Seizures And Sleep Apnea, Revisited

I just came across an article in the NY Times that described a condition called SUDEP (sudden unexplained death in epilepsy), where people with seizures can die in their sleep. It’s throughout to be due to loss of protective reflexes and possibly obstruction. This article brought back memories of the time I was on my neurosurgery rotation and a young woman with seizures just died in her sleep. It was a very emotional and distressing situation for everyone involved, especially when I had to tell the family about what happened. In retrospect, she probably died of SUDEP, and come to think of it, I vividly remember that she had a very narrow face.

What I found interesting was the fact that when it happens, people are usually found lying on their stomachs. References were made to SIDS (sudden infant death syndrome) and its’ many similarities. Unfortunately, it goes on to describe the typical genetic causes for this condition, without exploring the upper airway issue at all.

If you Google sleep apnea and seizures, you’ll see tons of papers and references showing a highly significant association between these two conditions. Just to review, here’s my take on this link:

Seizures are thought to develop when abnormal connections form between nerve endings in your brain, leading to a short of “short circuit.” Many of the medications that are used to control seizures essentially calm or lessen the excitability of the brain’s nerve cells. Even the newer vagal nerve stimulation technique works by enhancing the parasympathetic nervous system (which controls the vagus nerve). Anything that helps to calm or relax your nervous system can also help to prevent seizures.

Not too surprisingly, numerous recent studies have shown that untreated obstructive sleep apnea can cause brain damage in a variety of different ways, including multiple mini-strokes, major strokes, decreased brain tissue density, decreased brain volume, diminished brain functioning, and diminished reflexes. All these effects were found to occur in critical areas of of the brain, such as areas that control memory and cognition, executive functioning, breathing, autonomic nervous system control and motor movements.

I’ve also noticed that every patient that I see that has a seizure diagnosis has very narrowed upper airway anatomy, and usually can’t sleep on their backs. More often than not, parents of people who have seizures often snore heavily and likely have untreated obstructive sleep apnea. We also know that untreated obstructive sleep apnea can significantly lower your seizure thresholds, making you more susceptible to experiencing attacks.

What all this implies is that if you have an underlying sleep-breathing problem, whether or not you have obstructive sleep apnea, you’re going to be more prone to various degrees of brain disfunction and miswiring.

What do you think about my theory? Should all epilepsy patients get screened for obstructive sleep apnea? I’d like to hear your opinion.

Please note: I reserve the right to delete comments that are offensive or off-topic.

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52 thoughts on “Seizures And Sleep Apnea, Revisited

  1. I read your article I have been having an increase in my seizures recently followed by headaches. I have sleep apnea but I am afraid to use a mask since I an active sleeper and I afraid that the mask would not stay on in my sleep

  2. Look up normal breathing. Breathing exercises can help.. I had seizure after cpap use. Have found a site that air force used a mouth piece many years ago. . Billions are made from this sleep business. . If you’d let me know which of my posts you have read I can better respond. I have plenty of time to send you links to some of what I’ve found. Charts for underwater diving. Chart that show cpap testing above 5k ft isn’t reliable. . Side effects like bluish skin, damage to lungs that can’t be found unless looked for, eyes hurting and fraud in studies. I no longer use cpap. Another note in breathing as I understand it you need to completely exhale to get rid of toxins in body. Cpap doesn’t let you do that. When you breath in about 10 seconds and hold your breath for about 10 seconds then exhale for 10 seconds it allows for that exchange of toxins. . Just doing this for 3 min’s can change your health. If that is to long for you just do what is comfortable. I’m now on disability do to being on seizure meds. Lost our house and my driving job. My wife and I had 4 million safe driving miles before I was put on cpap. 2/7/12.