What types of headaches can be caused by sleep apnea?
Typically, headaches caused by Sleep Apnea
Is there a link between migraine and sleep apnea?
People with chronic migraine  are more at risk for sleep apnea. Sleep disorders increase the risk of chronic headaches. There are many histories of Migraine
Why would apnea cause headaches?
Obviously, we breathe for a reason. When we stop breathing, the oxygen in our blood decreases and the carbonic gas increases. This triggers different reactions in the body, like hypertension. All these metabolic changes during the night are thought to trigger the morning headaches.
The apneas (there are usually multiple episodes each night) disrupt the quality of the sleep and lead to daytime sleepiness, somnolence and fatigue. This may have a significant impact on migraine.
What are symptoms that could suggest that I have sleep apnea?
- Habitual snoring
- Witnessed apnea
- Waking gasping or choking
- Headache upon waking
- Hypersomnia (or Insomnia<span style="font-weight: 400;">Medical providers have known for over a century that there is an association between poor sleep and the frequency and intensity of migraine and other pain syndromes. Insomnia, also referred to as psychophysiologic insomnia by many, is one type of poor sleep. Other common types of sleep difficulties include sleep apnea, frequent snoring, and excessive daytime sleepiness.</span><span style="font-weight: 400;">Insomnia, of one or both types, is a common finding amongst individuals with chronic migraine. In many cases, insomnia may stem from other medical problems which cause chronic pain (making it difficult to sleep comfortably) or which disrupts normal sleeping patterns.</span><i><span style="font-weight: 400;">Reference : by Rashmi Halker, MD; Bert Vargas, MD; and David Dodick, MD,</span></i><i><span style="font-weight: 400;">https://americanmigrainefoundation.org/resource-library/sleep-insomnia-migraine/</span></i><i><span style="font-weight: 400;"> ,july 4</span></i><i><span style="font-weight: 400;">th</span></i><i><span style="font-weight: 400;">,2019</span></i><i><span style="font-weight: 400;"> </span></i>" >Insomnia )
- Night sweats
What are risks factors for sleep apnea?
We think of the person with sleep apnea as an obese older snoring man, and it’s not wrong, but many other factors are to consider, and even younger slim females can have sleep apnea.
- Overweight to obese
- Wide neck (male > 17˝ and female > 16˝)
- Women more than men, after menopause almost equal
- Older age
- Family history (especially multiple family members)
- Small chin or jaw (micrognathia)
- Mouth/throat anatomy: large tongue, tonsils
- Neuromuscular disorders
- Substances (eg, tobacco, alcohol, sedatives, Opiates<span style="font-weight: 400;">Opiates are drugs used to treat pain derived from the opium plant. These substances are highly addictive and carry a high risk for opiate addiction for anyone who takes them for a prolonged period, even if they are used as prescribed.</span> <span style="font-weight: 400;">For almost as long as opiates have existed, they have been used for both medicinal and recreational (i.e., to get high) purposes. Opiates exist on the drug market in a few different forms: as prescription pharmaceuticals (morphine, codeine, methadone, etc.), and illicit street drugs (heroin, opium, etc).</span><i><span style="font-weight: 400;">Reference: written by The Recovery Village®, reviewed by Patrick Moser </span></i><i><span style="font-weight: 400;">https://www.therecoveryvillage.com/opiate-addiction/#gref</span></i><i><span style="font-weight: 400;"> , consulted on july 5</span></i><i><span style="font-weight: 400;">th</span></i><i><span style="font-weight: 400;">,2019</span></i>" >opiates , muscle relaxants)
What tests are available for sleep apnea?
- Polysomnography: overnight monitoring attended by technologist in a sleep lab
- Portable cardiorespiratory monitoring home sleep apnea test (HSAT) at home
The key result of testing is usually the Apnea Hypopnea Index (AHI). 5-15 is mild, 15-30 is moderate and >30 is severe.
What are treatment options?
- Conservative measures: positional therapy to avoid supine sleep, smoking cessation, non-surgical weight loss
- Avoidance of alcohol, muscle relaxants, anxiolytics, opiates, sedatives, and hypnotics)
- Positive airway pressure (continuous or CPAP, bilevel PAP)
- Oral appliances (mandibular advancement devices, tongue retaining devices)
- Surgery of the upper airway
- Hypoglossal nerve stimulation
- Bariatric surgery for weight loss
- Nocturnal oxygen (case-by-case basis)
The CPAP mask is not always easy to tolerate. The pressure can even trigger migraines. Discuss other option with a Sleep Medicine specialist.
The coverage of testing and treatments varies a lot. Considering the health consequences of untreated sleep apnea, it would be an advantage to our society to see this covered by public insurance.
In summary, if your migraines have worsened, if you snore, if you have morning headaches…it might be a good idea to discuss sleep apnea testing with your physician.
1. Buse DC, Rains JC, Pavlovic JM, Fanning KM, Reed ML, Manack Adams A, et al. Sleep Disorders Among People With Migraine
2. Ferini-Strambi L, Galbiati A, Combi R. Sleep disorder-related headaches. Neurol Sci. 2019;40(Suppl 1):107-13.
3. Rains JC. Sleep and Migraine: Assessment and Treatment of Comorbid Sleep Disorders. Headache. 2018;58(7):1074-91.