Nocturnal Seizures

What is a nocturnal seizure?

Nocturnal seizures cause abnormal movements while you sleep. You may also hear the terms nighttime seizures or sleep seizures. Nocturnal seizures typically happen shortly after you fall asleep or right before you wake up.

Sleep seizures can happen at night or even during daytime naps. Because you’re asleep when they happen, you might not know you’re having a seizure. A bed partner is often the first to notice unusual movements or behaviors.

You may notice other signs that suggest a nocturnal seizure, such as:

• Not feeling rested after a full night’s rest
• Urinating in bed
• Biting your tongue in your sleep

The Level 4 Epilepsy Center at Massachusetts General Hospital provides the highest level of epilepsy care available. Our team provides advanced neurodiagnostic monitoring, along with comprehensive medical, neuropsychological, and psychosocial treatment for even the most complex cases. We also offer full evaluations for epilepsy surgery, including intracranial monitoring and specialized surgical procedures that are not widely available at other institutions.

The Pediatric Epilepsy Program at Mass General Brigham for Children provides advanced diagnostic tests and treatments for epilepsy conditions that cause sleep seizures in children.

Are nocturnal seizures dangerous?

While nocturnal seizures may seem less disruptive because they happen during sleep, they can carry serious risks.

One rare but serious concern is sudden unexpected death in epilepsy (SUDEP). SUDEP occurs when someone with epilepsy who is otherwise healthy dies for no apparent reason. SUDEP often occurs during sleep — and having nocturnal seizures may increase the risk.

Fortunately, SUDEP is not a common occurrence – about with epilepsy die from SUDEP every year. And regular follow-up care with your team and proper seizure management can help reduce the risk. Call the Epilepsy Center at 617-726-3311 to schedule an appointment.

In addition, seizures while sleeping can affect sleep quality, leading to daytime fatigue, memory issues, or difficulty concentrating. You can take steps to sleep better.

Symptoms of nocturnal seizures

Nocturnal seizures can go unnoticed since they happen when you’re asleep, especially if you sleep alone. You may not remember anything unusual, but certain signs can suggest that seizures are happening at night.

Common symptoms of nocturnal seizures include:

• Feeling fatigued or drowsy despite a full night’s rest
• Jerking body movements or thrashing around
• Peeing the bed
• Screaming or shouting in your sleep
• Sore tongue from biting it during a seizure
• Stiffening of arms or legs
• Waking suddenly for no apparent reason

Learn more about seizure warning signs.

What causes night seizures?

Different types of focal epilepsies cause nocturnal seizures. Focal epilepsies cause seizures that start in a specific part of the brain. They typically begin in early childhood.

Sleep-related hypermotor epilepsy (SHE) is the most common cause of nocturnal seizures. It’s also called nocturnal frontal lobe epilepsy because the seizures start in the brain’s frontal lobe, which is the part responsible for movement, behavior, and decision-making. People with SHE may experience several nocturnal seizures while they sleep.

Risk factors for nocturnal seizures

Other conditions that increase the risk for nocturnal seizures include:

• Brain infections, such as meningitis or encephalitis
• Brain injury or concussion
• Brain tumor
• Lack of oxygen to the brain (cerebral hypoxia)
• Stroke
• Family history of nocturnal seizures

Learn more about epilepsy symptoms, diagnosis, and treatments from a Mass General Brigham epilepsy specialist.

Diagnosis of nocturnal seizures

If you or your child has nocturnal seizure symptoms, a doctor may order an electroencephalogram (EEG). This test detects changes in the brain’s electrical activity that cause different types of seizures.

Because nocturnal seizures happen during sleep, the EEG test is often done as part of a sleep study. Sleep studies monitor brain activity overnight. You may participate in an at-home sleep study or spend the night at a sleep study lab.

Treatment of nocturnal seizures

Managing nocturnal seizures starts with or other neurological condition. In many cases, seizure medications can reduce or prevent seizures during sleep.

Medications for nocturnal seizures include:

• Oxcarbazepine
• Carbamazepine
• Lamotrigine
• Clobazam
• Diazepam nasal spray
• Diazepam rectal gel
• Midazolam nasal spray

Safe sleep practices for nocturnal seizures

If you or your child has sleep seizures, these steps can help prevent injury:

• Place the mattress on the floor or use a low bed frame to reduce the chance of falling.
• Keep nightstands, furniture, lamps and other items away from the bed to prevent bumping into them during a seizure.
• Sleep on your side or back (not the stomach) to lower the risk of SUDEP.

FAQs about nocturnal seizures