12 Dec 2025
Waking up to discover you've had a seizure during the night can be frightening not just for you, but for your loved ones too. If you're living with epilepsy, you've likely worried about what happens when you're asleep and unable to call for help. Perhaps you're a parent lying awake, listening for sounds from your child's bedroom, or a partner wondering if you'd know if something went wrong.
The relationship between epilepsy and sleep is more complex than many people realise. Sleep doesn't just provide a backdrop for seizures to occur, it actively influences seizure patterns, and seizures can significantly disrupt sleep quality.
Understanding Nocturnal Seizures: Why Sleep Matters
Around 10-15% of people with epilepsy experience seizures exclusively or predominantly during sleep, a condition known as nocturnal epilepsy. According to Epilepsy Action UK, certain seizure types. particularly frontal lobe seizures and generalised tonic-clonic seizures, are more likely to occur during specific sleep stages.
The Sleep-Seizure Connection
Your brain doesn't simply "switch off" when you sleep. It cycles through distinct stages, each with different electrical activity patterns:
Non-REM sleep stages 1-2: Light sleep where seizures can emerge or go unnoticed
Non-REM stage 3 (deep sleep): When many nocturnal seizures occur, particularly in the first third of the night
REM sleep: Generally protective against most seizure types, though some exceptions exist
Sleep deprivation significantly lowers seizure threshold. Missing just one night's sleep can trigger seizures in people whose epilepsy is otherwise well-controlled. The NHS emphasises that maintaining consistent sleep patterns is one of the most effective non-medication strategies for seizure management.
Recognising the Signs: Did You Have a Seizure While Sleeping?
Unlike daytime seizures, nocturnal seizures often leave only indirect evidence. Watch for these warning signs:
Waking with a bitten tongue or cheek
Unexplained bruises or injuries
Bedding or pillows on the floor
Unusual muscle soreness or headache upon waking
Extreme fatigue despite adequate time in bed
Confusion or disorientation in the morning
Urinary incontinence during the night
Objects knocked off bedside tables
If you're experiencing these symptoms regularly, speak with your neurologist. Adjusting medication timing or dosage may help, and having a clear seizure action plan in place becomes even more critical. Click here to download a fillable template and share it with your loved ones.
Creating a Safer Sleep Environment: Practical Safety Measures
The good news? Many nocturnal seizure risks can be significantly reduced with straightforward bedroom modifications.
Essential Bedroom Safety Modifications
Bed positioning and height
Place your bed away from radiators, sharp-cornered furniture, and windows. A low-platform bed or mattress on the floor minimises fall risk. If you prefer a standard bed, ensure there's clear space around it.
Bedding choices:
Avoid heavy duvets that could cause overheating (a known seizure trigger) or potentially restrict breathing. Remove decorative pillows that serve no purpose. Consider a single firm pillow to reduce suffocation risk whilst maintaining comfort.
Floor safety:
Install thick carpet, foam tiles, or large rugs beside the bed to cushion potential falls. Remove clutter, electrical cords, and small furniture that could cause injury.
Furniture considerations:
Secure or remove freestanding wardrobes, mirrors, and shelving units that could topple. Use corner guards on sharp furniture edges near the bed.
Temperature and Environment
Overheating can lower seizure threshold. The Epilepsy Society recommends:
Keeping bedroom temperature between 16-18°C
Using breathable, natural-fibre bedding
Avoiding electric blankets if possible
Ensuring good ventilation
Should You Sleep Alone?
This deeply personal decision depends on seizure frequency, seizure type, and individual circumstances.
Benefits of sharing a room: Someone present can provide immediate assistance, call for emergency help if needed, and offer reassurance. For children with epilepsy, many parents feel more comfortable sleeping in the same room or using a baby monitor. However, this can take a real tole on caregivers sleep quality, so be aware of this.
When solo sleeping might work: If seizures are well-controlled, brief, and don't involve injury risk, sleeping alone with appropriate safety measures and monitoring may be perfectly safe.
Whatever you choose, ensure someone knows your situation and can check on you, and always have a clear seizure first aid protocol in place.
The SUDEP Risk: Understanding and Reducing Danger
Sudden Unexpected Death in Epilepsy (SUDEP) remains the most serious risk associated with nocturnal seizures, though it's important to note it's rare, affecting roughly 1 in 1,000 people with epilepsy annually.
Most SUDEP deaths occur during or shortly after nocturnal seizures, particularly generalised tonic-clonic seizures. Risk factors include:
Frequent generalised tonic-clonic seizures (more than 3 per year)
Poor seizure control
Not taking epilepsy medication as prescribed
Sleeping alone without monitoring
Young adults (ages 20-40) are at slightly higher risk
Reducing SUDEP Risk
The National Institute for Health and Care Excellence (NICE) recommends:
Take medication exactly as prescribed: This is the single most important protective factor
Aim for the best possible seizure control: Work closely with your neurologist to find the most effective treatment
Avoid known seizure triggers: Including sleep deprivation, alcohol, missed medications, and stress
Consider monitoring solutions: Especially if you have frequent nocturnal tonic-clonic seizures
Sleep positioning: Some evidence suggests sleeping on your side (recovery position) may be safer than sleeping prone (face-down)
Don't let SUDEP statistics create paralyzing anxiety, but do let them motivate practical safety measures. Most people with epilepsy live full, normal lifespans with appropriate management.
Special Considerations: Children with Nocturnal Epilepsy
Parents of children with epilepsy face unique nighttime concerns. Balancing safety with your child's need for independence and your own need for rest requires thoughtful planning.
Age-Appropriate Safety Strategies
Young children (under 8): Consider room-sharing or using reliable monitoring technology. Safety-proof the room thoroughly, use a low bed or mattress on floor, and maintain a consistent bedtime routine that your child finds calming.
Older children and teenagers: Involve them in safety planning to build ownership and compliance. Discuss the purpose of safety measures openly. As they mature, gradually increase independence whilst maintaining appropriate monitoring.
Sleepovers and independence: These important social experiences needn't be off-limits. Speak with other parents beforehand about your child's epilepsy, provide written seizure first aid instructions, and ensure your child has emergency contact information. Consider whether monitoring technology could provide peace of mind whilst enabling these experiences.
Frequently Asked Questions
Should I set alarms to wake me up during the night?
No. Fragmenting your sleep can actually increase seizure risk by causing sleep deprivation. Focus instead on quality sleep and appropriate monitoring systems.
Is it safe to use an electric blanket if I have epilepsy?
Electric blankets can cause overheating, which may trigger seizures in some people. If you do use one, set it on a timer to switch off before you fall asleep rather than running all night.
How can I tell if my child had a seizure while sleeping?
Look for indirect signs: disheveled bedding, unusual tiredness, bitten tongue, muscle soreness, or confusion upon waking. However, new monitoring technologies can provide definitive answers and more reassurance.
Will my epilepsy medication stop nocturnal seizures?
Medication can significantly reduce nocturnal seizure frequency, but timing matters. Some people benefit from taking their evening dose closer to bedtime. Always discuss timing optimization with your healthcare provider.
This article provides general information about epilepsy and sleep safety. It should not replace personalised medical advice from your neurologist or epilepsy specialist nurse. If you have specific concerns about nocturnal seizures, please consult your healthcare provider.
