Headaches and sleep relate to each other in many ways. Headaches
can disrupt sleep. Headache treatments can lead to insomnia or
sleepiness. Some sleep disorders can lead to headaches, while
healthy sleep may relieve them.
Healthy
sleep for most adults consists of about 8 hours a night, at
about the same time
each night. Children need more. The same amount of sleep
broken up
into shorter segments is not as refreshing. Sleep disruption may also make
headaches more likely. So, for people with chronic headaches,
getting a full night's sleep
may be a helpful strategy for headache prevention.
Sleep
Disorders
Sleep disorders can cause insomnia (difficulty getting to
sleep or staying asleep), excessive daytime sleepiness,
or unwanted behavior in sleep. Sleep
apnea is a
syndrome of repeated episodes of stopping breathing in sleep. While morning
headaches are a complaint of many patients with sleep apnea, many different
sleep disorders
have been linked to morning headache. In people with frequent headaches upon
waking, sleep apnea should be considered, but so should other causes of sleep
disruption.
Obstructive
sleep apnea, due to collapse of the upper airway, is the most
common type of apnea and the most commonly diagnosed
sleep disorder. It is
typically
associated with snoring and often causes excessive daytime sleepiness.
An episode of apnea often causes reduced blood oxygen level,
increased blood
pressure,
and brief awakening.
Treatment
of sleep apnea may help prevent headaches that awaken one from
sleep or occur first thing in the morning.
Most apnea is easily treated.
CPAP (continuous
positive airway pressure) provides pressurized air through a mask worn
over the nose during sleep, and almost always controls apnea. Weight
loss can
also help
and sometimes cure apnea. Others may benefit from surgery to remove the
uvula and some of the soft palate at the back of the throat, but this
is only effective
in fewer than half of patients. An oral appliance can be worn during
sleep to reposition the jaw forward. This treats some people
with mild to moderate
sleep
apnea, but is not generally effective in severe cases.
Since low
oxygen (such as at high altitude) can trigger cluster headaches,
and
sleep apnea can cause low oxygen levels, some have speculated
that
sleep apnea
may trigger cluster headaches in some people. A relationship between
cluster headache and sleep has long been known, but it is still not
well understood.
Cluster headache is a brief but severe one-sided head pain with associated
symptoms such as tearing or redness of the eye, facial swelling, nasal
congestion or runny
nose on the side with the pain. The headaches often occur in REM (rapid
eye movement) sleep. Sleep apnea is also worse in REM sleep. There
is now some
evidence to
show that treatment of sleep apnea can reduce the cluster headaches
that occur during sleep.
Improving
Poor Sleep
The relationship between headache and insomnia is complex,
varying greatly among individuals. Some patients with chronic
headaches may
awaken from
sleep aware
of the pain that led to the awakening. Others may have sleep disruption
from increased arousal without fully awakening, causing sleep to
be less refreshing.
Insomnia for other reasons may make headaches more frequent at other
times, but this relationship is not clear. Insomnia is a symptom,
not a diagnosis,
and the
underlying causes should be identified and treated. Sleeping pills
may help temporarily, but eliminating the actual cause is more helpful
in
the long
run.
Our sleep
habits (sleep hygiene) have great impact on how well we sleep
each night. Keeping a regular schedule and avoiding behavior
that promotes
sleep
disruption can help minimize insomnia, allow an adequate amount
of
sleep, and may reduce
sleep-related headaches in some. The following are guidelines for
healthy sleep hygiene:
1.
Go
to bed when you are sleepy, not earlier. Going to bed
before you are sleepy will promote lying awake in bed,
which can condition (teach) the brain to be awake in
bed. Limiting your time in bed helps consolidate and
deepen your sleep. Excessively long times in bed lead
to fragmented and shallow sleep. When you wake up refreshed,
get up. Don't linger in bed for long.
2.
Get
up at the same time every day, 7 days a week. A regular
wake time will help you fall asleep more easily at night,
and helps set your "internal clock."
3.
Sleep
only in bed. Sleeping in other locations at home may
make it more difficult to sleep in bed.
4.
Use
the bedroom only for sleeping and sexual activity. Avoid
reading, watching TV, eating, or talking on the phone
in bed. Also avoid lying awake thinking in bed. If you
need to problem-solve, make plans, or sort things out
in your mind, do it elsewhere. Get up and sit in another
room to "process" your thoughts. Do not take
your problems to bed. It is often helpful to spend time
earlier in the evening to work on your problems or plan
the next day's activities. Some people find it helpful
to designate "worry time" before bed to work
through difficult issues that might otherwise keep them
awake. All this should be done in a room other than the
bedroom.
5.
Cover
the clock or put it where you cannot see it. Looking
at the clock when you either can't fall asleep or have
awakened and can't get back to sleep only perpetuates
the problem.
6.
Regular
daily exercise may help deepen sleep. Exercise too close
to bedtime may disturb sleep. Finish exercising at least
3 hours before bedtime.
7.
Insulate
your bedroom against sounds. Carpeting, wearing earplugs,
and closing the door may help. Noise may disturb your
sleep even if you are not fully aware of it. This is
especially problematic for third-shift workers who need
to sleep during the day when most people are awake.
8.
Keep
the room temperature moderate. Excessively warm rooms
may disturb sleep, even more than you might be aware
of.
9.
Don't
go to bed hungry, as it may keep you from falling asleep.
A light snack at bedtime may help sleep, but avoid having
a big meal. Stomach and intestinal activity slow down
and food is not well digested during sleep.
10.
Avoid
excessive fluid intake in the evening to minimize the
need for nighttime trips to the bathroom. While it is
generally healthy to drink plenty of water during the
day, limiting this for the last 2-3 hours before bedtime
can help you sleep through the night.
11.
Avoid
caffeine, especially in the afternoon or evening. A single
cup of coffee in the morning can affect sleep at night,
even if you are not aware of it. This doesn't mean caffeine
should be avoided by everyone, but it does mean that
anyone with trouble sleeping should stop it completely,
at least until the insomnia is in control. Many people
say "caffeine doesn't affect me," or "I
stopped caffeine once and it didn't do any good." If
a person has insomnia and uses any caffeine, there could
be a relationship. And, stopping caffeine without following
all the points of good sleep hygiene may not have been
enough on its own. Use of caffeine to treat headaches
may actually disrupt sleep. If sleep disruption is an
issue for an individual, other treatments should be considered.
12.
Avoid
alcohol, especially in the evening. Although alcohol
may help some people fall asleep at the start of the
night, the sleep through the night becomes fragmented.
Occasional social use of alcohol in modest amounts is
fine for most people, but regular use or drinking large
quantities may be a significant problem for sleep.
13.
Avoid
using tobacco in any form, especially at bedtime or if
you awaken at night. Tobacco use disturbs sleep.
14.
If
you cannot fall asleep, do not "try harder" to
fall asleep. This often makes the problem worse. Instead,
get out of bed, go to another room, and do something
quietly (such as reading a book) until you become sleepy
again. Avoid television, computer use, snacks, or tobacco
use, as these can make you more alert. Return to bed
only when you become sleepy again. Get up at your regular
time in the morning, no matter how much you slept.
15.
Avoid
naps. If you have an irresistible urge to sleep during
the day, a single nap of 30 minutes or less may be taken
in bed. Longer or more numerous naps can disturb sleep
the following night.
The relationship
between headaches and sleep is complex, but important for many
people with
chronic headaches. Pain control
with medication
may be essential
for some to be able to sleep through the night. Maintaining
healthy sleep hygiene and treating specific sleep disorders
may in turn
be necessary
for relief of
chronic headaches.
