Migraines & Sleep Apnea: A Connection Worth Considering

By Dana

Migraines and sleep problems go together. According to the American Migraine Foundation, migraineurs are between two and eight times more likely to have difficulty sleeping. Chronic sleep problems could indicate a disorder like sleep apnea, where breathing is repeatedly interrupted during sleep.

Many people associate sleep apnea with overweight, middle-aged men who snore. Traditionally, so did researchers and doctors. The first item on many sleep apnea questionnaires will be some variation on ‘Do you snore loudly enough that you can be heard through closed doors? Does your snoring annoy your bed partner?’

But not all apnea patients snore, and a large number of them aren’t men. Here’s the problem — women have tended to report different symptoms than men when they develop sleep apnea (insomnia or fatigue are commonly mentioned). Since doctors weren’t expecting women to have sleep apnea, they didn’t test for it. Thankfully, that’s now changing.

Here is a list of other symptoms that could indicate apnea:

– Often waking up with a headache. This can be the most frustrating symptom for migraine sufferers. A sleep apnea headache, which is caused by lack of oxygen in the bloodstream, feels much like a migraine but will go away if the patient gets up and moves around. However, there are two other types of headache associated with sleep apnea (cluster and hypnic), and they require different treatments. Or the headache could be a migraine. Trying to make this determination can be tricky.

– Often waking up with a dry mouth or throat due to mouth breathing during sleep.

– Waking abruptly with a feeling that you are gasping or choking.

– Daytime sleepiness or fatigue, sometimes to the point that you fall asleep involuntarily.

Tests For Sleep Apnea

 Anyone who suspects they might have sleep apnea should contact their doctor. A likely next step will be a referral to a sleep clinic for a study. There are a couple of options available:

Nocturnal Polysomnography: This is an overnight study that monitors your body during sleep (brain waves, blood oxygen levels, heart rate, breathing, eye and leg movements). It will be necessary to spend the night at the sleep clinic for this. This is the more comprehensive of the two tests, and it can diagnose conditions other than sleep apnea. It’s also the more expensive option.

Home Sleep Test: Patient does the test at home and returns it to the clinic. The advantages of the home test are comfort and lower cost. Be advised that it only diagnoses sleep apnea. It may not be an option for patients with certain pre-existing conditions such as COPD. Home tests aren’t usually done for patients with mild apnea, because they can give inaccurate results in those cases.

Test results will show whether the patient has apnea, and its severity (number of events- interruptions in breathing- per hour).

  • Normal Sleep: Fewer than 5 events per hour
  • Mild Sleep Apnea: 5 to 14 events per hour
  • Moderate Sleep Apnea: 15 to 29 events per hour
  • Severe Sleep Apnea: 30 or more events per hour

Treatments For Sleep Apnea 

Mild sleep apnea has the largest number of potential treatment options. The doctor may start off by suggesting lifestyle changes (quit smoking, lose weight, get allergies treated). Sleeping positions will probably be reviewed and adjusted as the doctor thinks best. For mild sleep apnea, this may be all that’s needed. Some patients with mild sleep apnea may require a dental device (see below).

For patients with moderate or severe sleep apnea, additional steps will be needed. They fall into three categories:

Dental Devices: These work best for patients with mild to moderate sleep apnea. They’re popular with patients who travel because of their portability. Dental devices come in different forms–some bring your lower jaw forward to open the airway, while others hold the tongue in a different position. They’re made by dentists who specialize in dental sleep appliances and work with patients to find a comfortable fit. Be sure to check prices and insurance coverage in advance, as this option isn’t covered by some plans.

Positive Airway Pressure Therapy: A machine brings air pressure through a mask on the sleeper’s face. This is the gold standard of sleep apnea therapy, and the one most likely to be covered by insurance. Continuous Positive Airway Pressure (CPAP) is the most common. Manufacturers have done a lot to make current models smaller and quieter than previous ones, with more choices for masks. There’s another option available, Bilevel Positive Air Pressure (BPAP or BiPAP), which delivers a preset amount of pressure for inhalation and a different amount for exhalation. Getting a mask that fits and also feels comfortable is key here.

Surgery: Usually considered a last resort, when other therapies haven’t worked or aren’t considered appropriate by the doctor.

Summing Up

Scientists know pain and sleep are controlled by the same part of the brain. That’s why a regular sleep schedule is so important in managing the pain caused by migraine attacks. Many researchers also believe getting less sleep, and especially less REM sleep, can increase the chance of migraines. It would seem to follow that sleep apnea also increases the likelihood of migraines, but studies are needed to support this theory.

Untreated sleep apnea has also been linked to serious health problems such as high blood pressure, stroke, and heart disease. Migraine sufferers who experience symptoms for sleep apnea are well advised to consider contacting their doctor.


Resources 
American Migraine Foundation-Sleep Disorders and Headaches https://americanmigrainefoundation.org/resource-library/sleep/
The Mayo Clinic- Patient Health Care and Information https://www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-2037763 
National Sleep Foundation- Women and Sleep Apnea https://www.sleepfoundation.org/articles/women-and-sleep-apnea
The New York Times- Sleep Apnea Guide https://www.nytimes.com/guides/well/sleep-apnea-guide
 The Sleep Zone- The Difference Between Migraines and Sleep Apnea Headaches https://www.cheapcpapsupplies.com/blog/migraines-and-sleep-apnea-headaches/
WebMd.com- What Do My AHI Numbers Mean? https://www.webmd.com/sleep-disorders/sleep-apnea/sleep-apnea-ahi-numbers

 

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