Headaches and Sleep
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.
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.
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. Treatment of sleep apnea may help prevent headaches that awaken one from sleep or occur first thing in the morning. For more information about sleep apnea, please see the link at left, or click here.
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. 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. 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. 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. 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. 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 moderate 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; for others, maintaining healthy sleep hygiene and treating specific sleep disorders may provide relief of chronic headaches.
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