Seizures And Sleep Apnea, Revisited

July 28, 2010

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.

17 Responses to “Seizures And Sleep Apnea, Revisited”

  1. Paula Martin on November 26th, 2010 7:21 am

    I absolutely think (undiagnosed) sleep apnea triggers my husband’s unexplained seizures.

  2. Myles Callan on November 28th, 2010 2:45 pm

    Given that the association between seizure frequency and sleep apnea has been known since the early 80s (where one doctor treated a patient with sleep apnea, giving him a tracheotomy, which also stopped his seizures) and that the link between sleep and seizures has been assumed since the time of Hippocrates (literally, he wrote a book on the topic), it would appear that not testing a patient for sleep apnea (especially in the case of late onset epilepsy), or at the very least inquiring about the possibility, is irresponsible.

    When I first started having seizures (which were in my sleep), my wife suggested that it could be to do with the fact that I “gasp” in my sleep. The doctors (3 different neurologists) ruled it out – one of them because I was “not fat enough” for sleep apnea. At the time, I was unaware of all of the published research on the relationship. It was very frustrating (to say the least) to find out that my wife’s diagnosis trumped that of 3 different neurologists. After years on anti-epileptic medication (which was hell), and another few years on CPAP (which cannot be considered a long term solution), I had MMA. I have been seizure-free, with no medication, for close to 3 years (initially my seizures were one every six months, which increased to once a month, and maxed out at two in one week – all grand mal, all in my sleep).

    Why ignore the evidence? Every patient with late-onset epilepsy should be questioned about their sleeping habits and possible snoring/gasping.

    Dr Beth Malow at Vanderbilt U is undertaking a randomized controlled experiment to determine whether there is any placebo effect due to the CPAP. I am confident that she will conclusively prove the relationship – which will help to avoid other people having to have inane conversations with neurologists about the difference between “evidence” and “proof.”

  3. Steven Park, MD on November 28th, 2010 7:36 pm

    Mr. CAllan,

    Thanks for your candid response. Granted, not all seizures are caused by sleep apnea, but even if it’s 25% or 50%, it would make sense to at least screen for it. Questionnaires can help to find some sleep apnea, but you can be completely asymptomatic, not snore and be thin and still have significant sleep apnea. A home test is a simple procedure that any doctor can order.

    You can also have significant numbers of breathing pauses at night and not have any apnea. Something to think about.

  4. Bryant T. on February 8th, 2011 3:20 am

    I believe they should. when i was 8 i could remember shaking a lot in my sleep and now i look back and realize i was probably having a seizure. I never had a seizure awake until the age of 10, i had a seizure in church and i was hospitalized for a few hours. In the ninth grade i had problems sleeping, i would wake up in the middle of the night with my heart racing and i had no idea why. My uncle heard me sleep and recorded my snoring so that i could hear how loud it was, when i heard it i didn’t believe that was me. the problem plagued me for a while so i eventually went for a sleep study. The results showed i had sleep apnea, a couple of months later i started using a cpap and noticed i slept much better and had more energy. Currently i haven’t been able to use my cpap because i get stuffed up at night. Although i had my adenoids removed and a turbinate reduction im still stuffy. But back to the topic i believe that anyone that has had siezure shold get tested for OSA and the people who have OSA should be aware that their at risk for a seizure.

  5. Steven Park on June 11th, 2011 10:26 am

    You may want to consider undergoing CPAP titration first to see if your possible siezure activity still remains while on an optimal pressure. Good luck!

  6. Debbi on January 8th, 2012 3:22 pm

    I believe the same. My fiance’ has unexplained seizures. No neurological concerns from any of the tests. It was automatic put on medication and anyone has refused to look further as a matter of fact because the seizures still occur they increased his mg and the seizures are closer together. He suffers from sleep apnea. I have to move him to get him to breathe. This will be something I will be looking into further. Your article makes sense.

  7. Sleep Deprivation | Treatments for Sleep Deprived | Sleep Deprivation Cures and RemediesSleep Deprivation on March 26th, 2012 6:06 pm

    [...] the removal of any obstructing uvula, can be performed. Add your own answer in the comments! Question by Julia: How do i cope with an epileptic who has sleep apnea? My partner was recently dia…oint, I'm too scared to sleep. Considering he had his seizures in his sleep and he always stops [...]

  8. HBMom on April 24th, 2012 7:26 pm

    I know this is a blog for human health issues, but my pug has really bad sleep apnea and just started having seizures the last year or so. They are always while he is sleeping and they stop as soon as I can get him to wake up and start breathing again. The blanket denial of any correlation between apnea and seizures is frustrating. Even vets are unlikely to correlate the two. And why can’t they be related? Doesn’t apnea cause a lack of oxygen to the brain? Can not seizures be caused by a lack of oxygen to the brain? Anyone else see the commonality here? Evidently everyone but doctors who would rather pump us all full of chemicals than actually reveal an underlying cause and treat that instead of the symptom!!!!

  9. cmagee on August 30th, 2012 4:31 am

    I believe my seizures were caused by sleep apnea. I am 31 yrs old and had my first grand-mal seizure in feb of this year. I have had every test you could think of and they all come back normal. I had a second one at the end of march. Just after the second one i demanded that my doctor do the home sleeping test. My husband said i “breath funny”. As i had every other test i wanted to see if 1: i did indeed have sleep apnea and 2: if the lack of oxygen to the brain could be a cause for my seizures. Turns out i do have mild sleep apnea, I stop breathing only 7-10 times a night, but my oxygen levels drop down to 80% and sometimes lower. I now have a cpap machine and am on carbomazipine for my seizures. I have had no problems since march. What are the chances that all other tests came out normal except the sleep test? I have had this breathing problem all my life, after 30 years of my oxygen levels dropping, it only seems natural that some sort of problem would arise from it.

  10. William Carroll on August 30th, 2012 1:42 pm

    I have had epilepsy all my life but this is mostly under control during daytime hours
    I am at present taking 14 tablets a day for the epilepsy . A few years ago i was told
    i had apnea and was given a cpap machine wich has helped but not stoped the
    problems i have with sleeping . During the night i still take seizures wich i cannot
    help feeling are linked to the apnea as they leave me more confused than before
    and sometimes i am unable to put a sentence together for half an hour . This never
    happened when i was younger and before i had apnea . This situation is very
    frightening exhausting and alarming . I do hope someone can find an answer

  11. Kelly Bellringer on October 12th, 2012 3:59 pm

    I am a Physician with sleep apnea. Recently at age 68 I had my first grand mal seizure. I have had several head injuries – mostly mild (falling off a horse) but one serious (automoblie accident) – I also learned that my CPAP machine has not been working well for quite some time. Both of my doctors think that this is all related but it is clearly complicated. i have also apparently had “absence” seizures for a few years (since the car accident). So it is all somehow connected but I amnot sure exactly how. I hope this wil be helpful to others.

  12. Debra A on October 17th, 2012 11:20 pm

    Interesting reading all this. I turn 50 in January. Had my 1st grand mal seizure about 2 years ago. Rushed to the hospital, had all the tests–no diagnosis. After having a seizure every month or so, sometimes twice in a night, and reading online, I have self diagnosed this as OSA. So I use a dental device, sleep on my back and stay alert at night, with my husband’s help and can usually avoid seizure attacks. Medication is out of the question. I drink alkaline water all day, take high quality vits and eat healthy organic vegs and fruits mostly. Have been seizure free for 8 weeks now.

  13. Roy Ijams on November 8th, 2012 2:23 pm

    born in feb 1961. Never sleep walked before using cpap I was put on in feb 2012.
    6/8/12 I sleepwalked out of a semi like it was parked while wife was driving 60mph. Got concussion 3 frac ribs frac pelvic crushed rt wrist and road rash. After healing I started using cpap again in August 2012. Found I could be compliant with min 4 hrs usage for Truck driving. I was working may way up to using cpap all nite. 10/1/12 I felt disoriented that morning. I laid down without cpap to clear my head. About 5min’s later I had a seizure which lasted about 40min’s. You I can’t drive for a year after a seizure. No job no health ins. Some side effects I have found hypoxia,air embolism, bloating, change in skin color. You probably know side effects. And enormous amount of money being made from this industry. 1 case of fraud. 50 investors took for 4 million to build sleep centers. CPAP destroyed my life and was told 11/8/12 I’m to high a risk to rehire. Can’t find many post like mine. Maybe they are being deleted and passed of as other health problems. Even web site to donate cpap’s to people that need them.
    Because so many people don’t use the equipment.

  14. gina Johnson on May 30th, 2013 9:24 pm

    Yes! I as well believe seizures can develop from a sleep apnea problem. My son is 9 years old. Very recently, he had all the symptoms of a grand mal seizure upon awaking. Research is telling me that becsuse his CT, MRI, BLOOD WORK, AND EKG all concluded normal, that this must be apnea related. There has been past instances where he walks and talks in his sleep and he snores heavily. He has always had to sleep with his head propped up with a fan blowing directly on him for comfort. We go tuesday to childrens hospital seizure center for an EEG and consult with specialist. I will definately be requesting a sleep study be preformed. Thank you all for your info and comments here as it has helped me prove my therory

  15. Gina Johnson on May 30th, 2013 9:54 pm

    Yes! i definately feel sleep apnea can cause seizures after our experience! I have a 9 year old son that talks in his sleep, walks in his sleep, snores, and always sleeps with his head propped up with a fan blowing directly on him all seasons of the year. Recently, I caught him seizing during his normal waking school hours. His symptoms were all those included in a grand mal seizure. His CT, MRI, blood work, and EKG all came back normal. We have an appointment tuesday with childrens seizure specialist for an EEG with imediate consultation following. I will be requesting a sleep study be our next step! Thank you all so much for this blog as it has helped me prove my thoughts about it over the last couple weeks.

  16. Evan McAndrews on July 31st, 2013 5:13 pm

    During my birth, my breathing was cut off momentarily, though not enough to have any immediate effects, I don’t think. At six years old, I had a seizure during my sleep, sometime in the early or mid-morning, around 6 or 7am from what I was told. I went on some medication following the event, and, after a year of no activity, was taken off of them.

    I have had trouble breathing through my mouth for the majority of my life, and it wasn’t until I was about fifteen years old that I was informed of certain treatments, though I never followed through on receiving any of them. It was when I was twenty-two and a half years old, in 2005, that I had my first seizure since when I was six. Since then, I have been experiencing clusters (always clusters) of seizures ranging in gaps of, at the shortest, six weeks apart, to, at the longest, three months apart. They almost solely occur, or begin, in the morning, either just before or just after I wake up.

    More and more I have been having trouble, and in certain cases feel like I’m in a struggle to, get a good night’s rest. I wake up 2-3 times a night to urinate, which I feel is directly related to my medications, which by common name are Kepra, Lamictal, and Vimpat, and their common effect of dehydrating the body of it’s water more quickly. Thus, I have to drink even more water and, further, urinate more. I have been told of my heavy snoring at night, and sometimes I find myself waking up at the last moment of a strong gasp for air. Both of these, I have been told or figured out on my own, are common signs of sleep apnea.

    I’m more than ready to lower the mg amounts of my medications, my first priority being the Lamictal, which can be related to insomnia and sleep disturbance.

    I am scheduled for a sleep study at the end of this month, and I hope something good will come of it. After eight years of surface searching, quick conclusions, made by my family, mostly, and too much dependence on my doctor to look more deeply, I am ready to look for myself.

  17. Wa;t Dibert on August 1st, 2013 8:26 pm

    I have seizures in my sleep. Had my first at 56, was rushed to the hospital. All the tests can back normal. Was put on drugs by the neurologist, they all made me feel weird. I had a seizure while on one of the drugs so, we decided to stop the drugs. One of the doctors ordered a sleep study. I went to the sleep lab and started a sleep study, I had only been there a short time and they came in a put me on a cpap machine. I have OSA and still struggle with night time seizures. My dear wife took a T-shirt and made a pocket in the middle of the back and put a tennis ball in it to keep me from sleeping on my back. Last night, I removed the tennis ball because I was tired of it. At 3:00 a.m. I had a seizure while on my back. My wife heard me and tried to wake me. I don’t know if not sleeping on my back helps or not, but right now I’m trying the T-shirt with the tennis ball and of course, I faithfully use my cpap.
    I continue to search the internet for any new ideas or any new research.

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