Nocturnal Seizures: How to Recognize the Symptoms and Find Support
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Medically reviewed by Smita Patel, DOMedically reviewed by Smita Patel, DO
Nocturnal seizures are seizures that happen at night. They are caused by disruptions to sleep, which can lower your seizure threshold. Other triggers include sleep apnea, seizures themselves, and antiepileptic medications.
About 20% of people with epilepsy have seizures that only happen at night. Nocturnal seizures look different from person to person and may be hard to witness if you sleep alone. Some people remember their seizures, but others don’t. Being overly tired the next day is a major indication you may have had a seizure the night before.
Signs and Symptoms
There are about 30 different types of seizures, including:
Grand mal seizures on awakening (GMA): A common seizure disorder associated with sleep. These seizures usually happen directly after waking up or while relaxing in the evening. They usually present as rhythmic, whole-body jerking.
Nocturnal frontal lobe epilepsy (NFLE): A fairly brief seizure that occurs at night. Symptoms can vary, lasting from a few seconds to a few minutes. During a seizure, the person may sit up, jump, or scream.
Juvenile myoclonus epilepsy (JME): Begins between the ages of 8-26. Seizures usually occur within two hours of waking, often after poor or inadequate sleep.
The symptoms of a nocturnal seizure vary depending on your type of seizure. You may experience:
Spasms in your trunk, head, or neck
Grunting noises or changes in speech
Facial grimacing or eye-rolling
Difficulty breathing
Loss of consciousness
Seizures might go unwitnessed, and it may be hard to tell for sure if you've had a hard one. Here are some indications you may have experienced a seizure overnight:
A bitten tongue
Disheveled covers
Urine or stool in the bed
Some people may remember their seizures from the night before. Other people may not remember the seizure, but they may remember waking up during the night. It depends on what type of seizure you have.
It’s not uncommon to feel excessively tired during the day after a seizure. This can last over a day after the seizure occurs.
Some people may notice changes to their cognition the day after a nocturnal seizure. You consolidate your memories from the day when you sleep. A seizure can disrupt that process, making it harder for you to concentrate or remember things.
Causes and Triggers
Poor sleep—for example, waking up throughout the night—could put you at risk for a seizure. One study found that increasing sleep by about 90 minutes for one night decreased the risk of a seizure by 27% over the next 48 hours.
Because poor sleep is a trigger, anything that disturbs sleep can cause a seizure. This means seizures, which disturb your sleep, can actually trigger more seizures. The cycle can be difficult to break. Sleep disorders and antiepileptic (drugs used to treat epilepsy) can also alter sleep and cause nocturnal seizures.
It’s not uncommon for people with sleep apnea to also experience nocturnal seizures. Sleep apnea is a chronic breathing disorder that causes your breathing to stop and restart repeatedly while you sleep. Some evidence indicates sleep apnea may make nocturnal seizures worse. One study found that treating sleep apnea patients also lowered the number of seizures they had.
Risk Factors
Some people may be more at risk for developing epilepsy. Common risk factors for seizures include:
Stroke
Traumatic brain injury (TBI)
Brain tumors
Smoking
Other sleep disorders
Several medical conditions can cause seizures while sleeping. For example:
West syndrome: This condition typically occurs in infants. Parents might witness brief clusters of seizures during sleep or shortly after waking.
Panayiotopoulos syndrome: This condition usually occurs in children, typically during sleep. Seizures usually start with nausea and vomiting and can be longer than other disorders. Most people experience five or fewer seizures before they go into remission.
Benign rolandic epilepsy: This is the most common form of epilepsy in children. Seizures usually occur right after falling asleep or awakening. Children are typically aware of the seizures and remember them the next day.
Diagnosing Nocturnal Seizures
A sleep specialist or neurologist—a doctor who specializes in the brain and nervous system—often diagnoses nocturnal seizures. They will likely perform an electroencephalogram (EEG) test to measure your brain activity while you sleep during a nap or overnight. They may use medication to help you fall asleep. Abnormal brain activity can be a sign of nocturnal seizures.
Your healthcare provider may need to take an image of your brain. This can help rule out other health conditions or help the provider understand the cause of your nocturnal seizures. Common brain imaging scans include:
Magnetic resonance imaging (MRI) scan: Uses a strong magnetic field and radio waves to generate images of the body (no radiation)
Computed tomography (CT) scan: Uses a specialized device that rotates around your body to use X-rays that generate the images (radiation)
Healthcare providers won’t order these imaging tests if your nocturnal epilepsy is genetic.
Treatment for Seizures During Sleep
One of the most important treatment strategies is prioritizing sleep. This is important for caregivers as well as for people with nocturnal seizures. Improving sleep can help reduce the risk of a seizure.
Here are some key sleep tips:
Try to go to bed at the same time every night
Have a calming sleep routine before bed
Keep your bedroom dark and quiet
Exercise earlier in the day versus right before bed
A neurologist or sleep specialist may recommend medications to help manage your seizures. Antiepileptic medications may help, but they may also disturb your sleep. You may also experience side effects during the day. Some antiepileptics cause daytime drowsiness, while others cause weight gain, sleep apnea, or affect learning ability.
The ketogenic diet may help control nocturnal seizures when medication is not effective. This diet focuses on a high-fat, low-carb diet to increase the seizure threshold (the amount of stimulus required to trigger a seizure). Always work closely with a registered dietician (RD) when making significant diet changes.
Vagal nerve stimulation (VNS) may also be useful if medication does not work. It can manage daytime sleepiness for nocturnal seizures. A device is surgically implanted under the collarbone to stimulate the vagus nerve and help control seizures.
Coping Strategies and Support
Sleep seizures can cause stress and anxiety for people experiencing them and their families. The anticipation of a seizure can make it difficult to relax.
Some people may find relief in monitoring the person with nocturnal seizures. Monitoring options include:
Sharing a bedroom
Using a monitor for remote observation of the person sleeping
Putting sensors on the person with nocturnal seizures
Choose the method that works for you and your family. Monitoring for nocturnal seizures can also help prevent breathing issues from prolonged seizures.
Are Seizures Deadly?
Seizures can be a scary medical event to watch, especially when it happens to a loved one. However, sudden death from nocturnal seizures is rare.
It might be helpful to join a local support group. For example, the Epilepsy Foundation has local chapters and offers support like the following:
Educational events and fundraisers
Support groups for families, adults, teens, and bereavement
Overnight camps tailored for children with epilepsy
They also have a 24/7 call line (English and Spanish) for support with specific questions. They also have an online form you can complete to receive help within one day. They can also help connect you with a local doctor.
A Quick Review
Sleep and seizures are closely related. Disturbances to sleep can lower your seizure threshold and cause nocturnal seizures. Nocturnal seizures can cause increased fatigue during the day, keep you awake during the night, and cause more nocturnal seizures.
Most nocturnal seizures aren’t deadly. Treatment strategies include prioritizing sleep, trying medications, following the ketogenic diet, and implementing nighttime monitors.
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