Epilepsy Awareness Month: What is nocturnal epilepsy? Why is it difficult to identify?

Hyderabad: November is Epilepsy Awareness Month. It is a time when public conversations often centre on stigma, diagnosis, and treatment.

Neurologists, however, say one area consistently overlooked, even within medical discussions, is nocturnal epilepsy, where seizures occur primarily or exclusively during sleep. Families describe it as the “most unpredictable” form because it disrupts the one activity considered universal and restorative: sleep.

Speaking to NewsMeter, Dr. Raghav Menon, senior neurologist, says, “Night-time seizures are underreported, undertreated, and misunderstood. Many patients do not know they are having seizures because they are asleep when it happen.”

What makes nocturnal seizures difficult to identify?

Unlike daytime convulsions, nocturnal seizures often have subtle signs: rhythmic movements, choking sounds, sudden awakenings, bed-wetting, or confusion upon waking.

Dr. Menon notes, “People often attribute nighttime events to bad dreams, anxiety, sleepwalking, or tiredness. By the time they come to us, they may have had years of undetected seizures.”

Sleep disorders like parasomnias or REM behaviour disorder can also mask seizure activity. A correct diagnosis usually requires a detailed sleep history, overnight EEG monitoring, and sometimes home-based video recordings.

The impact: physical, cognitive, emotional

Neurologists emphasise that the effects of nocturnal seizures extend far beyond night-time.

1. Sleep disruption & daytime fatigue

Patients often experience what families describe as “unexplained exhaustion.”

Dr. Sana Qadri, consultant neurophysician, explains, “Even if the seizure lasts less than a minute, the resulting sleep fragmentation can cause profound daytime fatigue and impact work or school performance.”

2. Memory & concentration issues

Repeated sleep interruptions affect cognitive functioning, especially in children and adolescents.

3. Fear of sleeping alone

Many families install CCTV cameras, baby monitors, or wearable trackers. Parents of young patients frequently sleep in the same room well into their teenage years. Adults, too, report anxiety around staying in hotels, travelling alone, or sharing rooms with colleagues.

Safety risks during nighttime Seizures

Nocturnal seizures pose unique risks due to the unsupervised environment.

According to Dr. Qadri, “The biggest challenge is that the patient is unconscious and usually alone. Injuries are more common in the bedroom, hitting furniture, falling off the bed, or choking on saliva.”

Common risks include:

• Striking bedside objects

• Breathing irregularities

• Tongue biting

• Post-seizure confusion leading to unsafe wandering

• Rare cases of Sudden Unexpected Death in Epilepsy (SUDEP)

Experts emphasise that SUDEP risk is reduced with consistent medication, proper sleep, and seizure monitoring.

How families change the way they sleep

Across households, routines evolve once nocturnal seizures are identified.

• Bedroom layouts are altered, sharp edges removed, low-height beds used, soft surfaces added.

• Alarms and sensors such as bed-shake devices or motion alerts are installed.

• Shared sleeping arrangements become common in the early months of diagnosis.

• Families often track sleep cycles, stress levels, and medication timings more closely at night than during the day.

A parent interviewed at a support programme in Hyderabad shared, “We live with a sense of vigilance. Night-time is quieter, but our worry is louder.”

Why are nighttime seizures more common?

Nocturnal seizures occur because the brain’s electrical patterns change during sleep. Transitions between sleep stages, especially light sleep and deep sleep, can trigger abnormal electrical discharges.

Dr. Menon explains, “Sleep is not a uniform state. Several micro-transitions occur, and these transitions can be fertile ground for seizure activity.”

People with certain epilepsy syndromes (like frontal lobe epilepsy or benign epilepsy with centrotemporal spikes) are more prone to nighttime events.

Diagnosis: Why do many patients go years without knowing

Even with modern tools, nocturnal epilepsy remains underdiagnosed.

• Family members may not witness the seizures.

• Patients often have no memory of the episode.

• Symptoms overlap with sleep disorders.

Dr. Qadri says, “We depend heavily on patient videos. Smartphones have become one of the most important diagnostic tools today.”

In some cases, neurologists recommend sleep labs or long-term ambulatory EEG for accurate assessment.

Managing Nocturnal Epilepsy: What Helps

1. Medication adjustments

Doctors may time anti-seizure medication closer to bedtime or change dosage patterns.

2. Sleep hygiene

Lack of sleep is a well-known seizure trigger. Patients are advised to maintain consistent bedtimes and avoid sleep deprivation.

3. Safety protocols

Simple changes, like placing the bed against a wall or using padded rails, can reduce injuries.

4. Technology aids

Wearable seizure detectors, mattress motion sensors, and audio-alert devices are increasingly used.

Dr. Menon, however, cautions, “Technology helps, but it does not replace medical treatment or supervision.”

The emotional landscape: “the night feels longer.”

Patients frequently describe night-time seizures as emotionally overwhelming. The fear is two-fold:

• Fear of having a seizure

• Fear of not knowing it happened

A 29-year-old patient from Hyderabad said during a support group meeting,

“You wake up and your body aches. You know something happened, but you did not witness it. That uncertainty is difficult.”

Caregivers add that their sense of hypervigilance grows at night, making them light sleepers and contributing to long-term stress.

Why this topic needs more attention during awareness month

Public conversations around epilepsy rarely focus on how the condition reshapes ordinary life, especially sleep. Neurologists believe acknowledging nocturnal epilepsy is central to improving safety, diagnosis, and support systems.

Dr. Qadri concludes, If families recognise the signs early, treatment outcomes are much better. Awareness can change how people sleep, but more importantly, it can change how they live.”