Sleep and migraine
Even within the states of sleep and wakefulness, there are faster, shorter cycles of brain activity. In sleep, the brain successively ascends and descends through various depths of sleep in a regular pattern, alternating between rapid eye movement (REM) sleep and nonrapid eye movement (NREM) sleep. During REM sleep the body is paralysed, except for the eyes, which dart about rapidly. It is during this phase that most dreaming occurs. During NREM sleep, the brain enters a deeper state of sleep known as slow wave sleep, which is thought to be very important in many processes including memory processing and regulation of the immune system and metabolism. These stages of sleep also exert regulatory effects on the autonomic nervous system, which is the part of the nervous system responsible for controlling bodily function such as blood pressure and blood flow through the arteries and veins, including those within the brain.
Sleep and headache: the evidence
It is clear that some headache disorders are profoundly influenced by sleep, and some seem to occur exclusively in relation to sleep. Conversely, both of these groups of headache disorders can affect sleep, giving rise to a causality dilemma (or a “chicken and egg” scenario).
Migraine attacks are said to be more likely to occur between 04:00 and 09:00 am, which might suggest a timing mechanism that relates to sleep or circadian rhythms, or both. Lack of sleep is a well-known trigger, as is too much sleep (such as lying in at the weekend). Similarly, shift-work and jet lag have been reported to be triggers in some individuals, suggesting an influence of both sleep and the circadian timing system. Excessive sleepiness may be part of the premonitory phase before a migraine attack, or a symptom following the attack. Sleep can also be very therapeutic during a migraine attack, and may often help terminate the attack if achievable, particularly in children.
Cluster headache attacks show a striking relationship to sleep. Attacks arise mainly, although not exclusively, during sleep, and often occur at similar times each day and night. This again points towards disruptions in the biology of sleep and/or circadian rhythms in sufferers.
Hypnic headache is thought to be a rare form of headache disorder, mainly affecting women of older age, whereby attacks seem to wake sufferers from nocturnal sleep with a dull, featureless headache, often occurring several times a night. The integrity of sleep stages alters with age, with older populations having less slow wave sleep than younger people, so it may be reasonable to assume that hypnic headache might result from a reduction in slow wave sleep in susceptible individuals. Interestingly the stimulant caffeine is reported to be an effective treatment in some cases.
Insomnia and migraine may co-exist, especially in chronic sufferers. Both insomnia and migraine are more likely in people who sustain often quite mild head injuries, as part of a post-concussion syndrome. Excessive sleepiness, particularly during the daytime, can be associated with headache. Dull morning headaches are often a symptom of obstructive sleep apnoea, a condition of disordered breathing during sleep, which causes such significant sleep disruption at night that sufferers find it very hard to stay awake during the day. In addition, people with narcolepsy, who have sudden, uncontrollable sleep attacks, are said to have a higher proportion of headaches than the general population.
The parasomnias are a group of sleep disorders, which represent abnormal behaviour during sleep. Sleep walking and night terrors are said to be more common amongst migraine sufferers, especially children. Restless legs syndrome is associated with an uncomfortable urge to want to move one’s legs, particularly in the evening hours and at night, causing sleep disruption. This condition has recently been shown to have a higher incidence amongst migraine sufferers.
Finally, several of the drugs known to be helpful as headache preventatives have notable affects on the sensation of sleepiness during the day, sleep stages, dream experiences and circadian rhythms.
Why such a close relationship?
The balance of sleep and wakefulness, and its correct timing, relies on a finely tuned system, which in nature is referred to as homeostasis. If too much overloads this system in favour of one state (sleep or wakefulness) versus the other, such as staying up late, having fragmented sleep, sleeping in at the weekends, or sleeping at inappropriate times relative to your body clock (as happens in jet lag), the system will try and compensate to redress the balance.
One idea might be that a migraine attack may actually represent one of these regulatory mechanisms, albeit an extreme and abnormally over-compensating one. For instance if you are sleep deprived, suffering a migraine may actually force you to keep still and lie down in the dark, in the hope of trying to sleep as a way of ridding yourself of the migraine. Having too much sleep may also have the opposite effect and keep you awake with a migraine on subsequent nights. Both scenarios may be a way of trying to redress both sleep pressure and circadian alignment, and keep the system in equilibrium.
How can we use this to our advantage?
Clearly these homeostatic mechanisms aren’t the only basis for migraine, but it is logical to think that trying to maintain a well-balanced sleep-wake cycle may make triggering a migraine attack less likely. It is therefore perhaps important for migraine sufferers to observe something called good sleep hygiene, which is a set of suggestions designed to keep the sleep-wake cycle, and the quality of sleep, as even as possible.
Despite some rather compelling evidence of a close interaction between sleep and headache, there is clearly much to still be learnt and therapeutically exploited. Assessing both brain states in tandem, both scientifically and clinically, is likely to yield a much clearer view of this complex relationship in future.
- Try to go to bed and get up at the same time each day, as sleeping during the correct phase of your circadian cycle is important.
- Understand your sleep need, including both the timing of sleep (when feels right for you to go to bed), and the duration of sleep (most adults need about 8 hours a night).
- Do try and spend some time outdoors or in natural light during the daytime, as this provides an important cue to your brain for finetuning timing of the body clock.
- Try and make your sleeping environment as restful as possible, including sufficient darkness and quiet, comfortable bedding and few devices around the bed, particularly those with lights.
- Exercise, preferably before dinner rather than before bed, can be helpful as can stopping smoking as nicotine has a stimulant effect and suppresses melatonin.
- It would be sensible to recommend that you don’t use your bed for activities that could be done elsewhere (such as watching TV, studying), and try to avoid staying in bed if you are wide-awake.
- Avoiding caffeine before bed is recommended, as is avoiding alcohol, as this actually reduces the overall quality of your sleep rather than improving your sleep as is commonly assumed.
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Whether you always struggle to sleep or you’re just going through a particularly rough patch, missing out on those precious hours of shut-eye can drain you mentally and physically. If feeling fatigued and irritable weren’t enough, you may also notice that you get headaches more frequently when you don’t get enough sleep. Neurologists say there’s a clear link between the two, so you officially have another reason to prioritize getting those seven to nine hours each night.
“Lack of sleep from any cause — including insomnia, obstructive sleep apnea, periodic limb movements, and circadian rhythm disorders — can trigger headaches,” Gretchen Tietjen, MD, a board-certified neurologist and professor of neurology at the University of Toledo College of Medicine and Life Sciences, told POPSUGAR. She also noted that sleep disorders are common among people who have existing headache disorders such as migraines, tension-type headache, and cluster headache.
There’s science to explain the connection. “Sleep promotes proper functioning of the glymphatic system, which clears waste products from the brain,” Dr. Tietjen said. “This is protective against headaches.” According to Robert Dias, MD, a board-certified neurologist and sleep medicine expert at Dignity Health Mercy Medical Group, sleep deprivation can also cause headaches “by various mechanisms involving chemical and physiological processes in the brain, which include alterations in metabolic, endocrine, and hormonal factors.”
Both doctors also emphasized that sleep apnea is a common cause of headaches. This is because individuals with sleep apnea often have poor sleep quality despite getting the recommended seven to nine hours of shut-eye. “In obstructive sleep apnea, there’s disordered breathing, periods of low oxygenation,” Dr. Tietjen explained, adding that this lack of oxygen has been associated with early-morning headaches. “Headaches upon awakening can be associated with changes in cerebral blood flow, low oxygen, and elevated carbon dioxide levels,” Dr. Dias said.
What’s more, the connection between sleep and headaches runs so deep that it’s not just lack of sleep that causes them — Dr. Dias told POPSUGAR that sleeping too much, or having irregular sleep patterns, can also trigger headaches. He explained that for patients who suffer from migraines or experience frequent headaches, establishing a healthy, consistent sleep pattern is the most effective prevention strategy. If you adjust your nighttime routine and you still experience frequent headaches and migraines, it may be a sign of an underlying medical condition. If this occurs, it’s time to schedule an appointment with your doctor.
Image Source: Getty / Moyo Studio
Sleep deprivation symptoms
By Dr Simon Kyle
Research tells us that sleep deprived people find it more difficult to perform to their full potential during the day. You may well be familiar with the feeling of gritty eyes in the morning, but there are many other symptoms of a lack of sleep, which you may not be aware of.
Humans have a natural sleep drive which builds throughout the day whilst we remain awake. This grows into the evening until we eventually feel an overwhelming ‘pressure’ to sleep. Sleep pressure is then relieved as we sleep, until we wake up and the process starts once again.
Insufficient sleep, however, has been found to exacerbate the symptoms of several sleep disorders. Sleep paralysis and sleepwalking, for example, are more likely to occur after several nights of poor sleep or irregular sleep-wake schedules.
Symptoms of sleep deprivation
Lack of sleep symptoms tend to vary according to how long and how often we are sleep deprived within a certain period of time. In general though, it is fair to say that sleep deprivation affects us on physical, mental and emotional levels.
Experimental studies with healthy good sleepers, where total sleep time is restricted, indicate that lack of sleep (or certain stages of sleep), negatively impacts a huge range of functions, including emotional processing, pain thresholds, immune functioning and glucose metabolism.
Physically, lack of sleep may leave us struggling with low energy levels during the day. Findings from the Great British Sleep Survey show that poor sleepers are twice as likely to feel fatigued. In fact, 88% of poor sleepers struggled with reduced energy compared to only 29% of ‘good’ sleepers.
Sleepiness, as opposed to ‘tiredness’, is another physical symptom, demonstrated by our propensity to fall asleep or trouble to stay awake during the day.
Although not terribly common, lightheadedness can also be a consequence of sleep deprivation. Often, headaches and tension are found to increase after poor sleep; occasionally this may be accompanied by feelings of dizziness and light-headedness. It is recommended that you consult your doctor if you experience symptoms such as this.
Mentally, poor sleep may result in poorer concentration and memory. In research studies, sleep deprived people have shown impairments in both sustained attention and memory performance.
Of those who participated in our survey of the nation’s sleep, poor sleepers were 62% more likely to report struggling to concentrate or ‘think clearly’.
Emotionally, we may find ourselves more irritable and lower in mood, as a result of poor or insufficient sleep. Research has consistently found that sleep deprived people show less stable patterns of behavior and are more likely to be emotionally labile. Indeed, the Great British Sleep Survey revealed those suffering from insufficient sleep were twice as likely to suffer from low mood as those who sleep well.
Whilst only restorative sleep can relieve signs of sleep deprivation, some people may have trouble inducing or maintaining sleep. Given how much our quality of sleep affects us the next day, it is important to seek treatment for any sleep problem that you are experiencing.
Cognitive behavioral therapy (CBT) has been shown to be highly effective in helping people establish a regular sleep schedule. Further to this, the clinical trial of the Sleepio program found participants’ mood, alongside their sleep, to have improved at two months post-treatment.
Participants also saw their energy and daytime well-being more than double compared to levels prior to embarking on the Sleepio course.
Durmer, J.S., Dinges, D.F. (2005). Neurocognitive consequences of sleep deprivation. Seminars in Neurology, 25(1), 117-129.
Filed under: Sleep science
What Are Signs of Sleep Deprivation?
Everyday Health: What are the most common signs of sleep deprivation, and why is it important not to ignore them?
David O. Volpi, MD, FACS (nycsnoringsleepapneacenter.com)
Daytime symptoms of sleep deprivation include waking with headaches and feeling fatigued throughout the day. The sleep deprived can feel irritable. They can have poor memory, lack of concentration, and inability to perform certain tasks, which leads to poor job performance. They can have difficulty with motor function, and it can be dangerous for them to operate a car or machinery. Cognitive functions such as math skills can be affected. It can lead to depression as well. It’s important not to ignore these symptoms because sleep deprivation ultimately affects their work life and relationships, and gives them a poor quality of life — not to mention that there may be the underlying physical cause of snoring or sleep apnea.
William Dement, MD, PhD (end-your-sleep-deprivation.com)
The main sign of sleep deprivation, in an otherwise healthy person, is being tired all the time. Falling asleep requires a lesser degree of bodily activity. Heavy eyelids are the major sign of sleep deprivation. Sleep deprivation leads to cognitive impairment and the potentially fatal danger of falling asleep in a hazardous situation, like behind a wheel of a car.
Russell Rosenberg, PhD (sleepfoundation.org)
The primary sign of sleep deprivation is fatigue and sleepiness during the day. In extreme cases, sleep may overcome an individual at the most inopportune time (e.g., when driving). Many people significantly underestimate the degree to which they are sleep deprived. The National Sleep Foundation’s annual polls have consistently shown that sleep deprivation negatively affects mood and relationships. Inadequate sleep can also increase irritability, reduce tolerance to stress, and affect mental abilities such as memory or problem solving.
Scott Eveloff, MD (somnitech.com)
Morning grogginess is a common complaint. If severe enough to interfere with arrival at school or work, or to otherwise affect quality of life, “quick tips” may not be enough. Sleep disorders (sleep apnea), circadian rhythm (internal clock) problems, medication effects, or actual disorders of sleepiness may all warrant consideration before trying quick solutions. Morning light exposure and keeping a regular schedule may both help.
Conrad Iber, MD (hcmc.org/sleep)
Perhaps the scariest thing about sleep deprivation is that we can be as impaired as someone who is drunk and yet we may not realize it. Computer simulation of facial expression shows that if you look sleep deprived to others, you are more likely to make mistakes! Pay attention to your sleep needs and your friends.
John K. Mori, MD (sleepcenterinfo.com)
The most common sign of sleep deprivation is an excessive level of daytime sleepiness. Some other signs of sleep deprivation include short-term memory loss, depressed mood or irritability, and poor attention. Sleep deprivation increases the risk of motor vehicle accidents, thus it is particularly important to obtain adequate sleep.
Researchers at Missouri State University’s Center for Biomedical & Life Sciences found that REM (rapid eye movement) sleep deprivation caused increased expression of the proteins which are known to play an important role in initiating and sustaining chronic pain. REM sleep occurs in 90 to 120 minute cycles during the course of the night and is also thought to be involved in the process of storing memories, learning and balancing our mood. Dreaming often occurs in REM sleep. According to Dr. Durham, they approached the study because “previous clinical data support a relationship between sleep quality and migraine.” The researchers used an established model of sleep deprivation to measure levels of proteins that lower the activation threshold of peripheral and central nerves involved in pain transmission during migraine. Their research shows that REM sleep deprivation leads to changes in the levels of key proteins that facilitate events involved in the underlying pathology of migraine. Paul L. Dunham, Ph.D. and his team presented their research at the American Headache Society’s 52nd Annual Scientific Meeting.
It’s no surprise that a night without enough Zzzs can lead to a groggy morning. But bleary eyes and gaping yawns aren’t the only things that can happen when your body needs more shut-eye.
Indeed, there are more nightmarish side effects to sleep deprivation.
If a person is deprived of sleep, it can lead to “tremendous emotional problems,” said Dr. Steven Feinsilver, the director of the Center for Sleep Medicine at Icahn School of Medicine at Mount Sinai in New York City. “Sleep deprivation has been used as a form of torture,” he said.
There isn’t a clear definition of exactly how long a person must go without sleep, or how little sleep a person has to get to be considered sleep-deprived, and different people need different amounts of sleep, so there may be no universal definition of “sleep deprivation.” Rather, a person is considered sleep-deprived if they get less sleep than they need to feel awake and alert, researchers say.
But still, research over the years has shown that people can be physically and psychologically damaged from not getting enough sleep, said David Dinges, a professor of psychology and the director of the Unit for Experimental Psychiatry at the University of Pennsylvania.
In fact, the damage is so apparent that it is unethical to coercively deprive someone of sleep, Dinges said. In the studies of sleep deprivation that Dinges and his colleagues conduct in their lab, healthy volunteers are placed in medically safe environments and constantly monitored.
But studying sleep deprivation is important, according to these researchers and others who study the condition. They say that learning what happens in people who are deprived of sleep can help researchers better understand the function of sleep and its importance for both physical and emotional health.
The problems can start on a somewhat minor scale.
“Clearly, your brain doesn’t work very well when you’re sleep-deprived,” Feinsilver said. Even a low level of sleep deprivation has an impact on cognitive and emotional function, he said.
Dinges explained that some of the first emotional impacts of sleep deprivation involve positive emotions. “When people get sleep-deprived, they don’t show positive emotion in their faces,” Dinges said. A sleep-deprived person may say they’re happy, but they still have a neutral face, he said.
And they won’t recognize other people as happy, either. A positive look on someone’s face can appear neutral to a sleep-deprived person, and neutral look is often interpreted as a negative look, Dinges said. The sleep-deprived brain may not be as capable of detecting positive emotions as a more rested brain, he said.
And sleep-deprived people also don’t tolerate disappointment very well, Dinges added.
As little as a single night of sleep deprivation can result in a person having a phenomenon called “microsleeps,” the next day, Feinsilver said.
A person begins to fall into mini-snooze sessions, which last up to 30 seconds. Some people’s eyes remain open during microsleeps, but the disturbing thing about microsleeps is that during sleep, the person is essentially blind, even if their eyes are open, Feinsilver said. They’re not processing information, he said.
Studies show that during microsleeps, the brain goes into a sleep state rapidly and uncontrollably, Dinges said. People can force themselves awake, but they will soon fall into another microsleep, he said.
Both Dinges and Feinsilver said that this condition can be incredibly dangerous, especially if you’re behind the wheel.
People often say they feel loopy after a night of no sleep. But in more extreme cases, losing sleep may cause delirium.
True delirium occurs when a person becomes completely disoriented, Feinsilver said. “Sleep can play a role in that,” he said.
Patients who have been hospitalized in intensive care units — where lights and sounds may continue all day and night — can develop a condition that doctors call “ICU delirium,” he said. And while it’s unclear if sleep deprivation is the cause of this delirium, doctors do think that loss of sleep is one reason people in the hospital for extended periods develop bizarre behavior, he said.
The worst thing you can do for sleep is put someone is a hospital, Feinsilver added. It’s fairly common for for hospitalized patients to develop insomnia, he said.
Seeing things that aren’t there can be a side effect of chronic sleep deprivation, but whether sleep deprivations can induce true hallucinations may be up for debate.
Feinsilver said he personally experienced hallucinations due to sleep deprivation, in October of his first year out of medical school. A newly minted medical resident, Feinsilver said he had been chronically sleep-deprived for several months.
“I it was October, because I was in the ICU after a night on call,” and there was pumpkin by the nurses’ station, he said. “I had a very vivid feeling of the pumpkin talking to me,” he said.
But Dinges was more skeptical about hallucinations.
“There’s no question that misperceptions can occur,” Dinges said. When people are very sleepy and performing a task, they may see something flicker in their peripheral vision, or they may think they see blinking lights, but not be sure, he said. All of these are indications that the brain isn’t interpreting information clearly, he said.
Can you die of sleep deprivation?
In a famous series of animal experiments, researcher found that total sleep deprivation could kill lab rats.
In 2012, a Chinese man reportedly died after going 11 days without sleep. However, it’s unlikely that lack of sleep alone caused his death (other factors likely played a role, such as drinking and smoking).
Of course, studying this phenomenon in humans is difficult – even when you put aside the clear ethical dilemmas.
“Can you die of sleep deprivation? It’s not easy,” Feinsilver said. “Because you’ll fall asleep,” he added.
“I don’t believe that people can keep themselves awake until they succumb to death,” because the drive to sleep turns on, and then continues to turn on, he said. “You can’t will yourself to stay awake that long,” he said.
Still, there’s no question that sleep deprivation has “serious adverse health effects,” Dinges said.
“Everything we know about sleep loss is harmful,” he said. But — on a more positive note — most of the effects of sleep deprivation dissipate after you sleep, he added.
Follow Sara G. Miller on Twitter @SaraGMiller. Follow Live Science @livescience, Facebook & Google+. Originally published on Live Science.
- New research published in the journal Neurology suggests even just one night of fragmented sleep could boost migraine risk in the coming days.
- Regularly getting less than six hours of sleep each night can lead to other health issues, too, such as obesity, high blood pressure, diabetes, heart attack, heart failure, or stroke.
It’s easier than you’d think to throw your whole sleep schedule off. One late night of binging the newest docuseries to hit Netflix—Cheer, anyone?—can lead to not being able to fall asleep for nights to come and leave you with that feeling of a headache coming on when your alarm hits in the morning.
Associations between poor sleep and higher migraine risk have been established in several previous studies, and new research suggests even just one night of fragmented sleep could boost migraine risk in the coming days.
Published in the journal Neurology, the study looked at 98 adults who reported episodic migraines in the past. They wore sleep-tracking devices for six weeks, as well as provided daily information on sleep, headaches, caffeine and alcohol intake, physical activity, stress, and headache frequency.
Researchers found that short sleep duration wasn’t significantly associated with migraine, but sleep fragmentation increased their odds of having a migraine two days later. This is the kind of sleep where you’re still in bed but wide awake, according to lead study author Suzanne Bertisch, M.D., clinical director of behavioral sleep medicine at Brigham and Women’s Hospital in Boston.
“Sleep duration was not associated with higher risk of headaches, but time awake in bed was,” she told Runner’s World, adding that the higher the percentage of time of you’re awake versus asleep, the higher your risk of migraine—not the next day, but the day after that.
This held true even when researchers adjusted for other factors like stress, activity, caffeine, and alcohol, she said.
In terms of why a delayed-onset migraine might occur, that’s still a bit of a mystery, and warrants more research to investigate, Bertisch added. However, she and fellow researchers speculated that fragmented sleep may cause changes in control of the hypothalamus, the area of the brain associated with functions like hormone release and body temperature regulation—which can both play a role with migraines.
There’s also a chicken-and-egg question here, as to which comes first: migraine risk or fragmented sleep? In other words, poor sleep may not be a cause for more migraines, but instead, an early indicator that a migraine could be on the way.
This study is similar to others that have looked at blood flow in the brain, said W. Christopher Winter, M.D., president of Charlottesville Neurology and Sleep Medicine and author of The Sleep Solution. Although he wasn’t involved in this recent study, Winter has participated in past research on fragmented sleep.
“Interestingly, we found that blood flow was enhanced during a sleep-deprived night, but that it significantly worsened during the fragmented night,” he told Runner’s World. “Migraines are clearly related to brain blood flow, so it’s not surprising they would go hand in hand with sleep quality.”
As we’ve previously reported, most experts advise getting more than six hours of sleep each night—any less can put you at risk for other health issues, too, such as obesity, high blood pressure, diabetes, heart attack, heart failure, or stroke.
The takeaway here and with other similar studies, he added, is that if treatments such as medications, hot or cold compresses, relaxing in a dark and quiet room, or even Botox aren’t working to alleviate migraine frequency and intensity, you may want to consider a sleep study.
Lowering the chances of a racing brain in the wee hours could yield benefits even days later.