Waking up confused, exhausted or with unexplained injuries can be alarming, especially when you have no memory of what happened during the night. For many people with epilepsy, nocturnal seizures go unnoticed simply because they occur while sleeping. Understanding the warning signs and knowing what steps to take can make a significant difference in managing your condition and staying safe.

If you're concerned about nighttime seizures, new technology like Lampsy is making it easier to monitor nocturnal seizures without uncomfortable skin sensors, giving you and your loved ones greater peace of mind.

What Are Nocturnal Seizures?

Nocturnal seizures are epileptic episodes that occur during sleep, while falling asleep or upon waking up. These seizures typically occur during transitions between sleep stages, particularly during non-rapid eye movement (NREM) sleep when the brain's electrical activity becomes more synchronized.

Key Signs You May Have Had a Seizure While Sleeping

Since you're asleep when these episodes occur, recognizing the clues requires almost detective work. Here are the most common indicators:

Physical Signs Upon Waking

• Unexplained bruises, cuts or soreness from falling out of bed or hitting nearby objects

• Bitten tongue or cheeks, often on the sides

• Wet bedding from loss of bladder or bowel control

• Muscle aches similar to an intense workout

• Morning headaches

Morning Symptoms

• Extreme fatigue despite a full night's sleep

• Confusion or disorientation upon waking

• Difficulty speaking or finding words

• Unusual irritability or mood changes

• Memory gaps about the night before

Nighttime Behaviors (Often Noticed by Others)

• Unusual sounds like grunting, moaning, screaming or crying

• Sudden jerking movements of arms or legs

• Rigid body posture or unusual positioning

• Repetitive movements such as lip smacking, hand clasping, or picking at bedding

• Wandering or confused behavior during the night

Types of Epilepsy More Likely to Cause Nocturnal Seizures

Certain epilepsy types have stronger associations with nighttime seizures:

• Sleep-related hypermotor epilepsy (SHE), formerly known as nocturnal frontal lobe epilepsy, is the most common cause

• Frontal lobe epilepsy tends to produce clusters of brief seizures during sleep

• Juvenile myoclonic epilepsy often causes seizures upon awakening

• Benign rolandic epilepsy, common in children, typically resolves before adulthood

Why Sleep and Seizures Are Connected

The relationship between sleep and epilepsy is complex. During sleep, your brain cycles through different stages, each with distinct electrical activity patterns. These transitions between sleep stages can trigger seizures in people with epilepsy. Additionally, sleep deprivation is one of the most common seizure triggers, creating a challenging cycle where nocturnal seizures disrupt sleep quality, leading to increased seizure risk.

What to Do If You Suspect Nocturnal Seizures

If you recognise any of these signs, taking action is essential:

1. Document Everything

Keep a sleep journal noting:

• How you feel each morning

• Any physical evidence you notice

• Sleep quality and duration

• Stress levels and medication changes

2. Talk to Your Healthcare Provider

Schedule an appointment to discuss your concerns. Your doctor may recommend:

• Electroencephalogram (EEG) to detect abnormal brain electrical activity

• Overnight sleep study to monitor brain activity during sleep

• MRI or CT scans to identify any structural brain issues

3. Ensure Someone Knows

If possible, have a partner, roommate, or family member observe your sleep. They may notice behaviors you're unaware of and can provide crucial information to your doctor.

4. Make Your Sleep Environment Safer

Until you have a diagnosis and treatment plan:

• Use a low bed frame or place your mattress on the floor

• Add padded gym mats beside the bed

• Remove sharp objects, lamps, and furniture from around your bed

• Keep nightstands clear of hazardous items

• Consider a seizure alert device that can notify caregivers

Treatment Options for Nocturnal Seizures

The good news is that nocturnal seizures are manageable with appropriate treatment:

• Anti-seizure medications: Your neurologist may adjust medication timing or dosage, sometimes recommending a higher evening dose. Always consult with your healthcare team first.

• Lifestyle modifications: Maintaining consistent sleep schedules, managing stress and avoiding known triggers;

• Monitoring technology: Devices like Lampsy provide continuous monitoring of movements that may be indicative of tonic-clonic seizures without disrupting sleep

Understanding SUDEP and Taking Precautions

While rare, Sudden Unexpected Death in Epilepsy (SUDEP) is a concern, particularly for those with frequent tonic-clonic seizures during sleep. Research suggests that being face-down in bedding may be a contributing factor. This is why seizure monitoring and creating a safe sleep environment are so important.

Effective seizure management significantly reduces SUDEP risk. Regular follow-ups with your epilepsy care team, consistent medication adherence and proper monitoring can provide crucial protection.

Living Well With Nocturnal Epilepsy

Having nighttime seizures doesn't mean you can't sleep peacefully. Many people achieve seizure control with the right combination of medication, lifestyle adjustments and monitoring!

Key strategies include:

• Prioritising sleep hygiene: Aim for 7-8 hours of quality sleep each night

• Avoiding triggers: Limit caffeine after lunch, avoid alcohol, and manage stress

• Staying consistent: Take medications at the same time daily and maintain regular sleep schedules

• Building your support team: Connect with epilepsy support groups and keep loved ones informed

Frequently Asked Questions

Can I have seizures in my sleep and not know it?

Yes, absolutely. Many people with nocturnal seizures are unaware they're having them, especially those who sleep alone. The only clues might be unexplained fatigue, morning headaches or evidence of injury upon waking.

How are nocturnal seizures diagnosed?

Diagnosis typically involves an overnight EEG combined with a sleep study. Because many people with nocturnal seizures have normal brain activity while awake, observing brain patterns during sleep is essential for accurate diagnosis.

Will I need to stop driving if I have seizures only during sleep?

Driving regulations vary by location, but seizures that occur exclusively during sleep are generally treated differently than daytime seizures. Consult with your neurologist and local licensing authority about your specific situation.

Do seizure medications cause drowsiness?

Some anti-seizure medications can affect sleep quality either causing drowsiness or, less commonly, disrupting sleep. If you notice changes in your sleep or daytime alertness after starting a new medication, always discuss it with your healthcare team.

While there's no universal cure for epilepsy, around 70% of people achieve seizure control with medication. Some children with certain epilepsy types, like benign rolandic epilepsy, naturally outgrow their condition. Treatment advances continue to improve outcomes for people with all forms of epilepsy.

Sources: Information compiled from Epilepsy Foundation, Sleep Foundation, Johns Hopkins Medicine, Massachusetts General Hospital, Cedars-Sinai, and peer-reviewed epilepsy research.