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Can we “hack” sleep to improve epilepsy in children?

Dr Samantha Chan

Dr Samantha Chan

Paediatric Neurologist & Clinical Research Fellow

- UCL Great Ormond Street Institute of Child Health

Date Published: September 28, 2022

Author: James Matejka

Childhood is a crucial time in the development of the brain and its functions, and sleep is when much of this development happens. However, research suggests that poor sleep in childhood (due to epilepsy or other reasons) can delay this progress. Dr Samantha Chan at the Great Ormond Street Institute of Child Health is studying the relationship between epilepsy, sleep, and brain function in children. Here, Samantha discusses this work, and how sleep could be “hacked” as a  strategy to improve brain function in children with epilepsy.

Ancient history: Sleep and epilepsy

The relationship between sleep and epilepsy has been observed since ancient times. Aristotle (in On Sleep and Sleeplessness c.350 BC) wrote of epilepsy: “the beginning of this malady takes place with many during sleep, and their subsequent habitual seizures occur in sleep, not in waking hours”. Yet, fast forward a couple of millennia and clinicians have only gotten as far as manipulating sleep to provoke seizures – such as in sleep or sleep deprived EEGs. But what if we could ‘hack’ sleep to improve the lives of people with epilepsy?

The future: Modifying sleep to help people with epilepsy

The study of sleep through EEG has provided insight into brain activity during what actually isn’t a dormant state at all. Whilst we slumber, our brains are busy re-processing the experiences and facts we have taken in during waking hours, writing some of this information into longer term storage. This process is essential for learning and memory, but also restores the capacity of neurons to make new connections the following day. In addition, the length and depth of sleep is tightly regulated – our brains adjust this according to need.

I have studied these processes using EEG polysomnography (where the subject is hooked up to breathing and heart monitors as well as EEG) and cognitive (memory and IQ) testing in children with epilepsy and in healthy children, and shown that in many children with epilepsy, memory still benefits from sleep. Further computerised analysis of the sleep EEG data suggests that a disconnect between sleep need and sleep recovery may be linked to seizures occurring over the next 1-4 days.

Both these discoveries open the possibility of sleep hacking – by boosting naturally occurring sleep brainwaves – to improve learning and decrease seizures in children with epilepsy. One way of doing this is through pulses of sound applied at a particular phase (a point in the waves’ cycle) of brainwaves to make them stronger. I am currently working with researchers from the University of Exeter to investigate the possible consequences of this method of sleep hacking, using a mathematical model.

For now: Getting a good night’s sleep

It will take collaboration with scientists from many fields in order to make sleep hacking a reality. For now, there is good evidence that maintaining a healthy sleep schedule and habits (“sleep hygiene”) is beneficial for seizure control. The good news is that all the practical measures and medical treatments that work in children without epilepsy also work in children with epilepsy, including those with learning difficulties. So, no screens in the hour before bedtime, open the shades (or preferably go outdoors) in the morning; wind down before bedtime – recapping the day’s events and new facts to aid future recall.