Epilepsy and Sleep Apnea: Could Better Breathing Mean Fewer Seizures?

Better breathing during sleep may mean fewer seizures for some people with epilepsy. About one in three people with epilepsy has sleep apnea. Studies have found that those who treat it with CPAP tend to have better seizure control than those who do not.¹ These studies are mostly small and observational. So treating sleep apnea is a possible addition to seizure care, not a replacement for it.

What is sleep apnea, and how common is it in epilepsy?

Obstructive sleep apnea (OSA) is a condition in which the throat narrows or closes many times during sleep. Breathing pauses or becomes shallow, and oxygen can dip. The brain briefly wakes to restart breathing.

Doctors measure it with a sleep study. The main result is the AHI (apnea-hypopnea index). This is the average number of breathing pauses or shallow breaths per hour of sleep.

A review that pooled many studies found that about 33% of people with epilepsy had sleep apnea. People with epilepsy were more than twice as likely to have it as healthy comparison groups. Men were more likely to have it than women.¹ The rate did not seem to differ by seizure type. It also did not differ by how many seizure medicines a person took.¹

Why might sleep apnea affect seizures?

Sleep apnea breaks sleep into pieces many times a night. Researchers think this broken sleep may make the brain more prone to seizures. In one small study, CPAP improved oxygen levels and reduced brief awakenings from sleep.⁴

Between seizures, many people with epilepsy have brief abnormal electrical bursts, often called spikes. These show up on an EEG (brain-wave test). In a study of 9 adults with epilepsy and sleep apnea, CPAP lowered these spikes. Spike rates fell by a median of about 78% during a night on CPAP compared with a night without it.⁴

This supports the idea that broken sleep matters. Fewer spikes do not always mean fewer seizures. But this finding fits with the other studies.

Does treating sleep apnea reduce seizures?

Several studies point in a hopeful direction. CPAP (continuous positive airway pressure) is the most common treatment for sleep apnea. A small bedside machine and a mask gently blow air to keep the airway open during sleep.

• Pooled review — People with epilepsy whose sleep apnea was treated with CPAP had much better seizure control than those who were not treated.¹
• Cleveland Clinic study — This study followed 132 adults with epilepsy for a year. Among those with sleep apnea, 74% of people using positive airway pressure had their seizures cut by half or more. Only 14% of people with untreated sleep apnea did as well.²
• Boston study — This study looked at 41 adults whose seizure medicines did not change during CPAP treatment. In regular CPAP users, seizures fell from about 1.8 to 1 a month. In those who did not use it regularly, seizures did not change much. Sixteen of 28 regular users were seizure-free, compared with 3 of 13 non-users.³

How strong is the evidence?

The findings are consistent, but the studies have limits. Most looked back at medical records or followed small groups. People were not randomly assigned to CPAP or no CPAP.²³ People who use CPAP regularly may differ in other ways. For example, they may follow their overall care more closely. The Boston researchers called for larger forward-looking studies to confirm their results.³

For now, the best reading is this. If you have epilepsy and sleep apnea, treating your sleep apnea may help your seizure control. Do not stop or change seizure medicines on your own. Sleep apnea treatment works alongside them.

How Universal Sleep Solutions can help

At Universal Sleep Solutions we offer in-lab and home sleep testing to look for sleep apnea. If you have it, we set up CPAP or BiPAP. We follow up to help you use it comfortably every night.

Using CPAP regularly matters. In the studies above, the benefits were seen in people who used it consistently.³ For people who cannot use CPAP, we can discuss other options. These include an oral appliance referral or an evaluation for Inspire.

When should you get evaluated?

Ask your neurologist or a sleep specialist about a sleep study if you have epilepsy and:

• Snoring or gasping — You snore loudly, or someone has noticed you gasp or stop breathing in sleep
• Daytime sleepiness — You feel tired or sleepy during the day even after a full night in bed
• Hard-to-control seizures — Your seizures remain hard to control despite medicines

Sleep apnea is very common in people with epilepsy. So testing is a reasonable step, especially when seizures are not well controlled.¹