Nights can be the hardest part of living with epilepsy. Whilst the world sleeps, you lie awake wondering if tonight will bring another seizure. Or perhaps you wake exhausted, with unexplained injuries and no memory of what happened in the darkness. For families, it's the constant worry of not knowing if your loved one is safe in the next room.

You're not imagining these concerns. Between 10 and 15 out of every 100 people with epilepsy experience seizures during sleep, and many occur without anyone realising. Understanding nocturnal seizures signs transforms anxiety into action, helping you recognise what's happening and respond with confidence.

What Are Nocturnal Seizures?

Nocturnal seizures are seizures that happen whilst you're asleep, caused by sudden bursts of abnormal electrical activity in your brain. They can strike at any point during sleep, whether you're settling into bed at night or catching an afternoon nap.

Most nighttime seizures occur during non-rapid eye movement (non-REM) sleep, particularly the lighter stages when your brain is more susceptible to the electrical disruptions that trigger seizures.

Common Signs You May Be Having Nocturnal Seizures

The challenge with seizures during sleep is that many people never witness them happening. If you sleep alone, you might go months or years not knowing. Your body, however, leaves behind evidence.

1. Morning clues:

These include waking with an unexplained headache that feels different from typical morning grogginess, finding yourself completely exhausted despite a full night in bed, discovering cuts, bruises or soreness you can't account for, and noticing your tongue or cheek feels sore or looks bitten. You might find your bedding twisted, pulled off the bed, or soaked with sweat, or experience bedwetting when this hasn't been an issue for you before.

2. Throughout the night:

You may wake repeatedly without understanding why, feel confused or disoriented when you do wake, or experience what feels like muscle soreness similar to intense exercise. Some people describe feeling like they've "fought through the night" even though they have no memory of moving.

3. What others observe can be even more telling:

If someone shares your bedroom or checks on you during the night, they might witness sudden jerking movements of your arms, legs, or entire body, unusual postures or positions, repetitive movements like cycling legs or picking at bedding, loud cries, screams or grunting sounds. During tonic-clonic seizures, the most recognisable type, they may see your body stiffen followed by rhythmic jerking movements.

Children experiencing nighttime seizures might call out for parents repeatedly, seem frightened without clear cause, or resist going to bed when they previously enjoyed their bedtime routine.

How to Tell Seizures Apart from Normal Sleep Movements?

Everyone moves during sleep. We shift positions, occasionally kick or twitch and some people talk or even sleepwalk. So how can you distinguish normal sleep behaviour from nocturnal seizures?

1. Seizures follow patterns:

They typically happen the same way each time, with a clear beginning and end. The movements appear stereotyped, meaning they look identical episode after episode. If you're thrashing about randomly one night and perfectly still the next, you're likely experiencing normal sleep movements or possibly nightmares.

2. Timing offers clues:

Nightmares and night terrors usually occur during REM sleep in the latter part of the night or early morning. These are not nocturnal seizures. Nocturnal seizures more commonly strike during the first few hours of sleep, during non-REM stages. If episodes consistently happen within an hour or two of falling asleep, seizures become more likely.

3. The person's awareness differs:

During sleepwalking or night terrors, people often respond to voices or touch, even if their responses seem confused. During seizures, the person typically doesn't respond to voices, touch or attempts to wake them. After sleepwalking, people often remember fragments of dreams or experiences. After seizures, there's usually complete amnesia for the event.

4. Physical signs separate the two:

Seizures may leave behind a bitten tongue or cheek, something extremely rare with other sleep disorders. The confusion following a seizure (called the postictal state) typically lasts longer and appears more settled than the brief disorientation after waking from a nightmare.

If you're uncertain what you're experiencing, keeping a detailed record helps. Note the time events occur, how long they last, what movements or behaviours you observe or others report, and how you feel the following morning. Video recordings, if possible, provide invaluable information for your healthcare team.

Practical Steps for Safer Sleep:

You don't need to wait for appointments or approvals to start making your nights safer. These practical steps work immediately.

1. Create a safer sleep space.

Lower your bed or place your mattress directly on the floor to prevent injuries from falls. Remove clutter, particularly charging cables, headphone leads and other items that could cause entanglement. Place cushions or padding on the floor beside your bed. If you use bed rails, ensure they're padded and positioned to prevent falls rather than cause entrapment.

Keep your bed free from excessive pillows or heavy duvets that could pose suffocation risks during a seizure. A lighter duvet and a single pillow often provides adequate comfort whilst improving safety.

2. Establish a sleep routine that supports seizure control:

Go to bed and wake at consistent times every day, including weekends! Your brain thrives on routine, and irregular sleep patterns can trigger seizures. Create a calming pre-sleep ritual: dim lights an hour before bed, avoid screens, practice gentle stretching or breathing exercises and keep your bedroom cool, dark and quiet.

3. Manage known triggers:

Avoid alcohol, especially before bedtime, as it disrupts sleep architecture and can increase seizure risk. If stress worsens your seizures, incorporate relaxation techniques into your evening routine. Missing medication doses raises seizure risk significantly, so establish systems: phone alarms, pill organisers, link taking your meds to a daily activity or try apps that ensure you never miss your evening medication.

4. Implement monitoring appropriate for your situation:

Options range from simple to sophisticated. Audio monitors alert others to unusual sounds. Video monitors let caregivers check without entering the room. Specialised movement sensors, placed under the mattress, can notice patterns associated with seizures. Some families find reassurance simply from keeping bedroom doors open or sleeping nearby.

Sharing your bedroom with a partner, family member, or trusted friend provides immediate help if needed. If you live alone, consider informing close neighbours or using technology that connects to emergency contacts.

5. Keep emergency information accessible:

Place a seizure action plan on your bedside table and send it to your close family member os support people. This document should clearly state what type of seizures you experience, how long they typically last, when someone should call emergency services and any specific instructions for your care.

You can download our FREE seizure action plan template here! Simply donwload it, fill it and share it!

When to Seek Urgent Help?

Most seizures stop on their own within a few minutes and don't require emergency medical attention. However, certain situations demand immediate action.

Call emergency services if:

• A seizure lasts longer than five minutes

• A second seizure follows immediately after the first

• The person has difficulty breathing after the seizure ends

• The person sustained a significant injury during the seizure

• This is the person's first known seizure

• You're uncertain whether emergency help is needed

First aid during nighttime seizures follows the same principles as daytime seizures: stay calm, protect the person's head with something soft, time the seizure, and turn them gently onto their side once jerking movements slow or stop. The side position allows saliva or vomit to drain from the mouth rather than entering the lungs.

You should never restrain someone during a seizure, place anything in their mouth or attempt to move them unless they're in immediate danger. Stay with them until they're fully recovered and aware of their surroundings.

After the seizure ends, speak calmly and reassuringly. They may be confused, tired or frightened. Explain simply what happened, ensure they're comfortable and stay nearby. Most people need anywhere from a few minutes to an hour to feel like themselves again.

How families can reduce anxiety during the night?

The worry never completely disappears, but families managing nocturnal seizures find that preparedness transforms paralysing fear into manageable concern.

1. Knowledge builds confidence:

Understanding what seizures look like for your family member, knowing exactly what to do when one occurs, and having practiced the response creates muscle memory that activates even when you're frightened. Many families rehearse their response plan during calm moments: walking through the steps, locating supplies, and practicing positioning techniques on cooperative family members.

2. Routines provide structure and calm:

When bedtime becomes predictable, anxiety lessens for everyone. Children especially benefit from consistent routines that include calming activities, appropriate safety measures that don't feel frightening, and gentle conversations that acknowledge concerns without amplifying fears. Parents often create simple visual schedules showing the bedtime routine, which gives children a sense of control and predictability.

3. A Seizure Action Plan removes the midnight panic:

Having a seizure action plan eliminates the terrifying question "What do I do?" when crisis strikes, especially during the night. Writing down the plan forces you to think through scenarios whilst you're calm and rational. Keeping copies in multiple locations: bedroom, kitchen, with babysitters and ensure it's always accessible. Reviewing and updating the plan every few months keeps it current as circumstances change.

4. Support systems share the weight:

Managing nocturnal seizures shouldn't rest entirely on one person's shoulders. Extended family members, trusted friends, or support workers can provide overnight care occasionally, giving primary caregivers the deep sleep they desperately need. Support groups, whether in-person or online, connect you with others navigating identical challenges. Organisations like Epilepsy Action and the Epilepsy Society offer helplines staffed by advisors who understand your situation.

5. Self-care isn't selfish, it's essential:

Caregivers experiencing chronic sleep deprivation make poorer decisions, respond more slowly in emergencies, and suffer significant health consequences themselves. Finding ways to rest, whether through rotation of overnight duties, afternoon naps, or occasional respite care, ultimately improves safety for everyone. Click here to read our tips for caregivers.

6. Privacy-first technology supports without surveillance:

Many families appreciate tools that provide reassurance without creating an environment of constant monitoring. The goal isn't to watch every movement but to gain confidence that help will arrive if needed. This balance preserves dignity whilst addressing legitimate safety concerns. Click here to find out how Lampsy is helping families feel safer during the night with a revolutionary invisible seizure monitoring device.

This article provides educational information and should not replace professional medical advice. Always consult your healthcare team about your specific situation, treatment options, and safety needs.