Empatica
Epilepsy

Am I having seizures while sleeping?

One of the main concerns of living with epilepsy is making sure that you get help fast during a seizure. In the daytime, this may be less of a problem because you have friends or family members that are available and by your side.

However, the nighttime could be a trickier time: everyone is sleeping, so it is harder to notice a seizure when one happens, even if you are in the same room. Sometimes, you might wake up with a headache, or feel sore, and wonder whether you had a seizure the night before.

Or maybe the situation is that your son or daughter has epilepsy. During the day, they are always with their teacher or other kids at school, so you may be less worried that they’d be alone if a seizure happens. However, as a parent during the night, you may worry about letting them sleep alone. Many of you have told us that you sleep in the same room, out of fear that a seizure will go missed.

Surely, in these situations, nights can be filled with fear, worry, and doubt. That’s exactly why we wanted to prepare this blog post for you, so you don’t stay in the dark. We are going to shine a light on:

  1. How common nocturnal seizures are
  2. Why they can be dangerous
  3. How you can know if you or your loved one had a nocturnal seizure
  4. How you can protect yourself by implementing a few, simple changes.

Let’s get started.

What are nocturnal seizures?

Any kind of seizure can be a nocturnal seizure, and they can happen to anyone who has epilepsy. Although, certain kinds of epilepsy are more prone to them: juvenile myoclonic epilepsy, awakening tonic-clonic (grand mal), Benign Rolandic, electrical status epilepticus of sleep, Landau-Kleffner syndrome, and frontal lobe epilepsy [1].

Some people have seizures that happen both during the day and at night [1], yet up to 45% of people have seizures predominantly during sleep [2]. If you only have nighttime seizures in your sleep, then you would have pure nocturnal epilepsy [1].

Although nocturnal seizures occur during sleep, some of their characteristics are similar to daytime seizures. During a nocturnal seizure, you may:

  • cry out or make unusual noises, especially before muscles tense
  • suddenly appear very rigid
  • lose bladder control
  • twitch or jerk
  • bite your tongue
  • fall out of bed
  • wake up for no clear reason [3].

When do nocturnal seizures occur?

As the name suggests, they are seizures that happen during sleep, but this does not mean that they are limited to nighttime. They may also happen during a daytime nap [1].

According to Epilepsy Action Australia, there are more common times that you could have a nocturnal seizure: “Within the first or second hour after going off to sleep (early nocturnal seizures), one to two hours before the usual time of wakening (early morning seizures), within the first hour or so after awakening (early morning seizures)” [1].

Are nocturnal seizures dangerous?

Since nocturnal seizures mostly happen at night, they are less likely to be noticed, even by the person experiencing them [1]. Unfortunately, most cases of sudden unexpected death in epilepsy (SUDEP) occur after a seizure, and most deaths happen when people are in bed, supposedly sleeping [4].

However, if someone is there to provide first aid, keep the person on their side during a generalized seizure, or reposition them to keep their airway open, it may help limit SUDEP [5].

Another reason why nocturnal seizures may be dangerous is that people can get hurt: they may fall out of bed or have bruises when they wake up from injuries at the night. Since a lack of sleep can be a trigger for seizures in general, nocturnal seizures may also cause more daytime seizures [1]. Sleep monitoring solutions, like the Mate App, could help you understand when you’ve had a good night’s sleep.

How can I know if I had a seizure in my sleep?

If there is no one there to witness a nocturnal seizure, it might be difficult to know whether you’ve had one. However, there are some signs to help you understand whether you or someone you love has had one:

  • the bed is wet
  • they’ve bitten their tongue
  • they’ve fallen out of the bed
  • they feel confused, exhausted, or sleep-deprived
  • they have a headache
  • they have bruises [3].

It can be challenging to separate a nocturnal seizure from sleepwalking or night terrors. As with other types of epilepsy, having a good history of seizures or an eyewitness account is important for the diagnosis [1]. Your doctor may do an EEG (electroencephalogram) to see the electrical activity in the brain. Sometimes, he may also do an MRI or CT scan. If someone only has nighttime seizures, a sleep study may be done to rule out other sleeping issues, like sleep apnea [6].

How can I prevent injury from seizures during sleep?

The correct treatment can help someone lower or prevent seizures. A doctor will decide on treatment based on the seizure type, the cause, and individual patient characteristics. Some treatment options are anti-seizure medications, the ketogenic diet, avoiding known seizure triggers, a vagus nerve stimulator, surgery, amongst others [6].

However, those with nocturnal seizures can take some preventative measures to reduce injury:

  • choose a low bed frame
  • put the mattress on the floor
  • put a safety mat, like those for gymnastics, on the floor beside the bed
  • mount lamps to the wall instead of keeping them on the nightstand
  • move furniture away from the bed
  • use a nighttime seizure monitor [3] like Embrace2 that alerts someone when the person has a possible tonic-clonic seizure.

It is important to recognize that there are no devices that have been proven to prevent SUDEP [7], but seizure alerting devices could help someone get seizure first aid more quickly [8].

Embrace2 may be able to help.

If you are looking for a solution like this, Embrace2 may be able to help. It is a wristband cleared by the FDA to detect possible generalized tonic-clonic seizures with 98% accuracy [9], both day and night. When it detects a possible tonic-clonic seizure, it sends a text message and makes a phone call to caregivers to alert them that you need help. It doesn’t matter how far you are from each other; you could be sleeping in adjoining rooms or different cities. The text message also contains your GPS location, in case your caregiver has to find you or send your position to emergency services.

In periods of rest, the false alarm rate (FAR) is low for both children and adults, 0.05 and 0.02 respectively [10]. With a low FAR and high sensitivity, Embrace2 only calls for help when you need it.

This way, you can sleep more soundly, knowing that your loved one will be alerted and can come to help you quickly. Or, if you are a parent, with Embrace2, you can sleep in your own bed, with the peace of mind that you’ll be called if Embrace2 detects a possible seizure.

What else does Embrace2 have to help with nocturnal seizures?

The Alert and Mate Apps have features designed to track nocturnal seizures.

Embrace2 works with two companion apps, the Alert App and Mate App.

One useful feature of Embrace2 is Alert Review. In the Alert App, every time that Embrace2 detects a possible convulsive seizure, the alerts are stored in a “pending bar”. The pending bar shows you how many alerts you have to review before they show up in your seizure diary inside the Mate App.

When reviewing an alert, you can indicate if it was a false alarm, indicate how long it lasted, and add notes about how you were feeling beforehand. If you see pending alerts for seizures that you do not remember, it could possibly mean that you had a nighttime seizure.

The Mate App is the seizure diary that visualizes the information tracked by the Alert App. If you are looking for a seizure tracker, then Mate can help with this. You can also add in other seizure types that are not detected by Embrace, to have a more complete picture of your health.

Mate also shows your rest and physical activity information. It provides detailed statistics, such as the time you woke up and went to bed, the number of tosses and turns, and interruptions. All of this information together could be helpful to show your doctor to help them understand your lifestyle patterns better.

We hope that this blog post has given you helpful and useful information on nocturnal seizures. By knowing more about them, you can be better prepared on how to protect yourselves and your loved ones. If you have any questions about Embrace2, feel free to email our support team at support@empatica.com.

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References:

  1. https://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/nocturnal-seizures-seizures-during-sleep
  2. Malow, B. (2005). Sleep and Epilepsy. Neurologic Clinics, 23(4), 1127-1147. doi: 10.1016/j.ncl.2005.07.002
  3. https://www.medicalnewstoday.com/articles/326864#in-children
  4. Mostacci, B., Bisulli, F., Vignatelli, L., Licchetta, L., Di Vito, L., & Rinaldi, C. et al. (2015). Incidence of sudden unexpected death in nocturnal frontal lobe epilepsy: a cohort study. Sleep Medicine, 16(2), 232-236. doi: 10.1016/j.sleep.2014.09.019
  5. https://www.epilepsy.com/learn/early-death-and-sudep/sudep/sudep-faq
  6. https://www.cedars-sinai.edu/Patients/Health-Conditions/Nocturnal-Seizures.aspx
  7. https://www.epilepsy.com/learn/early-death-and-sudep/sudep/role-seizure-alerts
  8. Devinsky, O., Hesdorffer, D., Thurman, D., Lhatoo, S., & Richerson, G. (2016). Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. The Lancet Neurology, 15(10), 1075-1088. doi: 10.1016/s1474-4422(16)30158-2
  9. https://www.accessdata.fda.gov/cdrh_docs/pdf18/K181861.pdf
  10. https://www.aesnet.org/meetings_events/annual_meeting_abstracts/view/2421091

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Embrace is currently available only in English. Embrace is an investigational device in the USA and a medical device in the EU. If you do not see your country listed, please visit the International site.
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