Nocturnal seizures and sleep stages

[masterjen]

For those who don't know or don't recall, my seizures are nocturnal. I somewhat understand the now accepted concept that stages 3 and 4 of NREM are where abnormal EEG discharges are most likely to occur, but that it is in the lighter stages of NREM sleep (stages 1 and 2) in which a higher number of seizures occurs. In light of this, however, I cannot piece together the following:

I have had an injury to my right arm for the past 10 days that has made my sleep intermittently restless most nights. The "upside" of the more restless nights has been fewer nocturnal seizures(!) Could this be because restless sleep means not getting into the deeper NREM sleep where the abnormal discharges are most likely to be initiated? Or do restless nights mean more time is spent in REM sleep, which is known to be a suppressor of seizure activity? Or do restless nights in fact mean more time is spent in NREM stages 3 and 4, and that stages 1 and 2 (lighter sleep, where a higher number of seizures is known to occur) are in fact bypassed??

Thanks in advance for any help.

 

[Lonewolf]

For those who don't know or don't recall, my seizures are nocturnal. I somewhat understand the now accepted concept that stages 3 and 4 of NREM are where abnormal EEG discharges are most likely to occur, but that it is in the lighter stages of NREM sleep (stages 1 and 2) in which a higher number of seizures occurs. In light of this, however, I cannot piece together the following:

I have had an injury to my right arm for the past 10 days that has made my sleep intermittently restless most nights. The "upside" of the more restless nights has been fewer nocturnal seizures(!) Could this be because restless sleep means not getting into the deeper NREM sleep where the abnormal discharges are most likely to be initiated? Or do restless nights mean more time is spent in REM sleep, which is known to be a suppressor of seizure activity? Or do restless nights in fact mean more time is spent in NREM stages 3 and 4, and that stages 1 and 2 (lighter sleep, where a higher number of seizures is known to occur) are in fact bypassed??

Thanks in advance for any help.

Jen,

That happens to me a lot at night. I'll wake up gasping for breath or my legs or feet will feel like I've kicked the wall. I seem to have always had nocturnal seizures. Other times I don't that I know of as I'll wake myself up but I'll go back to sleep. I've noticed if I can get cold that does the trick and I can go to back or to sleep then.

 

[Nakamova]

In a small study that looked at insomnia and epilepsy, people with epilepsy reported much higher rates of moderate to severe insomnia than the general population. Interestingly enough, insomnia and poor quality sleep did not correlate with worse seizure control (though it did correlate with lower overall quality of life).

Jen, it might be enlightening to have a sleep study done to see exactly how much time you are spending in each phase of NREM and REM sleep. Perhaps the restless sleep means that when you do finally hit REM sleep (however brief the phase), you get there much more quickly — abbreviating the more seizure-prone phases, or bypassing them altogether (as occurs in narcolepsy).

Another factor may be the [still poorly-understood] connection between seizures and circadian rhythms. Seizures are affected by modulations in circadian rhythms, and this modulation varies with the particular epilepsy syndrome as well as location of seizure foci. (see http://www.sciencedirect.com/science/article/pii/S1059131112000866). In addition to sleep timing, circadian rhythms include things like body temperature and hormone secretion. Current speculation is that circadian rhythms may be an even more important factor in seizure occurrence than any specific effect of the sleep-wake cycle itself. So perhaps there is something about your individual rhythms (it could even be metabolism of your meds) that is positively affected (in terms of seizure control) by your restless sleep, at least on a relatively short-term basis.

 

[masterjen]

I do in fact have an ambulatory EEG booked for August, for which I will also be able to provide video (at the epileptologist's request I've been visually recording my sleep for the past 3-4 months). The stereotyped nature of the episodes points to seizures as opposed to parasomnia, he suspects, but is interested to see if any abnormal brainwaves occur during an event since standard/non-sleep EEGs have all been normal. I had a one-night sleep study done, and while I didn't sleep well in a foreign environment at least it was enough to rule out things like apnea, PLMD, restless legs, etc.

Thanks for the link, Nakamova. So determination of sleep stage can be picked up from an EEG as well. This I did not know - as you say, this could prove very helpful!

 

[C0urt]

I am extremely prone to nocturnal seizures, stress makes mine worse, i am more likely to wake up somewhere else. or a overly full bladder.