Epilepsy affects approximately 0.5-1 percent of the population. It is a disease characterized by involuntary movements or seizures. Although numerous drugs have been introduced to treat epilepsy over the last few decades, almost one-third of those living with epilepsy do not benefit from these drugs. So, there is a need to find treatment strategies that are safe, affordable, and effective for epileptic patients.
Obstructive sleep apnea is a common sleep disorder that causes the disruption in normal sleep patterns. Various studies have indicated that sleep apnea is much more common among those living with epilepsy. According to numerous studies, it is estimated that one-third of more than half of those living with epilepsy have moderate to serious sleep apnea.
It is well known that just any sleep disorder would lead to changes in the excitability of brain cells. In healthy individuals, living without epilepsy, these changes would be felt as headaches, sleepiness during the day, and difficulty in concentration. While in those with epilepsy, sleep disturbances would increase the risk of seizures. Also, sleep deprivation is also known to increase sympathetic activities and change the hormonal balance, all of them can have an adverse effect on a person living with epilepsy.
Though it seems logical that if sleep alters the excitability of brain cells, it may also worsen the symptoms of epilepsy, however, researchers did not pay much attention to this relationship until recently.
Once it was realized that something simple like a lack of good quality sleep might be related to poor treatment outcomes in a large number of patients, researchers started to carry out clinical trials to understand the link between the quality of sleep and epilepsy. According to the latest recommendation of American Epilepsy Society, everyone living with epilepsy must be checked for sleep disorders including insomnia and sleep apnea.
Unlike other common ailments, obstructive sleep apnea is rarely, if ever, treated with medications. One of the most common and effective treatment methods is the use of a CPAP (continuous positive airway pressure) machine. A CPAP involves giving air under continuous pressure with the help of a small device, and the person being treated has to wear a mask while sleeping.
CPAP has been proven to help with sleep apnea, though adherence with CPAP is a huge problem because not everyone would like to wear a mask while sleeping. Since a CPAP helps in improving symptoms of sleep apnea, researchers decided to check its effects on epilepsy patients.
Although many studies have been done earlier to find out the beneficial effects of improved quality of sleep on seizure controls in epilepsy, most of the prior studies were done in a very small number of subjects. This means that, despite the encouraging results, these studies did not have any practical value for the clinicians.
Recently a study was published that had a larger sample size than earlier reports of a similar nature. Outcomes of the study were discussed in the American Epilepsy Society (AES) 71st Annual Meeting 2017. In the study, 197 adults living with epilepsy were observed for the presence of obstructive sleep apnea.
The study found that out of 197 patients with epilepsy, 62 percent had obstructive sleep apnea, and out of these, 60 percent received the CPAP therapy. Treated and untreated groups were of almost the same age group.
Apart from CPAP therapy, participants on treatment for sleep apnea were also taught about the benefits of weight loss, regular exercise, giving up alcohol or other centrally depressant agents, and advantages of improving sleep positions.
During the trial, special attention was given to any changes in drug therapy that may interfere with the results of the clinical trial. The study continued for the period of one year, and researchers found that those being treated for sleep apnea with CPAP benefited greatly.
Sixty percent of the patients receiving CPAP treatment reported a 50 percent or more drop in the number of seizures when compared to the pre-CPAP days, which was considerably better than the 14 percent drop rate in those who did not receive CPAP therapy. Further, the data analysis demonstrated that 85 percent of those on CPAP had success in controlling their seizures with treatment as compared to a mere 55 percent of those who did not receive CPAP therapy.
Clinicians and those living with epilepsy must also understand that the benefits of a CPAP are not limited to the decreasing frequency of seizures. A CPAP also improves other symptoms, like morning headaches, and it reduces the risk of developing depression, and it enhances the level of concentrations.
Most epilepsy specialists agreed that these results are highly encouraging, and the benefits offered by treatment of obstructive sleep apnea are substantial. However, they also noticed that the reported study was not a random clinical trial.
The random clinical trial is typically considered as a gold-standard in clinical research. Although this trial has been informative, it cannot be accepted as conclusive. There is still a need for more extensive, randomized clinical trials to confirm the benefits of a CPAP therapy of sleep apnea in epilepsy.
Nonetheless, this trial has laid the foundation for future studies. Results of this trial have been too encouraging to neglect. Moreover, these results were consistent with earlier findings and recommendations.
In conclusion, one can say that improving the quality of sleep may help to reduce the seizures in those living with epilepsy. Improving the quality of sleep would also better the response to the medications. Sleep apnea should be considered in every case of epilepsy, and anyone living with epilepsy must go through a polysomnography or sleep study.
- One-Third Of Epilepsy Patients Found To Have Sleep Apnea. ScienceDaily. https://www.sciencedaily.com/releases/2000/10/001012074517.htm. Accessed March 10, 2018.
- Anderson P. Treating Sleep Apnea in Epilepsy Reduces Seizures. Medscape. http://www.medscape.com/viewarticle/889551. Published December 4, 2017. Accessed March 10, 2018.
- Malow BA, Foldvary-Schaefer N, Vaughn BV, et al. Treating obstructive sleep apnea in adults with epilepsy. Neurology. 2008;71(8):572-577. doi:10.1212/01.wnl.0000323927.13250.54