Sleep Apnea & Epilepsy

Professor Terry O’Brien… Royal Melbourne Hospital says there has been some evidence from other studies that patients with epilepsy may have an increased incidence of sleep-disordered breathing…

Doctors recruited 87 patients with epilepsy and monitored them in a sleep unit. They found 25 per cent had significant sleep-disordered breathing that was severe enough to require treatment…

Thirty-six-year-old Daniel Goldstein had always had strange sleeping habits, which included rocking back and forth during the night while he slept. Eventually, he was diagnosed with epilepsy but it was hard to stop seizures…

Since being treated for sleep apnoea, Mr Goldstein has also been able to reduce his epilepsy medications. Mr Goldstein was also given a CPAP machine which he says helps him soundly throughout the night.

[Extract] Sophie Scott. (2 Jun 2013). Doctors find key link between epilepsy and obstructive sleep apnoea. [accessed 24 Jun 2018]

Lifestyle changes

For milder cases of obstructive sleep apnea, your doctor may recommend lifestyle changes:

  • Lose weight if you’re overweight.
  • Exercise regularly.
  • Drink alcohol moderately, if at all, and don’t drink several hours before bedtime.
  • Quit smoking.
  • Use a nasal decongestant or allergy medications.
  • Don’t sleep on your back…



  • Mouthpiece (oral device). Though positive airway pressure is often an effective treatment, oral appliances are an alternative for some people with mild or moderate obstructive sleep apnea. These devices may reduce your sleepiness and improve your quality of life.

    These devices are designed to keep your throat open. Some devices keep your airway open by bringing your jaw forward, which can sometimes relieve snoring and obstructive sleep apnea. Other devices hold your tongue in a different position.

    If you and your doctor decide to explore this option, you’ll need to see a dentist experienced in dental sleep medicine appliances for the fitting and follow-up therapy. A number of devices are available. Close follow-up is needed to ensure successful treatment.


Surgery or other Procedures

Surgery is usually considered only if other therapies haven’t been effective or haven’t been appropriate options for you. Surgical options may include:

  • Surgical removal of tissue. Uvulopalatopharyngoplasty (UPPP) is a procedure in which your doctor removes tissue from the back of your mouth and top of your throat. Your tonsils and adenoids may be removed as well. UPPP usually is performed in a hospital and requires a general anesthetic.

    Doctors sometimes remove tissue from the back of the throat with a laser (laser-assisted uvulopalatoplasty) or with radiofrequency energy (radiofrequency ablation) to treat snoring. These procedures don’t treat obstructive sleep apnea, but they may reduce snoring.

Lifestyle and home remedies

In many cases, self-care may be the most appropriate way for you to deal with obstructive sleep apnea…

  • Keep your nasal passages open while you sleep. If you have congestion, use a saline nasal spray to help keep your nasal passages open. Talk to your doctor about using nasal decongestants or antihistamines, because some medications may only be recommended for short-term use.

[Extract] Mayo Clinic Staff. (no date, accessed 24 Jun 2018). Obstructive sleep apnea. Mayo Foundation for Medical Education and Research (MFMER).



Memory weakness and epilepsy

William Barr, PhD, ABPP. Reviewed By: Joseph I. Sirven, MD (March 19, 2014). Types of Memory Problems. Epilepsy Foundation of America.

  • “Problems of attention and encoding” – information fails to become memory
  • “Problems of storage” – retention
  • “Problems of retrieval” – recall

Irene Elliott, RN, MHSc, ACNP and Janice Mulligan, MSW, RSW. How Epilepsy Affects Learning. (2/4/2010). AboutKidsHealth, The Hospital for Sick Children. Canada.

memory: a child may study a topic many times, but not remember it the next day


Diet and Epilepsy

Modified Atkins Diet

Modified Atkins Diet Can Cut Epileptic Seizures in Adults. (28 Jan 2008). Johns Hopkins Medicine. [Bold words my addition]

In 2002, Johns Hopkins researchers began testing a modified version of the Atkins diet in children with epilepsy… modified diet… high-fat focus of the ketogenic diet, prompting the body to generate ketones… allows more carbohydrates and protein, doesn’t limit fluids and calories, and has no fasting period… began testing it for efficacy and ease of use in adults.

30 adults with epilepsy, ages 18 to 53 years, who had tried at least two anticonvulsant drugs without success and had an average of 10 seizures per week, were placed on the modified Atkins diet… restricted them to 15 grams of carbohydrates a day. “… a few strawberries, some vegetables, or a bit of bread,”… most of its calories from fat-eggs, meats, oils and heavy cream-with as much protein and no-carb beverages…

…about half the patients had experienced a 50 percent reduction in the frequency of their seizures by the first clinic visit. About a third of the patients halved the frequency of seizures by three months. Side effects linked with the diet, such as a rise in cholesterol or triglycerides, were mild. A third of the patients dropped out by the third month, unable to comply with the restrictions… diet won’t be a good fit for all patients


Katie Barwick, Senior Paediatric Dietitian, Mater Health Services, Mater Children’s Hospital. (Nov 2011). The Modified Atkins Diet. Epilepsy Queensland Inc.

…high-fat diet… for difficult to treat seizures. Heavy cream, butter and vegetable oils provide the necessary fat… allows all protein rich foods… meat, chicken, eggs and fish. It completely eliminates sweets… lollies, biscuits and desserts… carbohydrate rich foods… bread, potatoes, rice, pasta and cereals are not allowed in the first month… may be introduced later.

Children and teenagers with uncontrolled seizures may be helped by the diet.

Medications may act stronger with the Modified Atkins Diet therefore close medical monitoring is necessary.

The diet is generally used for a period of 2 years… If the diet is not helpful, it will be stopped within a few months.

Most children do not develop high cholesterol levels while on the diet. If a child develops high cholesterol or lipids, the diet can be modified to lower these.

This diet should not be started without medical and dietetic supervision.

See also:

David C. Spencer. (2017). Navigating Life with Epilepsy. New York. Oxford University Press. [Diet Therapy]

Other medications/remedies – Epilepsy

This post is linked to an earlier medication resource/research on epilepsy (Singaporean source).

Here we focus on 2 medicines – Carbamazepine (earlier generation) and Levetiracetam (newer generation). The intent is to analyse/compare potential side/adverse effects.  Where similar side effects are found, I have listed them in BOLD. The side effects of each drug are displayed through 4 columns with the title of each source at the top rows. The sources differ on the frequency of the side effects as well. Bear in mind that dispensing medication is a complex decision process. At times it takes monotherapy (medical treatment using a single drug/therapy), the other approach is polytherapy (two drugs or more).

There are related resources at the end of this post.

Should you wish to explore further, please consult a qualified medical profession.

Some brands for Carbamazepine (United States):

  • Carbatrol®
  • Epitol®
  • Equetro®
  • Tegretol®
  • Tegretol®-XR
  • Teril® Suspension

Some brands for Levetiracetam (New Zealand and/or United States):

  • Everet®
  • Keppra®
  • Levetiracetam (Rex)®
  • Levetiracetam-AFT®
Health Navigator New Zealand   Medline Plus (US National Library of Medicine)   Understanding Epilepsy (UK)   Navigating Life with Epilepsy (US)
Last reviewed – 20 Dec 2017


  Last Revised – 15 May 2017   Published 2009   Published 2017
Feeling sleepy/drowsy/tired,

Feeling dizzy/faint,

Problems with your eyesight – blurred vision/ seeing double,

Feeling sick (nausea),

Stomach upset,


Low mood, suicidal thoughts — thoughts of harming yourself,

Easy bruising/ looking pale/ getting sick often,

Allergic reactions such as skin rash, hives, itches, swelling of the face, mouth or lips, trouble breathing.









Memory problems,




Dry mouth,

Back pain,


Loss of contact with reality,

Chest pain,

Yellowing of the skin or eyes,

Vision problems,

“mental health may change in unexpected ways and you may become suicidal”,

Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).

Double vision,





Gastro- intestinal disturbances,

Appetite deficiency,

Reduced white blood cell count,

Lowered blood sodium levels,

Hepatic (liver) disturbances,

Depression and psychological impacts,

Decreased libido,

Other cardiac and neurological impacts.

Reduced blood sodium levels (Tegretol),

Reduced white blood cell count (Tegretol),

Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN),

Double vision,


Trouble with balance,




_______________ _______________ ______________ _______________ _______________
Health Navigator New Zealand   Medline Plus (US National Library of Medicine)   Understanding Epilepsy (UK)   Navigating Life with Epilepsy (US)
Last reviewed – 21 Dec 2017


Last Revised – 15 Apr 2016 Published 2009


Published 2017


Feeling sleepy/


Feeling dizzy,


Feeling sick (nausea),

Stomach upset,

Suicidal thoughts/ anxiety/ depression,

Allergic reactions such as skin rash, itches, hives.


Unsteady walking,

Loss of balance or coordination,



Loss of appetite,



Being   constipated,

Excessive sleepiness,

Joint pain,

Neck pain,

Double vision,

Seizures that are worse or different than the seizures you had before,

Fever/sore throat/signs of infection,


Blisters on skin,



Swollen face/tongue, “mental health may change in unexpected ways and you may become suicidal”.





Psychosis (delusions/ hallucinations),







Gastro- intestinal disturbances,

Tremor (shaking/ trembling),

Visual disturbances,



Weight adjustments.






Libido issues,




Main sources:

  1. Levetiracetam.
  2. Carbamazepine.
  3. Carbamazepine.
  4. Levetiracetam.
  5. Matthew Walker & Simon Shorvon. (2009). Understanding Epilepsy. Poole, Dorset. Family Doctor Publications.
  6. David C. Spencer. (2017). Navigating Life with Epilepsy. New York. Oxford University Press.

Other references:

Mayo Clinic. Mayo Foundation for Medical Education and Research. See Medicine information.

Ketogenic Diet. (last reviewed 11 Jan 2014). Cleveland Clinic.

Epilepsy – First Aid

Some of the information is from my first hand experience. But each patient is different. As a passerby or caregiver, you have to make the judgment call based on your knowledge and the circumstances.

Some suggested precautions and reaction procedures

  • If the person stays at your home, surround his/her sleeping area (especially near the head, and if possible the floor) with cushioning; remove sharp/hard or any dangerous objects from the room if possible
  • When a seizure occurs, do not restrain the person (advice from Singapore Civil Defence Force personnel, Singapore Epilepsy Foundation, Cleveland Clinic PDF poster in 2009) – the patient may struggle even more violently when restricted; you may then hurt yourself in the process
  • The patient may be confused/disoriented for hours or days after the seizure episode, so be watchful of the person and supervise (and limit his/her activities) accordingly
  • Call the emergency services if the seizure
    • lasts more than 5 minutes (Singapore Epilepsy Foundation, Cleveland Clinic PDF poster in 2009, Epilepsy Society UK in Sep 2015)
    • ‘repeats without full recovery’ or reoccurs within 24 hours
    • it is their first seizure

Related information:

Approximately 20,000 (information from Flag Day image) are afflicted with epilepsy in Singapore (Epilepsy Care Group, Singapore). A post on their book resource is found here.

Causes of the condition is unclear and varied. There is no certainty that it would run in the family. The Singapore Epilepsy Foundation records that ‘in 70% of all cases, there is no known cause.’ The Khoo Teck Puat-National University Children’s Medical Institute (KTP-NUCMI) in Singapore, states that for roughly 50% of the cases: ‘no specific cause can be identified’. Some possibilities opined by the Singapore Epilepsy Foundation,  KTP-NUCMI, and National Healthcare Services, UK include:


  • Severe head injury/trauma
  • Infections that damage the brain (meningitis or encephalitis)
  • Toxic substances that affect the brain (plausibly from drug or alcohol abuse)
  • Brain tumor and stroke
  • Hereditary disease affecting the brain (e.g. tuberous sclerosis)
  • High Fever
  • Lack of oxygen to the brain
  • Metabolism or nutrition imbalance
  • abnormalities in genes regulating nerve excitability in the brain
  • events or complications to a foetus prior to/at delivery

Epilepsy (Singapore): Case Studies and Medications

Choong Chew Thye, Michael Chee Wei Liang, Diana Koh Hwee Hoon, Sherman Goh Keng Hwee (Editors).(2013). Seizures in the city: a collection of writings on epilepsy. Singapore. Candid Creation Publishing for Epilepsy Care Group.

Perhaps the old me would have gone through the book like a train. But these are not just writings. These are peoples’ lives…

This post is split into two parts, it opens with treatment then it follows with a few life experiences.


Professor Michael Chee Wei Liang at the time of writing was a neuroscientist (with the Duke-NUS Graduate Medical School) and was a former clinician (active medical doctor). He wrote the chapter on the development of epilepsy care. I shall focus on the medications specifically coined – anticonvulsants.

In Professor Chee’s analysis, an approximate 50% of epilepsy sufferers have well controlled epilepsy via medication. (With further research elsewhere or reading through the book, some undergo surgery as remedy.) To side track, some ‘psychogenic seizures’ may appear to be epilepsy but they are not so. (I do recall I hearing about this back when I attended a talk during my healthcare sector days.) Thus, this presents greater challenges for correct and accurate diagnosis.

[Do note that the year now is 2017. Things may have changed. Further, it is critical to seek qualified medical advice on the issue. If needed, seek a second or even a third opinion. The medication list below is not exhaustive. I have selectively highlighted some side effects and put them in italics. The trade/brand name of the drugs on the market most likely differ from the names provided.]

There are two groups categorised by age. The prior/elder generation of drugs include:

  • Phenytoin
  • Sodium Valproate
  • Phenobarbitone (risks of inducing sleepiness/has sedative effects)

The more recent/younger group comprise:

  • Lamotrigine (rashes)
  • Topiramate (cognitive decline in areas like word finding; falling weight)
  • Gabapentin (limited side effects but not very useful)

Resident Accounts and related issues

Tony Loh Kia Hiang – seizures hit him at age 35 (complicated by sleep apnea if my memory serves me right).

Fan Yew Meng – left store with unpaid merchandise: ‘did not have clarity of mind’; charged with theft and acquitted.

Tan Pek Ann – seizures from age 7 post severe fever; was able to get married; supportive work environment with colleagues who know ‘what simple steps should be taken when I have a seizure.’

Discrimination faced by some at work and in leisure because of their epileptic condition.

Epilepsy may intertwine with depression given the (potential) job losses; sense of helplessness; and relationship rejection. The flow on risk is suicide. Hence, carers and families or friends need to take precautions as required.