Sleep Apnea Headaches

Can Morning Headaches be Caused by Sleep Apnea?

There is a long-running debate in the medical science about whether the complaint of waking up with a blinding headache every morning is a symptom of sleep apnea.

One patient from five of all severe sleep apnea sufferers report that headaches on awakening were the reason for their coming to the sleep laboratory.

However, the complaints of headache on awakening are very common among people with a variety of sleep disorders and are not exclusive to sleep apnea.

How Sleep Apnea Headaches Manifest?

In sleep apnea syndrome, patients complain of diffuse headache in the morning localized to the frontal region, with a frequency that is independent of the severity of sleep apnea.

The pain of the headache is mild to moderate and tends to disappear within 30 minutes after getting out of bed.

In this video you can learn more about the sleep apnea headaches from Steve Paceta, M.D., which discusses for almost an hour about this subject.

The Link between Sleep and Headache

These are the mechanisms that have been implicated in sleep apnea headaches:

  • hypoxemia
  • hypercapnia
  • change in cerebral blood flow
  • increased intracranial pressure
  • sleep disturbance caused by depression

Now, it's not necessary that if you have a headache in the morning you have sleep apnea. You need to know that morning headaches are also observed in relation to:

  • Depression
  • Systemic hypertension
  • Bruxism - clenching or grinding of teeth during sleep occurs predominantly in stage 2 of sleep, although it has also been noted in REM sleep.

Hundreds of these bruxism events occurring during the night may lead to abnormal wear of the teeth, temporomandibular joint disorder, and jaw pain.

Headaches associated with bruxissm are presumed to be secondary to the muscle activity of the temporomandibular joint stress.

  • Insomnia and daytime fatigue are common complaints in the patients with chronic headache.
  • Dreams loaded with anxiety and terror may culminate in migraine.
  • Alcohol intoxication
  • Sinus inflammation
  • Restless legs syndrome - complaints of headache upon awakening and daytime headaches are 3 to 5 times more frequent among those afflicted with RLS.
  • Brain tumors or intracranial tumors.

Diagnosis of Sleep Apnea Headaches 

There are so many types of headaches in a person's lifetime, that it can be difficult to distinguish a migraine from sleep apnea headaches. That's why many of sleep apnea patients may present to other specialists with sleep complaints, but not a sleep doctor.

The physician specialist may or may not recognize the presenting symptoms as being related to a sleep disorder.

For example, a patient with cardiomyopathy (a weakening of the heart muscle or a change in heart muscle structure) and a daytime fatigue may or may not be referred for sleep apnea evaluation, depending on if the cardiologist knows that cardiomyopathy patients are at high risk for sleep apnea or other forms of sleep breathing disorders.

The same thing we can say if you go to the urologist because you have nocturia. An urologist may evaluate an obese young male for nocturia and recognize that sleep apnea may be a significant contributor to this problem and that sleep apnea treatment may result in decreased symptoms.

The same case if you go to the neurologist... The neurologists may or may not refer you for headache evaluations to determine if your recurrent headaches are caused by sleep apnea.

Bottom line... Many non-sleep specialists have seen sleep apnea and remained unaware of it. So it's a good idea to ask your doctor about the possibility of having sleep disorders. Remember that sleep apnea and headaches tend to improve with the sleep apnea treatment.

Treatments for Sleep Apnea Headaches

The sleep disorders most implicated with headache include obstructive sleep apnea, insomnia and circadian phase abnormalities. To confirm that you have headache caused by sleep apnea, you need a polysomnographic evaluation.

The good news is that sleep apnea treatment can also improve the headaches. Primary treatment for obstructive sleep apnea include:

It is also prudent to avoid sedation with hypnotics or opiates until the breathing is treated adequately.

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