Sleep Disorders and Headache
Jeanetta Rains, PhD
- Allow yourself to sleep 7-8 hours per night.
- Regular, adequate sleep leads to fewer headaches.
- Sleep loss and oversleeping are common headache triggers.
- Frequent waking from sleep with headache is a potential sign of a sleep disorder.
- Insomnia increases risk for depression and anxiety; discuss combined headache-sleep-mood disturbance with your healthcare provider for a holistic plan.
- Nightly snoring can cause daily headache. Habitual snoring may be a sign of sleep apnea. Treating apnea can reduce or even eliminate headache.
- Record sleep time to bed and rising, length and quality, along with headache to help diagnose insomnia and identify sleep related headache triggers.
Scientists do not argue about a link between headaches and sleep disorders; nor should headache sufferers. Headache sufferers have a great risk for sleep disorders. This risk is 2 to 8 times greater than the general public. In specialty headache clinics, well over half of headache patients have chronic sleep problems. Sleep disorders increase as headaches become more frequent and severe. Regular restful sleep improves headache. Fortunately, specific sleep patterns identify sleep disorders for treatment.
Nearly half of all migraines occur between 4AM and 9AM. The pattern of waking often or daily with a headache is an important sign that sleep may be provoking headache. This is often called “awakening headache.” This may present as migraine, tension type or other headache. The key features are the timing of the headache and tendency to come on during or shortly following sleep. To wake up first thing in the morning often with a headache suggests the need to assess sleep as a cause. It just makes sense. Sometimes the cause, but more often the trigger for headaches is found in sleep.
Chronic daily or awakening headache patterns, regardless of diagnosis, are suggestive of sleep disorders. It appears that almost any sleep disorder can provoke headache. Obstructive sleep apnea and insomnia are the most common. Others common conditions include restless legs, excessive daytime sleepiness and the abnormal sleep behavior of jaw clenching. Others include circadian rhythm or ‘body clock’ disorders, narcolepsy and sleepwalking.
Snoring and Sleep Apnea
Regular snoring is a risk factor for chronic daily headache. Snoring is the first sign of serious abnormal breathing. All snorers do not have obstructive sleep apnea. Snoring is an important result of sleep apnea. Other symptoms of sleep apnea include apparent pauses in breathing witnessed by the bed partner, awakenings, nighttime urination, night sweats, and daytime sleepiness. Sleep apnea is linked to hypertension, heart disease, and stroke. Those with awakening headache should report snoring to their healthcare provider. Overnight testing may be needed to confirm the diagnosis. A significant proportion of sleep apnea-related headaches will improve or stop with treatment of apnea.
The most common sleep problem for headache sufferers is insomnia. This includes difficulty falling or staying asleep, early morning awakenings and non-refreshing sleep. Total sleep time is usually < 6 hours per night for adults. Insomnia impairs daytime functions. This results in fatigue, poor attention and concentration and loss of motivation. Insomnia also creates worries over not sleeping and irritable, anxious or depressed mood. Providers diagnose insomnia by history or sleep diaries. Use a diary to record time to bed and getting up, duration, and quality of sleep for 2 weeks. Use a combined headache and sleep diary to diagnose insomnia and identify links between headache and sleep.
Headache sufferers with insomnia often suffer from anxiety or depression. Headache mixed with poor sleep and mood problems reduces function and quality of life. The combination increases headache frequency. Managing sleep and mood is critical for treating such headaches. Cognitive behavior therapy or antidepressant drugs can help. Choice of medicine depends on individual needs. Some antidepressants promote sleep and help insomnia. Nutrients may also help. Talk to your providers about pharmaceutical grade L-tryptophan, 5-HTP, or melatonin. The treatment of choice for insomnia is behavioral sleep therapy. See healthy sleep habits described below. Sleep specialists or psychologists offer more intensive treatments such as cognitive therapy, relaxation training, and sleep behavior modification.
Biology Links Headache-Sleep-Mood
The link between sleep and headache is not poor luck. Common brain regions control sleep, headache and mood. They also share chemical brain messengers. Therefore, not enough or poor quality sleep increases the odds for headache and mood change. Sleep loss lowers the pain threshold. This increases the physical and emotional experience of pain. On the other hand, restful sleep eases pain and improves mood. These shared factors explain why a wide variety of sleep events trigger headache.
Sleep-Related Headache Triggers
Sleep loss, oversleeping, and quick shifts in sleep schedule are common triggers for migraine and tension headache. The optimal sleep span for adult headache sufferers is 7 to 8 hours per night. Research found that both extreme ends of the sleep period including short (<6 hours) and long sleep periods (>8.5 hours) were associated with increased headache severity. Normal sleep periods (7- 8 hours) were associated with the least headache. Data supports the common wisdom that headache sufferers should have a regular sleep schedule and sleep an adequate number of hours. Allow for a good night’s sleep. Adults should determine their rise time and go to bed 8 hours earlier. Adolescents and young adults need more sleep.
Healthy Sleep Habits
Regular restful sleep improves headache. Because insomnia occurs often and behavioral sleep changes can reduce headache, practice healthy sleep habits:
- Establish consistent bed and wake times.
- Aim for age-appropriate sleep length, which for adults generally ranges from 7-8 hours in bed; longer if younger.
- Create a dark, quiet, optimal sleep space.
- Avoid caffeine, nicotine, and alcohol that impair sleep.
- Avoid alerting the brain—no television, reading, internet or texting in bed.
- Practice mind calming activities at bedtime to prevent sleep problems.
Practice regular sleep and other self-management skills at least 4 weeks to determine impact on headache. Headache diaries help to see patterns and evaluate the impact of sleep on headache.
National Sleep Foundation (www.sleepfoundation.org/)
American Academy of Sleep Medicine (www.sleepeducation.com/)
American Sleep Apnea Association (www.sleepapnea.org/).
American Headache Society Committee on Headache Education (www.achenet.org)
Jeanetta Rains, PhD, Clinical Director of the Center for Sleep Evaluation, Elliot Hospital, Manchester, NH.