Medical Edge Newspaper Column

Treating Two Conditions That Disturb Sleep

Jan. 29, 2007
Dear Mayo Clinic:
Please tell me what you know about sleep apnea and epilepsy. My 22-year-old son has been diagnosed with apnea and has had lifelong epilepsy. CPAP is not working out so far, but we are still trying to get it going. He's not obese but is sedentary. -- Athens, Ohio

Answer:
Because epileptic seizures frequently occur during sleep, they can rouse the patient and may result in daytime sleepiness. Over time, doctors usually discover the best choice of medications (from the many anti-seizure drugs available) to prevent seizures in most patients. For certain types of seizures, surgical treatment may be the most effective option. It is not clear what type of epilepsy your son has. If his condition is uncontrolled, consulting with a neurologist who specializes in epilepsy management is recommended, if you have not already done so.

Obstructive sleep apnea is a common condition that can affect patients of any age. While it is most common in overweight people, it can also occur in those who are normal weight or thin. In obstructive sleep apnea, the throat sucks shut numerous times during sleep, resulting in frequent arousals, often without the patient even being aware of waking. Sleep apnea can make seizures more difficult to control for two reasons. First, the many awakenings during the night cause sleep deprivation, and this lack of sleep may increase the frequency of seizures. Second, severe sleep apnea may result in low oxygen levels, which can also lead to seizures at night in patients with epilepsy.

Thus it is important for patients with poorly controlled epilepsy to get sleep apnea treated. Continuous positive airway pressure (CPAP), whereby a machine delivers pressurized air through a mask placed over the nose, is the treatment of choice for moderate or severe sleep apnea. There are a number of reasons why your son may be having trouble adapting to CPAP, including nasal congestion, mouth dryness, or a mask that is not the right fit for him. These practical issues are usually fixable at a sleep center through such measures as adding a humidifier or changing the way the air is administered.

For some patients with milder sleep apnea, the objective of CPAP -- to keep the upper-airway passages open -- may be achieved instead by wearing a dental appliance at night that moves the jaw forward. Conservative approaches such as weight loss (even a modest amount), keeping the nose decongested, and sleeping on one's side or stomach may also be sufficient in such cases. Surgery on the throat or jaw is also a possibility. Your son should explore these options with a sleep medicine specialist in an accredited sleep center or laboratory.

--Michael H. Silber, M.B., Ch.B., Neurology and Sleep Medicine, Mayo Clinic, Rochester, Minn.