Seizures that happen during sleep are called nocturnal seizures. For some people with epilepsy, seizures occur only at night — during sleep, while falling asleep, or while waking up. Studies suggest this pattern affects up to 15 percent of people with epilepsy.

Nocturnal seizures may have similar symptoms to parasomnias, which are unpleasant or undesirable behaviors that only happen during sleep. These similarities can include sleep terrors and sleepwalking. Doctors can usually distinguish between sleep disorders and nocturnal seizures by taking a detailed medical and family history in addition to medical testing.

This article discusses what you need to know about nighttime seizures, including why they happen, what they look like, and how they’re treated.

What Seizures Are Common at Night?

While nocturnal seizures can happen with any type of seizure disorder, some types of epilepsy are more likely to cause seizures during sleep. Knowing your epilepsy type can help you and your doctor understand when seizures may happen and how to lower your risk.

Juvenile Myoclonic Epilepsy

Juvenile myoclonic epilepsy, also called Janz syndrome, is a seizure disorder that often begins during the teenage years. It usually causes quick jerking movements in the neck, shoulders, and upper arms. These jerks often happen soon after waking up. Because juvenile myoclonic seizures are so brief, they may be missed or mistaken for clumsiness or tics. Some people with juvenile myoclonic epilepsy may also have tonic-clonic seizures.

Awakening Tonic-Clonic Seizures

Tonic-clonic seizures (sometimes called grand mal seizures) cause whole-body muscle contractions and a loss of consciousness. They are a common type of generalized seizure disorder. These seizures typically last from one to three minutes. Any seizure lasting longer than five minutes can be a medical emergency. Some people worry about whether seizures can cause long-term harm to the brain.

Self-Limited Epilepsy With Centrotemporal Spikes

Self-limited epilepsy with centrotemporal spikes (SeLECTS) is a childhood epilepsy. It used to be called benign rolandic epilepsy, named after the rolandic area of the brain, which controls movement. When SeLECTS happens during sleep, it typically causes face twitching and can progress into a tonic-clonic seizure. These seizures may also happen during daytime naps.

Landau-Kleffner Syndrome

Landau-Kleffner syndrome (LKS) causes seizures and difficulty with speech. When people with LKS have nocturnal seizures, they typically have focal onset aware seizures (seizures only affecting one part of the brain), but these seizures can also progress to tonic-clonic seizures.

Frontal Lobe Epilepsy

Frontal lobe epilepsy is a form of epilepsy that commonly happens during sleep. The seizures are usually brief and clustered (happening close together). Symptoms of frontal lobe seizures include uncontrolled muscle movement, such as jerky movements or rigid arms and legs.

Symptoms of Nocturnal Seizures

Even though a person may not notice them, nocturnal seizures can disrupt sleep. Sleep deprivation can lead to feelings of exhaustion and may even trigger more daytime seizure activity.

Nighttime seizure monitors can screen for excessive movement and alert you when they detect seizure symptoms.

If you live or sleep alone, you might not know if you’ve had nocturnal seizures, but you may wake up to clues that something happened during the night. These signs include:

• Bed-wetting
• Tongue biting
• A fall from bed
• Morning tiredness or confusion
• Unexplained bruises
• Trouble concentrating
• Sudden awakening
• Arm or leg stiffness
• Jerky movements
• Night sweats

As a MyEpilepsyTeam member said, “Typically, a nocturnal seizure happens shortly after I fall asleep, but there have been times when it has been midnight. I usually wake up after the seizure from being drenched in sweat.”

How Are Nocturnal Seizures Diagnosed?

If a neurologist suspects that you are having nocturnal seizures, they will usually perform a video electroencephalogram (EEG) with polysomnography (a combined brain wave test and sleep study). This test combines a sleep study and an EEG. These tests help the doctor monitor your brain activity and detect any abnormalities. An MRI scan may be needed to pinpoint where in the brain the seizures are happening.

Treatment and Safety With Nocturnal Seizures

Treatment options for people diagnosed with nocturnal seizures depend on several factors, including:

• Underlying conditions
• Type of seizure
• Severity of seizures
• Age
• Overall health
• Medical and family history

Anti-seizure medications (ASMs), sometimes called anti-epileptic drugs or anticonvulsants, are often very effective in reducing seizure activity. They may be prescribed to control both daytime and nocturnal seizures. In addition to ASMs, your doctor may also suggest lifestyle changes, such as:

• Following a modified Atkins, low-glycemic index, or ketogenic diet (high fat, low carbohydrate)
• Creating a consistent sleep schedule
• Avoiding what triggers your seizures, including lack of sleep
• Getting regular exercise
• Avoiding recreational drugs and alcohol

If medication or lifestyle changes don’t reduce seizures, epilepsy surgery may be an option. These may include:

• Inserting a vagus nerve stimulator under the skin of the chest to help lower seizure activity with electrical energy
• Removing or destroying the area of the brain causing seizures
• Placing a small device (neuromodulator) for deep-brain stimulation or responsive neurostimulation on the skull

Sudden Unexpected Death in Epilepsy

Because nocturnal seizures happen while you are sleeping, they may go undiagnosed. Undiagnosed seizures can be dangerous because they may lead to sudden unexpected death in epilepsy (SUDEP) if not treated and controlled properly.

People with frequent generalized tonic-clonic seizures, especially at night and without supervision, are at the highest risk for SUDEP.

SUDEP occurs in about 1 in 1,000 adults with epilepsy each year. People with frequent generalized tonic-clonic seizures, especially at night and without supervision, are at the highest risk for SUDEP.

Doctors believe that SUDEP is linked to body changes that may happen due to seizures and cause low blood oxygen levels, as well as heart problems.

Safety

Worrying about nocturnal seizures can be stressful for you and those close to you. It is important to talk with the people you spend time with to let them know what to do in the event of a seizure. A seizure action plan can often be helpful for these conversations. An action plan is a document that outlines what to do in case of an emergency, including seizure first aid.

Several nighttime seizure monitors can also screen for excessive movement and alert you when they detect seizure symptoms.

Other safety tips to avoid injury during nocturnal seizures include:

• Getting a low bed frame or putting the mattress on the floor
• Placing a mat next to the bed in case you fall
• Mounting bedroom lamps on the wall instead of placing them on a nightstand
• Moving furniture and other items away from the bed

Nocturnal seizures can affect sleep and daily life, especially if they go unnoticed. The good news is that with the right diagnosis and treatment plan, many people can reduce seizures and sleep more safely. If you or a loved one has new or worsening nighttime seizures, talk with your healthcare team. Together, you can review symptoms, adjust treatment if needed, and take steps to improve safety and peace of mind.

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