If you frequently wake up with headaches or migraines, the culprit could be a sleep disorder like sleep apnea. Sleep apnea is a potentially serious condition that causes breathing to repeatedly stop and start during sleep. While sleep apnea is most well-known for causing loud snoring, daytime fatigue, and increased risk of other health issues, it can also trigger morning headaches for many sufferers.
The Link Between Sleep Apnea and Headaches
Studies have found a significant association between sleep apnea and several types of headache disorders, including:
- Morning Headaches/Migraines – People with sleep apnea are much more likely to experience headaches upon waking in the morning. These are often migraines or migraine-like headaches caused by oxygen deprivation during the night.
- Chronic Daily Headaches – Frequent morning headaches can develop into a pattern of chronic daily headaches for some sleep apnea patients. The constant pain can severely impact quality of life.
- Cluster Headaches – Some research suggests sleep apnea may trigger or worsen cluster headache patterns, which cause excruciating headaches clustered together over weeks or months.
- Tension Headaches – Lack of quality sleep due to apnea can lead to tension headaches caused by tightening of the scalp and neck muscles overnight.
How Does Sleep Apnea Trigger Morning Headaches?
Oxygen Deprivation–Sleep apnea causes repeated pauses in breathing throughout the night. This leads to drops in blood oxygen levels and increased carbon dioxide levels, triggering inflammatory processes that dilate blood vessels in the brain and cause headache pain.
Treating Sleep Apnea and Associated Headaches
If your morning headaches are being caused by sleep apnea, the most effective treatment is to manage the underlying sleep disorder. Some options include:
- Custom Oral Appliances used during sleep that help keep the airway open are very effective to control sleep apnea and the associated symptoms including morning headaches.
- CPAP Therapy Continuous positive airway pressure (CPAP) therapy provides a steady flow of air that keeps the airways open, CPAP machines prevent apnea events and restore normal oxygen levels during sleep.
- Surgery may be recommended in patients who have not been able to tolerate an oral appliance, or CPAP.
- Lifestyle Changes like losing weight if overweight, avoiding alcohol before bed, and sleeping on your side can help reduce sleep apnea symptoms and morning headaches.
- Over-the-counter or prescription headache medication can provide temporary relief when headaches strike, but doesn't treat the root sleep apnea issue.
If you regularly wake up with headaches, sleep apnea could be to blame, especially if you also experience symptoms like loud snoring, dry mouth, and daytime fatigue. By treating the sleep disorder directly, most sleep apnea sufferers find their morning headache patterns improve dramatically or resolve completely. Don't let sleep apnea derail your mornings - talk to a BlueSleep doctor about an evaluation and treatment options. Controlling nighttime breathing issues could be the key to starting your days headache-free.
Clinical Research
- Patients initially diagnosed with primary headache disorders have a high risk for developing sleep apnoea.
- Patients with migraine are likely to develop sleep apnoea in a short period of time from first diagnosis of primary headache disorders.
- A cause-and-effect relationship between primary headache and sleep apnoea is reported.
Migraine and Sleep Disorders, a Systematic Review
While morning or awakening headaches are reported to be common symptoms of OSA, studies failed to find a causal relationship between OSA and migraine. Nevertheless, evidence suggests that OSA may be a trigger for migraine in predisposed patients and may facilitate migraine progression. Nevertheless, further evidence is needed to support this hypothesis, to understand the possible underlying pathophysiological mechanism, and to clarify if the treatment of OSA patients with continuous positive airway pressure improves migraine through a better oxygenation supply, or indirectly via a higher quality of slow wave sleep and sleep efficiency.
The available evidence about migraine and OSA, although not supporting the existence of a clear association, suggests that it is reasonable to systematically check for the presence of signs or symptoms attributable to OSA in migraine patients and to treat OSA according to the current guidelines, since an improvement of migraine is also expected (Fig. 3).
Patients reporting new-onset headache, or exacerbation of a preexisting primary headache, or morning headache, habitual snoring, witnessed apnea, and daytime sleepiness should be screened for sleep-related breathing disorders. Clinicians should be aware of the presence of known risk factors for sleep-related breathing disorders, including obesity, craniofacial morphology and oral anatomy, neuromuscular disorders and substances use.
Targeted questions or specific questionnaires may help for screening patients and selecting those to be studied with PSG for the diagnosis of sleep-related breathing disorder. In the presence of a sleep-related breathing disorder diagnosis, patients should receive the recommended treatments, including continuous positive airway pressure, surgery (eg uvulopalatopharyngoplasty or tonsillectomy), oral appliances, or conservative measures. Appraisal of a normal weight (body mass index = 18.5–24.9 Kg/m2) should be strongly encouraged in patients with comorbid OSA and migraine since an improvement of both OSA severity and migraine frequency might be expected.
Morning headache is accepted as part of clinical findings of obstructive sleep apnoea syndrome (OSAS). The prevalence of morning headache is at variable levels from 18% to 74% in patients with OSAS. However, there is controversy over the association of morning headaches and OSAS. We studied morning headache prevalence and characteristics in 101 controls with apnoea-hypnoea index (AHI) < 5 and 462 OSAS patients with AHI > or = 5. Morning headache was reported by only nine (8.9%) subjects in a control group compared with 156 (33.6%) of OSAS patients (P < 0.01). Morning headache prevalence was significantly higher in severe and moderate OSAS groups. AHI was significantly higher in OSAS patients with morning headaches compared with patients without morning headaches.
Oxygen saturation nadir during rapid eye movement and non-rapid eye movement sleep as well as mean oxygen saturation value during total sleep time were also found to be significantly lower in the morning headache group. However, none of the sleep parameters was found to be determinants of morning headache. Morning headache was more frequently reported by patients of female gender and with primary headache history. Morning headache was totally resolved in 90% of patients treated with nasal continuous positive airway pressure. The history of OSAS should be considered in the differential diagnosis of morning headache.
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