Is poor sleep giving me headaches?

Adults and children with headache often also experience sleep disorders. One of the most common sleep disturbances is insomnia. Sleep and headache are often part of a bad cycle. Sleep can relieve pain and migraine symptoms. But those symptoms can also disturb sleep and contribute to ongoing headache pain.

What is insomnia?

Insomnia is defined as difficulty falling asleep, difficulty sleeping through the night, or waking up too early and not being able to fall back asleep at least three nights a week for more than three months.

It can impact 50 to 75% of people with chronic pain and headache diseases, especially migraine.

Headache sufferers may use sleep to relieve their headache pain. While they may wake up feeling better, over time, using sleep in this way can contribute to insomnia and other sleep difficulties. Potentially developing a habit of spending excessive amounts of time in bed, and spending a lot of time sleeping during the day.  The body may start to lose the association between using the bed for sleep versus using the bed for being awake.

Sleep disorders and headache diseases also commonly co-occur with mental health disorders like anxiety and depression. Addressing anxiety and mood problems can be an important step in improving sleep and headache pain.

However, identifying if it is the headache pain that’s causing the sleep disturbance, or is it the sleep disturbance that’s causing the pain can be a difficult answer to nail down.  Studies have found poor sleep more often predicts onset of headache, or more sensitivity to pain the next day, than the opposite. Studies have also shown children who have poor sleep over a decade are at greater risk to develop an episodic or chronic headache problem in young and middle adulthood.

Further research has found that even when pain symptoms improve over a year-long period, the sleep disturbance does not. This means that while pain may initially spark sleep issues, insomnia can be a learned behaviour and can continue even when the pain improves.

How can you tell if you have sleep-related headache pain?

Using a sleep and headache diary can help you identify links between sleep and headache. To start, describe what type of bedtime or middle-of-the-night issues you experience. Do you have trouble falling or staying asleep? Do you have excessive daytime sleepiness or frequent night wakings? Do you go to bed and wake up at the same time every day? Does your timing change on the weekends? Do you have a consistent bedtime routine?

Lastly, bring attention to any clues of a medical condition that may affect your sleep. For example, do you or someone else notice you snoring or gasping for air while sleeping?

The answers to these questions can point to a potential behavioural sleep disorder like insomnia or a sleep disorder like obstructive sleep apnoea.

How can sleep habits prevent pain?

1.   Keep a regular bedtime and wake time. Try not to deviate more than 60 to 90 minutes from your regular time.

2.   Make your bed a sleep-only zone. Avoid using electronic devices or napping in your bed during the day.

3.   Store your electronics outside of the bedroom. Designate a recharging space for your phone, other devices in another room. That way you aren’t tempted to check them if you wake at night.

4.   Maintain a bedtime routine. Actions like dressing for bed and brushing your teeth tell your body to get ready for sleep.

5.   Make time to wind down. Spend 20 to 30 minutes before bed doing something relaxing off-screen. This can include reading, listening to music, stretching or having a cup of tea or a light snack. Doing this will set yourself up for a restful night.

Other lifestyle habits, such as limiting caffeine, can also be helpful for quality sleep.

Finally, your neck may also be contributing to your headache or insomnia.  If you have difficulty getting comfortable on your pillow due to a stiff or sore neck, spending the evening in a sub optimal position where the neck muscles or joints are strained may result in difficulty getting to sleep or waking prematurely. 

Speaking to your physiotherapist about your sleep and headaches will help gain insight about potential causes and possible solutions you can use to improve your symptoms.