individuals over the age of 65 (4). Given the high prevalence of both conditions in the elderly population, coexistence is frequently likely. This section discusses the inter-relationship between epilepsy and sleep apnea (more information on sleep apnea and epilepsy can be found in Chapter 22).

Occurrence of epileptiform discharges is significantly influenced by the sleep-wake cycle and stages of sleep. Generalized epileptiform discharges are more frequent during non-rapid eye movement (NREM) sleep than during REM sleep or the awake state (5) and also increase gradually with deepening of NREM sleep (6). On the other hand, REM sleep is associated with a focalization of interic-tal discharges with restriction of the electrical field (7). Transitional sleep states, for example, sleep onset, sleep stage changes, and arousals may also be epilepto-genic in susceptible individuals (8). More recently, the concept of cyclic alternating patterns (CAPs) further supports the observation that transitional CAPs activate epileptiform discharges (9).

During NREM sleep, virtually every cell in the brain discharges synchronously, which facilitates the spread of seizure discharges. In contrast, during wakefulness and REM sleep the brain cells discharge asynchronously and the divergent synaptic signals are less conducive for propagation of epileptic discharges. Also in REM sleep, there is tonic reduction in the interhemispheric transmission through the corpus callosum limiting the spread of epileptic discharges. REM deprivation may thus exacerbate epilepsy. It is well documented that sleep deprivation precipitates generalized epileptic seizures and particularly increases the epileptiform discharges in the sleep-wake transition state (10). Epileptic discharges may alter sleep regulation and cause sleep disruption, thus triggering seizures in turn.

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