Sometimes our migraine specialists will ask about health concerns that don’t appear related to migraine. Often, they are looking for unidentified comorbid health problems. These health problems don’t cause migraine and they aren’t caused by migraine. They do, however, occur frequently in people with migraine. Sleep disorders are one such problem, and the second most common is obstructive sleep apnea.
Sleep apnea, if left untreated, can disrupt sleep, causing us to wake up with a migraine attack or headache. It’s a common migraine trigger. Waking up with a migraine and nighttime snoring are the most common symptoms. Sleep apnea is most frequently treated with continuous positive air pressure (CPAP) therapy.
Several years ago, an alert migraine specialist asked the right questions. She was looking for undiagnosed or under-treated comorbidities that might explain why I wasn’t responding well to oral preventives. Had my husband not been with me for that appointment, we might still be searching for answers. If I had been alone, I might have downplayed the severity of my symptoms. Fortunately, my husband was all too eager to tell her about my snoring. When the sleep study confirmed her suspicions, I started using a CPAP machine every night.
Getting treated didn’t cure migraine.
I felt relieved, after so many years, to finally have a possible answer. CPAP therapy wasn’t a cure, but it did improve my health. Because I slept better, my body was able to maintain a consistent sleeping routine. Improving my sleep quality eliminated a strong migraine and cluster headache trigger.
Before using a CPAP, I would wake up at 3:00 am a few times each week because of a cluster headache attack. The cluster attack, in turn, would trigger a migraine just about the time I got it aborted. I was sleep deprived and in a lot of pain most of the time. Sleeping with a CPAP put a stop to all of those early morning attacks. I still got attacks more than half the time. They just moved to later in the day. Because I was awake and well-rested, I could start treatment earlier and abort the attacks sooner. This allowed me to have more headache-free time each day.
Common questions I hear about CPAP therapy
“I don’t know how you can stand that thing on your face all night. How in the world do you ever sleep?”
This is the most common question I get asked about sleep apnea and using a CPAP. Looking at the mask, it appears cumbersome. My initial sleep study showed airway closure over 100 times a night. No wonder I wasn’t sleeping very well. Being able to breath is essential for survival. It’s not just about waking up feeling refreshed. It’s about breathing clearly all night long.
Finally being able to breathe means that mask becomes a subconscious signal of relief. After a few good nights of oxygen-rich sleep, I began to crave sleep. In the early weeks, I took a lot of naps because I was making up a “sleep debt” from all the years of poor quality sleep. Over time, my sleep routine normalized into a 7-8 hours of restful sleep. The better I slept, the fewer migraine attacks, the better I felt. I sleep better now than I ever have. I don’t snore or grind my teeth anymore. And best of all, I rarely wake up with a migraine or cluster attack.
“Is migraine the worst thing that can happen if sleep apnea is left untreated?”
Unfortunately not. Untreated sleep apnea dramatically increases the risk of many health problems such as depression, anxiety, obesity, high blood pressure, high cholesterol, heart attack, and stroke. Hmm…that list sounds eerily familiar. Oh, wait! Those conditions are often comorbid with migraine, too. There are many reasons to get good quality sleep!
Tips for better CPAP compliance
It can take some time to get comfortable using the mask. It may be tempting to give up, but stick with it. Most people find that after about 6 weeks of consistent use the mask becomes a natural part of their sleep routine. Don’t give up or struggle alone. A call to the doctor or medical supplier can resolve most issues. They’re the experts at strategies to make the transition easier.
- Try several masks before taking one home. It’s not enough to just try it on. Check for possible air leaks or poor fit by turning on the machine. The respiratory therapist can help resolve these problems in advance. Think about your current sleep routine. Consider a mask without any gear on the forehead to allow for concurrent use of ice packs when needed. Mouth breathers may need a full face mask that covers both your nose and mouth.
- Make sure there is always plenty of water in the humidifier. Dry air can irritate the sinuses, causing sinus pain upon waking. Never use tap water. Instead, use distilled water to prevent hard water deposits from building up inside the reservoir.
- Prevent sinus infections by cleaning the mask and tubing daily. Warm water and mild soap is quite effective. Replace mask, tubing, filters, and water reservoir frequently, too.
- Removing the mask during sleep is common. This usually isn’t a long-term problem if you stick with it.
- Newer models submit sleep data electronically to the prescribing doctor. Patients can also view individual reports online through a secure portal. This feature can be used to track progress. When it’s time to replace an old CPAP machine, ask about these newer features.