Medical providers have known for over a century that there is an association between poor sleep and the frequency and intensity of migraine and other pain syndromes. There are 2 types of insomnia ;
Type 1; difficulty falling asleep (initiation or onset of sleep)
Type 2 ; difficulty staying asleep, early morning waking,
Insomnia, of one or both types, is a common finding amongst individuals with chronic migraine. In many cases, insomnia may stem from other medical problems which cause chronic pain (making it difficult to sleep comfortably) or which disrupts normal sleeping patterns.
Information from Research .
Researchers studied this association by interviewing 147 adults with chronic migraine (i.e. people suffering from migraines on at least 15 days per month for more than 3 months). None of the patients reported feeling “refreshed” upon awaking and four out of five regularly felt “tired” upon waking. This compares to responses of individuals with infrequent migraines – approximately one in four felt “refreshed” upon waking and only about one in three awakened feeling “tired.”
In this survey insomnia was a complaint of the majority of those who had chronic migraine with two-thirds having type 1. When asked about their sleep habits, almost 80% watch TV or read in bed, 70% get up in the middle of the night to use the bathroom, approximately 60% regularly nap during the day, and a little over 50% regularly use sleeping pills. Interestingly, less than one in ten used caffeine within 8 hours of bedtime. This poor quality of sleep and the suboptimal sleep habits reported by these researchers represent typical sleep issues for those with frequent, severe migraine.
The researchers attempted to see if making changes in sleep patterns could have an effect on migraine frequency and intensity. Forty-three women with chronic migraine were randomly placed into one of two groups. The first group received formal instructions on how to improve their sleep habits. The other received neutral instructions unrelated to improving sleep. They were asked to keep a diary of their headaches. Six weeks later at follow-up women who changed their sleep behavior saw a significant improvement in headache frequency and intensity. Dramatic improvement was seen in one of three, to the extent that they no longer met criteria for chronic migraine. None of the placebo group had such a dramatic change. However, this placebo group was then given the formal teaching that the other group received and followed for another six weeks. At the final visit, six weeks later, almost 50% of all subjects who followed the sleep suggestion experienced headache improvement so that they no longer met criteria for chronic migraine.
Risk Factors for a Sleep Disorder
So what factors place people at risk for developing a sleep disorder? Potential risk factors for insomnia include:
• Stressful life events, such as death of a loved one, divorce, or the loss of a job.
• Day-to-day life stresses such as concerns about school, work, family, and finances may lead to disruptive sleep.
• Depression, anxiety and other mental health disorders can lead to fragmented sleep patterns, and these individuals can have trouble sleeping or may even sleep too much.
• Medications including prescription drugs and medications available over-the-counter. Many prescription drugs, including antidepressants, corticosteroids, allergy medications, pain medications, and blood pressure medications can interfere with sleep patterns. Other over-the-counter medications, including those for allergies, cough and cold, pain, and weight loss can also disrupt sleep. Many can leave you feeling groggy; others contain caffeine and other stimulants that prevent you from getting a good night’s sleep.
• Using caffeine, nicotine, alcohol – especially before bed. Caffeine and nicotine contain stimulants that can keep you up at night. Alcohol can initially lead to sedation, but it prevents you from reaching deeper stages of sleep, can lead to wakening in the middle of the night, and a feeling of not being refreshed in the morning.
• Medical conditions associated with chronic pain, breathing difficulties, or frequent urination can lead to sleeping difficulties. Medical conditions that have been linked with insomnia include arthritis, gastro-esophageal reflux disease (GERD), cancer, lung diseases, congestive heart failure, overactive thyroid, obstructive sleep apnea, and Parkinson’s disease.
• Change in environment or work schedule, such as jet lag from changing time zones, working nights, or shift work.
• Eating too much or too late in the evening can lead to trouble sleeping due to heartburn.
• Poor sleep habits, including irregular sleep times, stimulating activities before bed, and reading, watching TV, or studying/working in bed can all contribute to insomnia.
• Female gender – women can experience hormonal shifts during their menstrual cycle and during menopause that can lead to trouble sleeping. Lack of estrogen is thought to play a role.
• Age over 60 – As sleeping patterns change with age, insomnia often becomes more common. It is estimated that nearly half of elderly individuals suffer from sleep problems.
Basic advice to improve sleep
1. As far as possible maintain a regular sleep pattern; going to bed at the same time and getting up at the same time.
2. Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
3. Have a small snack an hour before bedtime, perhaps some warm milk.
4. Try to develop a regular `stress free` pre-bedtime routine (warm bath, listening to relaxing music/radio, relaxation exercises*, `Declutter` brain*, non-challenging reading etc).
5. Make sure your mattress is comfortable and bedding suitable for the temperature. (plus; `tidy`, clean, & sweet smelling !).
6. Bedroom should be quiet, dark, well ventilated, with `coolish` ambient temperature.
7. If necessary use earplugs/eye patches/blackout blinds etc
8. Certain supplements, herbal remedies &/or homeopathic preparations can be helpful; please discuss with your therapist .
9. Attend/seek help regarding any breathing problems.
10. Check if any medication you are taking contains caffeine or has sleep disturbance listed as a side effect; if so ask your doctor regarding alternatives.
11. Try to get some fresh air &/or exercise during day/early evening.
12. Consider throwing out the bedroom clock!(or at least turn so you are not constantly checking time!)
13. Seek help with any other health conditions or other factors which you feel may be contributing to your insomnia (pain, hot flushes, teeth grinding, anxiety, depression, breathing difficulties, etc).
14. Check your medications to see if they have possible side effects which may be contributing to sleep problems
15. Adequately treat/seek advice about any other pain so that it’s not keeping disturbing your sleep.
16. Discuss situation with your partner/bedfellow if their habits are affecting your sleep!
17. Some Neuromodulatory devices seem to aid sleep in some people; please discuss with your therapist.
1. Avoid stimulants such as caffeine and nicotine too close to bedtime. Individuals vary in their sensitivity to caffeine but generally if you are having sleep problems it should not be consumed after 4pm.( remember caffeine is found not only in tea and coffee but also other `energy` drinks and some foods and medications ; check the labels) .
2. Avoid excessive alcohol prior to sleep. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol.
3. Do not go to bed hungry or thirsty. BUT:
4. Do not drink too much fluid within 2 hours of bedtime, frequent waking to go to the toilet results in disturbed sleep.
5. Avoid eating heavy meals within two hours of bedtime. Also dietary changes can cause sleep problems, you are struggling with a sleep problem, it’s not a good time to start experimenting with spicy dishes or `crash` diets.(nb. Avoid a diet that is excessively high in processed foods, animal protein and additives)
6. Try not to use sleeping medications regularly.( especially if you wakeup in the middle of the night)
7. Don’t work/ plan/organize/e-mail etc within an hour of bedtime
8. Avoid watching exciting films/playing video games/ or listening to `stressful` radio shows etc.
9. Try not to argue/shout before bedtime!
10. Do not partake in vigorous Exercise within two hours of bedtime (A relaxing exercise, like yoga, can be done before bed to help initiate a restful night’s sleep. )
11. Don’t have long lie-ins
12. Avoid naps in the late afternoon or early evening*
13. Do not use recreational drugs of any sort.
*additional information/advice required.
RE; relaxation exercises, use of light boxes, taking supplements/herbs, biofeedback, counseling & other possibly beneficial therapies; please contact Clinic for further information.
The following Supplements may be worth trying BUT always check with your G.P first especially if you are on any other medications or have any other health problem.
Vitamin B complex 50mg per day
Calcium 500mg per day
Magnesium 500mg per day
5-HTP (L-5 Hydroxytryptophan) try taking two (2 x 100mg) before bed
Valerian – available as tablet or tea
Further advice can be found at www.mercola.com & http://articles.mercola.com/sites/articles/archive/2010/10/02/secrets-to-a-good-night-sleep.aspx