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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59 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.

  3. Hi I am 69 years old male and 12 months ago suffered a nocturnal seizure I was then later then diagnosed with sleep apnea. I have only had seizures when not wearing my cpac machine.On one occasion I wore my cpac machine all night then took itoff in the morning and dozed off again in bed then had a seizure.
    I believe that people with sleeping problems caused by sleep apnea and given sleeping tablets by their doctor can possibly die because if they will wake when they have a sleep apnea attack.
    Over the years I have woken up in the night feeling dizzy but thought it was food poisoning.This was mainly when I had done an overnight flight to the far east and very tired in the hotel after missing sleep on the plane.

  4. As an individual with epilepsy who has been recognized to snore, and has experienced nocturnal seizures, I believe that it is strongly advisable to screen individuals with epilepsy for sleep apnea if they have a history of nocturnal seizures, snoring or severe allergies/asthma. It is much less invasive than brain surgery and may be a more affective way of getting seizures controlled without impairing cognitive functioning.

  5. I have been having a few nocturnal seizures the past two yrs.. I also feel I have sleep apnea .. I constantly wake up maybe 10-20 times a night.. I have not had one in 6 months but I am finding it’s hard to breath in my sleep lately and it ties into my dreams, I also have been getting pretty forgetful and having brain farts quite often.. I do smoke pot but it has noticing gotten worse… I’m thinking bout getting a mask but as I said I wake up way too much.. I’m burning out….

  6. Do a sleep study! Get a mask! 7 nocturnal seizures in 7 years. The mask takes time to get used to, but if you havebobstructive sleep apnea, or have seizures due to lack of oxygen, this will help.

  7. Def have a sleep study! I have both obstructive and central sleep apnea. All of my prior seizures have been nocturnal. It did take trial and error to find a mask I liked, and it did take weeks to get used to it, but fewer morning headaches and no nocturnal seizures are wonderful!

  8. Chest X-rays may show an alveolar interstitial pattern in an irregular distribution with evidence of a moderate loss of volume from atelectasis, however there is no clinical way of diagnosing O2 toxicity. Lung biopsy specimens may show changes consistent with O2 toxicity but the primary value of the biopsy is to exclude other causes of lung injury. Air pressure changes within the enclosed lung cavity and ventilator-induced injury may accompany and be indistinguishable from O2 toxicity. Oxygen toxicity can be minimized by keeping the PAO2 less than 80 mm Hg or the FIO2 below 0.40 to 0.50 [12]. The pulmonary cellular response to hyperoxic exposure and increased ROS is well described. Anatomically, the pulmonary epithelial surface is vulnerable to a destructive inflammatory response. This inflammation damages the alveolar capillary barrier leading to impaired gas exchange and pulmonary edema. Reactive O2 species induces pulmonary cell secretion of chemoattractants, and cytokines stimulate macrophage and monocyte mobilization and accumulation into the lungs, leading to additional ROS. The ROS leukocyte interaction further exacerbates injury. Research has shown that as these highly reduced cell layers become increasingly oxidized and levels of antioxidants fall, ROS-induced activation of multiple upstream signal transduction pathways regulates the cellular response: adaptation, repair, or cell death by apoptosis, oncosis, or necrosis [28, 29]. Mitogen-activated protein kinase (MAPK), toll-like receptor 4 (TLR4), signal transducers and activators of transcription (STAT), and nuclear factor kappa beta (NF kβ) are a few well-researched protein pathways that communicate the receptor signal to the deoxyribonucleic acid (DNA) of the cell thereby determining the cellular response. The MAPK pathway is a regulator of cell death genes, stress, and transformation and growth regulation. Mitogen-activated protein kinase activation precedes extracellular signal regulated kinase (ERK1/2), a promoter of cell proliferation. C-Jun-terminal protein kinase (JNK1/2) and p38 kinase both induce cell death and inflammation [30]. The TLR4, STAT, and nuclear regulatory factor 2 (Nrf2) pathways are associated with survival gene expression such as caspase-3 proteins and antioxidant response element (ARE) [31, 32]. The NF kβ pathway is an up-stream signal for inflammation and survival genes: anti-oxidant enzymes (AOE), Bcl-2, AKT, heme oxygenase (HO-1), and heat shock proteins (HSPs). The AKT1-4 family of signals plays an important role in glucose metabolism, cell proliferation, apoptosis, transcription, and cell migration. The Bcl-2 proteins are antiapoptotic while HO-1 and HSPs are ubiquitous stress-response proteins [33]. These signaling pathways are regulators of the pulmonary epithelial cell response to increases in ROS and hyperoxia [18, 34]. Cytokine and chemokine overexpression in response to hyperoxic stress can be protective. Tumor necrosis factor alpha (TNFα), interleukin 1 beta (IL-1β), interleukin 6 (IL-6), chemokine receptor 2 (CXCR2), interleukin 11 (IL-11), insulin and keratinocyte growth factor expression, and the beta subunit of Na, K-ATPase have been shown to attenuate death signals [35–37].3. The Formation of Free RadicalsOxygen is a requirement for cellular respiration in the metabolism of glucose and the majority of O2 consumed by the mitochondria is utilized for adenosine triphosphate (ATP) generation [38, 39]. The mitochondrial electron transport chain reduces the elemental molecular O2 to ionic O2 by the relay of electrons making O2 usable for ATP generation, during this process, oxidizing free radicals are generated [40, 41]. Toxic levels of O2 lead to the formation of additional ROS, which can impose damage to lipid membranes, proteins, and nucleic acids. Reactive O2 species mediate physiological and pathophysiological roles within the body [42]. Free radicals are a type of unstable, reactive, short-lived chemical species that have one or more unpaired electrons and may possess a net charge or be neutral. The species is termed free because the unpaired electron in the outer orbit is free to interact with surrounding molecules [42, 43]. Cells generate free radicals, or ROS, by the reduction of molecular O2 to water (H2O) (Figure 1) [44, 45]. 260482.fig.001Figure 1: Reduction of oxygen. A single-electron transfer which converts molecular oxygen to the superoxide anion, creating an unstable molecule. The decomposition of hydrogen peroxide can be a source of the hydroxyl radical; this reaction requires both superoxide and hydrogen peroxide as precursors. These steps reduce oxygen to water by the addition of four electrons, yielding three reactive oxygen species: superoxide anion, hydrogen peroxide, and hydroxyl radical.Chemically, three types of reactions lead to the formation of ROS. The one-electron reduction of molecular O2 to the superoxide anion (
    ) is catalyzed by transition metals including iron (Fe) and copper (Cu) such as. And the effects denied go on. ONE seizure you lose your CDL for 10 years. AND have to be drug free and seizure free for 10 years before you can get CDL back. At present a can’t get a drivers license. While on CPAP I sleep walked out of a semi while my wife was driving 6/8/12. At present I do not use CPAP, don’t sleepwalk or have seizures. Required to use seizure meds for my insurance and Doctors to continue to see me. I’m on total disability now. We lost our home. And for awhile Nabors helped us when we didn’t even have food. Our daughter stayed with family to make sure she could eat. It would not hurt me as bad to miss a few meals… Sleep clinics make billions. My sleep is with out CPAP.