Chapter 7 – Sleep and Epilepsy

The mutual relationship between epilepsy and sleep has been studied extensively. Seizures often follow a circadian pattern. In some patients, seizures are strictly nocturnal, while in others they can be diurnal or both. Frontal lobe seizures have a predilection for occurring during sleep. Seizures are exacerbated by sleep deprivation, which can increase cortical excitability. Obstructive sleep apnea is very common in patients with epilepsy, and its treatment with positive airway pressure can markedly improve seizure control. Interictal epileptiform discharges detected by electroencephalography also are affected by the sleep–wake cycle, sleep deprivation, and treatment of obstructive sleep apnea. Understanding the interactions between epilepsy and sleep is an important step toward optimal treatment of patients with epilepsy.