Guardian Angel Laurie & Angel Teddy
If your epi pup is agitated and either cannot seem to fall asleep easily or stay
asleep without waking up once or more during the night, you are not alone! This
problem is one that visits many epi-pup parents, and it should be taken
seriously, for at least two reasons:
1) Your pup needs his/her rest, and will be stressed out and more likely
to have seizures if he/she cannot sleep well;
2) YOU need your rest, and will be stressed out and incapable of giving your
pup the best care (not to mention be incapable of functioning in general) if you
keep having your sleep interrupted.
I became interested in this problem when our Teddy suffered extreme nighttime
agitation. My husband and I were up with Teddy 3-4 times every night, and both
of us were constantly sleep deprived. Clearly Teddy was having a miserable time
of it too.
MELATONIN helped Teddy a great deal, but did not entirely solve his
problem. For many pups, melatonin is an excellent first choice, not only because
it helps the pup to sleep, but also because, in some cases, it also decreases
the frequency and/or strength of seizures. This is what happened for Teddy:
he slept better and had fewer seizures and the ones he had were milder. For more
on melatonin, see:
After investigating nighttime agitation further, and putting all of the
following into effect with our Teddy, he began to sleep all night long and did
not wake us even once during the night. He also became seizure-free for two and
a half years, before he passed from liver cancer.
CONSIDER MEDICAL CAUSES:
Most of us are so taken up with treating our pup's seizure disorder that we tend
to blame it for everything. Many, if not most of our pups are immune-compromised
and this fact alone will contribute to their getting certain medical conditions
more frequently than non-epi pups (Levin 2002).
The first thing to consider, then, is that your pup may have a condition,
perhaps only marginally related to the seizure disorder, that needs veterinary
attention. The following list will help you observe your pup and discuss your
observations with your vet. Our Teddy was a rescue pup and came to us with both
ear infections and gum infections. Though these were treated by our vet, every
time they recurred he would once again have problems sleeping. Teddy also
experienced Dry Eye Syndrome, but his case was not advanced and did not disturb
1) EAR INFECTIONS. If your pup shows any of the following: rubbing his/her
head, pawing or scratching the ears, tipping the head to one side, pressing the
head into your hands, seems off-balance, seems warm to the touch, or has an odor
emitting from the ears, your pup may have an ear infection. Ear infections can
be very painful and often seem to get worse at night. If you have any suspicion
of an ear infection, take your pup to the vet.
2) TOOTH OR GUM INFECTIONS. Does your pup do any of the following: paw at
the mouth, tip the head, seem reluctant to chew, not want you near his/her face,
growl if you come near his/her head or face? If your pup will let you look in
his/her mouth, open the mouth and carefully prod the gums near the tooth line,
both outside and inside. Be careful! If there is pain, you may get bitten. Is
there tenderness? Look at the gum line: is there redness or swelling? Are the
teeth gummy with tartar? Is your pup's face sensitive to the touch? Some gum
infections are not visible to the untrained eye. If you have any suspicion of a
tooth or gum infection, take your pup to the vet.
3) EYE PROBLEMS. Epi-pups may be prone to Dry Eye Syndrome (reduced tear
production) and Uveitis (inflammation of the iris, ciliary body, or choroid)
(Levin 2002). One causes discomfort, the other pain. If you pup has "goopy eyes"
(green or light brown mucous discharge), blinks a lot, has redness in the whites
of the eyes, squints, rubs the face on the carpet or with the paws, you may be
dealing with an eye problem. Take your pup to the vet.
4) MAKE SURE YOUR PUP IS UP TO DATE ON BLOOD CHEMISTRY PANELS, BILE ACID TESTS,
AND BLOOD LEVEL CHECKS FOR ANY ANTI-EPILEPSY DRUGS (Pb, KBr, etc.) OR THYROID
MEDICATIONS (Soloxine, Thyroxin).
Both blood chemistry panels with the liver enzymes GGT, ALT and Alkaline
Phosphatase every 3 to 4 months and bile acid testing every 6 months are
necessary to insure that your pup's liver remains healthy if he/she is on Pb.
The Epi-Guardian Angels advise that you should have your pup tested with both
tests to catch liver disease early.
All AEDs (anti-epilepsy drugs) and thyroid medications need to be checked
regularly by your vet to make sure that they are at proper therapeutic levels,
neither too high nor too low, in the bloodstream. If the levels are too low,
your pup's agitation may in fact be pre-ictal behavior because he/she is about
to have a seizure.
Although agitation is not a regular side-effect of Pb or KBr when they are at
levels above therapeutic range, some pups may exhibit this, though it is not
confined to nighttime only. In addition, too-high levels of Soloxine and other
thyroid medications regularly cause agitation, but again this is not at night
only. Similarly, some pups who are treated for cluster seizures may react to
Valium with agitation, but this would occur only when the drug has been used.
NUTRITION FOR BETTER SLEEP:
In general, the healthier and more nutritious your pup's diet, the healthier
your pup will be, and the better he/she will sleep. The Epi-Guardian Angels
encourage home-prepared diets or the highest quality dog food, if you do not
have the time to prepare the diet at home. If your pup's digestion is not
compromised by a less than optimal diet, he/she will not experience a rise in
cortisol (the stress hormone) that can be caused by foods to which the pup is
allergic, or that are simply difficult to digest. The less stress, the less
cortisol. The less cortisol, the better the sleep. The following are other
nutritional considerations beyond providing a nutritious, easy-to-digest diet:
1) SNACKS TO SUSTAIN BLOOD SUGAR LEVELS
Some epis suffer from fluctuations in blood sugar and this may contribute to
agitation and, ultimately, to seizures. If you notice your pup pacing between
meals, or becoming otherwise agitated, small snacks throughout the day will help
to keep the blood sugar stable and keep pacing and agitation at bay. A 1/2 to a
whole meal right before bed works to calm nighttime agitation for many pups.
This should be a portion of the pup's regular food - something with high-quality
protein and carbohydrate to sustain your pup throughout the night. The amount of
protein should be lower than the amount of carbohydrate since protein
contributes to energy, carbohydrate to sedation. Do not eliminate protein,
however, because it helps sustain the blood sugar better than pure carbohydrate,
which can lead to a rapid decline in blood sugar after an initial rise.
2) DEFICIENCIES OF VARIOUS MINERALS AND VITAMINS CAN CONTRIBUTE TO INSOMNIA
Since epi-pups often show deficiencies of certain minerals and vitamins,
sometimes because of the use of AEDs that encourage depletion of these minerals
and vitamins through polydipsia and polyuria (excessive drinking and urination),
you may want to consider supplementation. The safest way to do this for minerals
(which must be carefully balanced for good health) is by adding whole foods to
your pup's diet (Levin 2002). It is NOT recommended that you give minerals as
pill supplements, at least without the guidance of a professional. Discuss any
program of supplementation first with your veterinarian.
Calcium, magnesium, manganese, potassium, and zinc are minerals whose deficiency
can contribute to insomnia and/or nervous irritability (Mindell 1979). All of
these can be safely supplemented by giving your pup pulverized (in a food
processor) raw green and green leafy vegetables. Dogs cannot digest vegetables
properly if they are given not pulverized. For best results, use a variety -
romaine lettuce, green beans, celery. Avoid too many in the "cabbage" family
(kale, collards, broccoli - anything that smells like cabbage - these in excess
can interfere with thyroid function). For acid/alkaline balance (crucial for
healthy bladders and urine), include a few root vegetables: carrots, turnips
(only occasionally), parsnips, etc. Zinc, which is most plentiful in spinach of
the green leafy vegetables, can also be found in broccoli, fish, meat, apples,
and peanut butter. Rotate combined vegetables to get the best all-around
B vitamins also aid in relaxation. Cortisol (the stress hormone) and AEDs are
known to lower tissue levels of B vitamins as well as vitamins C and E. B
vitamins are safely supplemented in pill form: for small dogs, use a
"regular" dosage B multiple; for medium dogs, use a "high potency B 50"
multiple; and for large dogs, use a "stress formula B 100" formulation (Dr.
Clemmons, 2002, cited in Levin, 2002). A small amount of organic beef or
chicken liver can also be given to supply B-vitamins. Since liver filters
toxins, it is best to use only organic or at least "naturally raised."
COMMON SENSE FOR GOOD SLEEP:
The Stanford University Sleep Research Center (est. 1970) has done sleep testing
on dogs and has discovered that dogs display many of the same sleep disorders as
humans. It stands to reason, then, that some of the factors that help humans
sleep better may help your pup. All of these have helped our Teddy immensely.
1) TURN LIGHTS LOW AS NIGHT PROGRESSES
Bright lights discourage melatonin production in the body, which can keep your
pup from falling asleep easily or staying asleep. Start turning lights down at
sundown, and if possible, keep them subdued throughout the evening.
2) DECREASE EXCITEMENT AND STRESS IN THE EVENING
Don't use nighttime hours to play with your pup, since even though this is
enjoyable, your pup will likely experience a rise in cortisol (the stress
hormone) that his/her compromised health cannot easily counteract. We noticed
that when we would play with Teddy during the evening, he could not calm himself
down like our other pups could easily do. Several hours later he would still be
very excited. Similarly, try to keep family interactions calm and relaxing
during evening hours. Keep voices low and avoid arguments to keep your pup from
feeling stress and experiencing a rise in cortisol, which counteracts melatonin
production and inhibits sleep. Music and TV should be kept at low volume. It is
best to avoid anything that sounds agitated or raucous since this can cause
stress to you pup, who cannot understand that this is not aimed at him/her.
3) PLAY SOFT, SOOTHING MUSIC AT BEDTIME
Soothing music, or any of the widely available "Sleep Soundly" type CDs were a
godsend for our Teddy. Every night we turned on sleep-inducing CDs and put them
on continuous play throughout the night. When Ted heard the music, he settled
down and went to sleep. A nice side effect was that I, a lifelong insomniac,
slept better than I had in decades!
4) HAVE A REGULAR BEDTIME, AND REGULAR TIME TO RISE, AND DON'T DEVIATE FROM
THESE TIMES BY MORE THAN A HALF HOUR
The body develops rhythms that, if broken, make sleep more difficult to achieve.
If you stay up some nights working long after bedtime, you may be disrupting
your pup's ability to sleep soundly.
THE RIGHT PLACE: SEPARATION ANXIETY/"POWER SPOTS":
Many pups have a preferred spot for sleeping. Some pups like to be in the room
with their "parents" and will feel anxious if separated, while others prefer
their own space. I have never known a dog who did not have a few of what I call
"power spots" in the house. These are the places to which they gravitate
naturally: the places they most often choose to sleep if given a choice, whether
during the day or at night.
If at all possible, let your pup sleep in a place where he/she feels most
comfortable. Ideally, choose one of his/her favorite spots that is nearest to
where you sleep, so that you can respond quickly to a seizure. For the pup's
safety, make this an enclosed space that is clear of things into which he/she
can bump or that he/she can pull down during a seizure. Knowing your pup is safe
will help YOU to sleep.
When Teddy first came to live with us, I thought (for no good reason) he
"should" be in the bedroom with the other dogs. But he felt more comfortable
sleeping in the hallway right outside the bedroom. We therefore "baby-gated" him
into this area, with access to the bedroom and kitchen. We pushed the kitchen
table into a corner with the stools under it, so he could not pull these over on
himself during a seizure. Teddy immediately began sleeping much more soundly
once he had his own "spot" to sleep in.
One other thing that is worth a try if your pup appears anxious at night is (of
all things) a T-shirt. To be effective, you will need one that fits snugly on
your pup. You can "adjust" a slightly larger T-shirt by cutting it along the
pup's back and tying the cut ends securely in a knot. Practitioners of
Tellington Touch (T-Touch) recommend a fairly complicated wrap of Ace bandages
to calm dogs, but a T-shirt works very well for many pups.
THE NEED TO ELIMINATE AND SLEEP DISRUPTION:
AEDs cause pups to drink more and therefore they need to urinate more often.
While it is important to provide ample fresh water during the day, you can
moderate the amount of water you give as night progresses to avoid your pup's
having to eliminate during the night, which disturbs his/her sleep as well as
yours, when you must see to his/her needs.
Another alternative is to provide a place for indoor elimination during the
night. Although this may seem like a drastic solution, it may be better choice
than constant sleep-deprivation. When our Ted was adjusting to KBr, and before
he was taken off Pb, he often needed to eliminate many times during the night.
We finally decided to provide crib mattress pads (which soak up a ton of urine
and are easily washable) for nights when we were simply too tired to take him
out one more time.
Hopefully these suggestions will help you and your pup get more sleep. We
welcome feedback on how these ideas work for you as well as other suggestions
not discussed here.
Clemmons, R.M., "Seizure Disorders in Dogs and Cats,"
Levin, Caroline D. Canine Epilepsy: An Owner's Guide to Living With and Without
Seizures. Oregon City, OR: Lantern Publications, 2002.
Mindell, Earl. Earl Mindell's Vitamin Bible, 1979.
Pitcairn, Richard H., DVM, Ph.D., and Susan Hubble Pitcairn. Dr. Pitcairn's
Complete Guide to Natural Health for Dogs & Cats. Emmaus, PA: Rodale Press,