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Migraine, Sleep and Snoring – Dr Nazeli Manukyan

18 April 2019

As headache specialists we frequently see patients with sleep disorders. We aim to educate migraine sufferers about the importance of sleep routine. We know that migraineurs are sensitive to changes in the brain’s biological clock which controls sleep and wakefulness cycle.

Migraine can be triggered by too much or too little sleep. But sleep can help relieve it as well. Migraine attacks themselves can disrupt sleep patterns.

 

There are various sleep disorders which may worsen migraine and can lead to chronic daily headache. Those with insomnia report a delay in falling asleep or interrupted sleep with frequent waking and feeling unrefreshed in the morning. But unless asked specifically, no-one volunteers to reveal their snoring habits.

Here are some of the many myths about snoring and sleep that are important to dispel.

 

Myth #1 Snoring is a common problem and is not harmful😴

 

Snoring is noisy breathing caused by turbulent airflow through the upper airway. Habitual snoring can be commonly ignored and dismissed or become a subject of jokes, but it can be more harmful than just annoying, resulting in poor sleep quality and quantity. Half of those who snore may have a serious sleep disorder such as Obstructive Sleep Apnoea (OSA) with accompanying severe daytime sleepiness.

Sleep apnoea is characterised by repetitive pauses in breathing that prevent air from flowing into or out of a sleeping person’s airways. It may be caused by anatomical obstruction in the pharyngeal airway or a reduction of pharyngeal muscle tone, or a combination of both.

Symptoms of sleep apnoea include apparent pauses in breathing, frequent awakenings, night-time urination, vivid dreams, night sweats, daytime sleepiness and morning headaches. The breathing pauses reduce blood oxygen levels, increasing heart strain and the risk of cardiovascular disease, leading to uncontrolled hypertension and obesity. Such chronic sleep deprivation negatively affects daytime functioning, resulting in increased irritability, decreased cognitive function, mood and memory problems, and reduced quality of life.

 

 Myth #2 ”I snore only when I am tired or sleep on my back”😴

 

Snorers may not be aware of the extent of the problem. In fact, many of them think they slept well all night, as they drop to sleep immediately when hitting the pillow and cannot understand why they wake up exhausted. It is their listeners, partners and family members, who frequently report the severity of the symptoms. So how to recognise the problem if you don’t have a partner to report the problem or your partner snores even louder and hence might be oblivious to your snoring?

One way to tell the difference between mild snoring and sleep apnoea is to look for the symptoms, such as waking up in the middle of the night gasping for air, frequent night-time urination, dry and sore mouth in the morning, continual fatigue and sleepiness during the day and morning headaches. Simple snoring doesn’t typically wake you up.

Some form of voice recording might be helpful in clarifying the type of snoring. Those with sleep apnoea tend to snore more regularly and loudly with choking sounds, they often gasp for air in their sleep and momentarily stop breathing.

 

Myth #3 Snoring is common in men only😴

 

Recent Swiss study showed that about half of men and about a quarter of women have significant sleep disordered breathing.

Obstructive sleep apnoea with excessive daytime somnolence affects approximately 3-7% of adult men and 2-5% of adult women.

 

Sleep apnoea might be under-diagnosed in women, as they do not present with the classical symptoms of loud snoring and breathing pauses but may complain of poor energy levels and fatigue. Men are more likely to have higher index of suspicion and be referred for an assessment.

Moreover, the women may be more likely to observe and report breathing abnormalities of their male partners. Snoring tends to get worse in postmenopausal women.

 

Myth #4 Only obese people have sleep apnoea😴

 

Sleep apnoea may be related to being obese, but it can also be found in children and thin adults. Facial structural features such as small jaw, recessed chin or deviated septum may contribute to sleep apnoea.

Habitual snoring occurs in 12% of children in the UK with sleep apnoea prevalence up to 1.8%.

 

This commonly occurs due to enlarged tonsils and adenoids, allergic congestion of airways as well as due to certain congenital neurological problems. Sleep apnoea in children may be associated with poor growth, developmental delays, cognitive and behavioural complications.

Sleep insufficiency and poor quality is implicated in many health problems such as hypertension, diabetes, obesity and depression. Chronic sleep deprivation suppresses growth hormone secretion and increases insulin resistance leading to weight gain and diabetes. In addition, central obesity leads to poor muscle tone and fatty tissue around the neck and worsens sleep apnoea, hence those with OSA find it very difficult to lose weight.

 

Myth #5 There is not much that can be done as snoring runs in the family😴

 

Up to 40% of the risk of OSA is genetically predisposed. OSA can be found in about 22-84% of first-degree relatives.

 

Evidence suggests that genetic predisposition is explained not only by familial tendency to obesity but can be due to inherited facial anatomical structural differences.

Sleep apnoea can be treated; men and women who snore loudly, especially if pauses in the snoring are noted, should consult a physician. Sleep-deprived partners are also at risk of significant health issues and relationship breakups.

The diagnosis of sleep apnoea is confirmed on polysomnography which is a sleep study recording brain waves, oxygen level in the blood, heart rate and breathing, as well as eye and leg movements during the study. This reveals the number and the severity of the episodes of oxygen deprivation during sleep phase as well as helps to diagnose other sleep disorders, such as narcolepsy, restless leg syndrome, etc.

Treatment options include continuous positive airway pressure (CPAP), surgical treatments and mouth devices. CPAP machine provides continuous pressure of the air to keeping the upper airway passages open. This can be very effective in improving excessive daytime sleepiness and restore cognitive alertness.

 

Snoring and headaches

 

Research shows that chronic daily headaches are common among snorers, but there is no proven causative link between snoring and headaches. Sleep disorders are potential risk factors for transformation from episodic to chronic headache (>15 days a month). Obstructive sleep apnoea is the commonest sleep disorder associated with headache, although headache is not related to sleep apnoea severity.

Chronic migraineurs who failed to respond to many treatment options will benefit if their associated sleep disorders are addressed and treated appropriately.

 

Snoring and self-help

 

Those with a mild form of apnoea and sleep disorders will benefit from lifestyle changes, such as losing weight, exercising regularly, quitting smoking, drinking alcohol moderately, if at all, and avoiding alcohol several hours before bedtime.

Be aware that smoking, alcohol as well as sleeping tablets and certain prescribed medications can increase airway muscle relaxation, worsening snoring. Alcohol leads to frequent awakening and loss of restorative sleep time. Caffeine is also implicated in poor sleep quality. One or two cups of coffee in the morning are acceptable. About half of caffeine is still circulating in our body 6 hours later and about a quarter of it 12 hours later.

Changing your sleep position can help as sleeping flat on your back relaxes throat muscles more and worsens airway blockage.

 

Don’t ignore the importance of good sufficient sleep and seek help as most sleep disorders can be treated effectively.

 

It’s the National Snoring Awareness Week from 22nd April – 26th April this year. To know more about it contact British Snoring and Sleep Apnoea Association.

 

You can also complete the Epworth Sleepiness Scale which helps measure sleepiness here .

 

For more information please speak to your GP or book an appointment with our headache specialists here.

 

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