by conducting a detailed history-taking session. The session primarily involves questions about the seizures, how they happen, what they involve, and other parameters. A person experiencing sleep seizures does not remember much about their ongoing episodes. Hence, bringing in someone who noticed these seizures can be helpful as they can describe the episodes to a doctor in a much better way.
Following are some questions that a doctor may ask as a part of history taking:
- Family history of epilepsy
- Any possible triggers
- How the seizures started
- Any unusual feelings that happen just before the seizure starts
- The body parts involved in the seizure
- A description of what happened during the seizure, such as movements, changes in awareness, or noises
- How long it took for the person to return to their normal baseline following the seizure activity
- How long the seizure lasted
- Any previous or current illnesses, medication use, or injuries that may have led to this seizure
After taking the history, a doctor will typically perform a complete physical examination to check for any signs of injuries due to seizures or any other injuries that may have led to these seizures. They may also check the neurological system of the patient to rule out any injuries to the nervous system or possible disorders affecting it.
Also known as EEG, electroencephalography is a crucial tool to diagnose all types of seizures. This investigation includes a painless procedure through which professionals record the brain waves of a patient. The test can take place at a doctor’s office, hospital, or even a patient’s home in some cases. As a part of the procedure, a trained professional places various flat metal electrodes around the patient’s head which are connected to a machine that detects and records electrical activity in the brain. The patient may be asked to remain quiet and still during the process or requested to look at various possible triggers.
Most people with sleep seizures have normal brain activity while they are awake. Hence, a doctor may advise going for an overnight EEG test combined with a sleep study to detect brain activity as they sleep. If a patient is admitted to a hospital, the test may sometimes continue over several days and nights for more adequate results.
If it is the first time a person had a seizure at night, a doctor may recommend undergoing a brain scan to look for any tumor, stroke, bleeding, or any other possible cause. However, this is only when the experts are unable to find out a cause through history and examination alone. Brain imaging is not recommended in children.
Depending on the suspected conditions, a doctor may perform additional tests, such as a heart scan, blood tests, or a lumbar puncture. Remember that the majority of people with sleep seizures do not need these additional tests.
Sleep Seizures Treatment and Prevention
There are several treatments recommended for people with sleep seizures. These treatments include the following.
Antiepileptic medications are the first line of treatment for all types of seizures. While these medications can effectively manage symptoms, they cannot cure the underlying cause or get rid of triggers. Hence, it is always a good idea to combine them with other forms of treatment for a more permanent cure.
Ketogenic Diet Therapy
Ketogenic diets have proven to be highly effective for people with seizures. This high-protein, high-fat, and low-carb diet can reduce the incidence of seizures in patients whose jerky movements are hard to control with antiepileptic medications alone.
When antiepileptic medications and diet therapy do not work to provide effective relief, experts may suggest going for surgery. These surgeries involve extracting a small portion of the brain known to cause seizure activity. The goal of these procedures is to decrease or eliminate epileptic seizures.
Sleep Safety Practices for Sleep Seizures
People experiencing seizures during sleep are at a high risk of getting injured or even dying during sleep. Hence, they must keep the following tips in mind to ensure their safety.
Supervision during sleep
People who get supervision while they are asleep are at low risk of sudden unexpected death in epilepsy or SUDEP than those who sleep alone. So always have someone sleeping next to you whenever possible.
Get rid of heavy furniture
Change the setting of your bedroom in such a way that there is no heavy furniture close to your bed. This will protect you from hitting your arms and legs with them and injuring yourself during a sleep seizure.
Try sleeping on the floor
If your sleep seizure is putting you at risk of falling from bed, consider moving your mattress to the floor.
Try back or side sleeping
Some studies suggest that people who diet with SUDEP are usually the ones who sleep on their stomachs. While this relationship is not clear, some experts believe that this position makes a person more vulnerable to choking or blocking their airways during a seizure. Hence, try sleeping on your side or back.
If you are a caregiver, parent, or a loved one of a person with sleep seizures, remember the following steps to take if you find them seizing through the night:
- Roll the patient on their side to prevent vomiting or choking on saliva
- Do not put anything in their mouth as they may clench it and break their teeth
- Ensure to time the seizure activity and call for emergency services if it lasts for more than five minutes
- Get rid of anything around their neck
- Protect them from anything that may potentially harm them
- Do not leave them alone until they have recovered
How can you have seizures in your sleep?
So far, there are multiple theories explaining why seizures happen during sleep. However, experts remain confused about the exact cause. Most believe that the heightened hypersynchronous activity in the brain as a person sleeps is the major contributor.
How can I know if I am having seizures in my sleep?
If you notice wetting your bed, falling out of bed more frequently, waking up feeling tired or sore, or waking up suddenly during the night for no reason, you may be having seizures during sleep. The only way to confirm it is by having someone supervise you as you sleep.
When should I call for help for someone having a night seizure?
Consider calling emergency medical help in the following situations:
- The seizure is lasting for more than five minutes
- Another seizure begins before the person wakes up
- A person hurts themselves during a sleep seizure
- A person does not breathe normally or wake up after the seizure is over
- The person having the seizure has diabetes or is pregnant
Can sleep seizures be fatal?
Sleep seizures are dangerous and may increase the risk of mortality due to epilepsy. They can also make a person more vulnerable to all types of injuries. Always seek medical help if you are experiencing sleep seizures as timely treatment can minimize the risk of complications.
Should I go back to sleep after a seizure?
Experts generally recommend going back to sleep after having a seizure to let the body rest. However, ensure that you have taken all necessary measures to prevent injuries should these seizures happen again as you sleep. These measures may include placing the mattress on the floor and removing all dangerous and sharp things from the surroundings.