**7. Sleep deprivation**

Sleep deprivation is one of the most potent triggers of epileptic seizures and epileptiform discharges in patients with generalized epilepsy, triggering seizures in up to 25% of patients suffering from epilepsy [61].

Back in the 1960s and 1970s a series of articles suggested that sleep deprivation was a facilitator of interictal epileptiform discharges, and therefore a promoter of seizures. Lack of adequate sleep causes dysregulation of the hypothalamic pituitary function with release of stress hormones such a cortisol and noradrenaline, which leads to worsening of seizure control [62]. In a recent study, more than 97% of patients with epilepsy reported at least one factor that provokes seizures, and the top three were sleep deprivation, stress, and fatigue [61]. In many cases alcohol consumption was also a common trigger.

Sleep deprivation is often used in epilepsy monitoring units to increase the frequency of seizures. In addition, interictal epileptiform discharges are also more apparent after sleep deprivation.

Environmental factors and sleep hygiene are also crucial in the control of seizures. Appropriate noise level, light intensity, surrounding temperature, humidity, and type of bed are needed for a comfortable sleep. Another important issue is sleep hygiene. Certain behaviors and practices interfere with normal nocturnal sleep. They include time of going to sleep, consumption of food and drinks before sleep, watching TV, working on the computer, using the phone, reading, or physical activity before sleep.

Sleep deprivation is the most common trigger for awakening seizures seen in juvenile myoclonic epilepsy.
