Sleep : how to improve it without medications
Many people with migraine have difficulty with sleep.
The first step to a better sleep is to make a few routine changes and maintain them over a few weeks at least. Have a look at our list below, pick the changes that seems to fit you best and stick to them.
Is my sleep really going to improve if I make changes to my routine?
According to a study by a team from South Carolina, making simple changes to the sleep routine allowed 48% of people with chronic migraine to improve back to an episodic state (< 15 headache days per month).
The Ultimate Sleep Check List
Adopt a regular daily routine
• Make sure you have enough time in bed to sleep (7 to 8 hours per night…5-6 hours is not enough). Go to bed and wake up at the same time each day, even on the weekend.
• Exercise regularly and try to find the right time for you to do it. For some people, vigorous exercise in the evening impairs sleep.
• Avoid naps or limit them to 20-30 minutes. Don’t nap after 3 PM. Avoid staying in bed at any other time than sleep time.
• Avoid eating dinner less than 2 hours before going to bed. You may consider a light snack if you feel hungry.
• Limit liquids 2 hours before bedtime. This will decrease your trips to the washroom.
Make your bedroom a good place to sleep
• Use your bedroom for sleeping and intimate activities.
• Reduce noise and light in your bedroom. Use ear plugs and eye masks if required.
• The optimal room temperature for sleep is between 15 and 20 degrees C (60 to 67 F).
• If you can’t sleep after 30 minutes in bed, get up and do something relaxing or boring, such as reading a familiar book, knitting, do a puzzle. When you feel tired, go back to bed (do not sleep on the sofa).
• If you have a bed partner who snores or disturbs you, consider sleeping apart for 1-2 nights per week to catch up on your rest.
• If you have young children, take turns getting up with them, if at all possible.
Prepare for bedtime and create a routine to wind down before going to sleep
• Keep a list of the things that you need to do so you don’t ruminate on it in your bed. If you’re thinking about something, get out of bed, write it down and go back to bed.
• Avoid bright sources of light, including any screens, 1-2 hours before bed. Remove screens from your bedroom or set your devices to “Do Not Disturb”.
• Avoid anything that is mentally stimulating, keeps you awake, or is emotionally loaded, such as important conversations, thrilling series or books.
• Use relaxation techniques, such as breathing exercises, progressive muscle relaxation, and mental imagery in bed (refer to our handout on relaxation techniques). Some people are helped by audio podcasts. (See this post)
Try to keep it natural
• Avoid stimulants such as caffeine, nicotine before going to bed. Alcohol can fragment sleep and cause headaches in the morning.
Talk to your doctor
Some people suffer from severe insomnia and may need either one-on-one cognitive behavioral therapy or a referral to a sleep clinic. Some medical conditions like sleep apnea, menopause hot flashes and others can significantly impact sleep. You may discuss this with your physician if sleep remains a problem despite sustained attempts at a better routine.
To read more:
- Begasse de Dhaem O, Seng E, Minen MT. Screening for Insomnia: An Observational Study Examining Sleep Disturbances, Headache Characteristics, and Psychiatric Symptoms in Patients Visiting a Headache Center. Pain Med. 2018;19(5):1067-76.
- Nesbitt AD, Leschziner GD, Peatfield RC. Headache, drugs and sleep. Cephalalgia. 2014;34(10):756-66.
- Gori S, Lucchesi C, Morelli N, Maestri M, Bonanni E, Murri L. Sleep-related migraine occurrence increases with aging. Acta Neurol Belg. 2012;112(2):183-7.
- Calhoun AH, Ford S. Behavioral sleep modification may revert transformed migraine to episodic migraine. Headache. 2007;47(8):1178-83.
- Rains JC, Poceta JS. Sleep and headache disorders: clinical recommendations for headache management. Headache. 2006;46 Suppl 3:S147-8.