A bi-directional relationship exists between sleep and headaches, including migraines, tension-type headaches, cluster, and hypnic headaches. Headaches impact sleep, and sleep loss, in turn, can trigger headaches. Both too little sleep (i.e., sleep deprivation) and too much sleep (i.e., hypersomnia) can trigger headaches. Migraines, for instance, can occur in individuals sleeping more on weekends to make up for lost sleep during the week.

Common brain mechanisms underlie headaches and sleep. Migraines and sleep share an anatomical pathway, beginning in the brainstem and spreading to the thalamus, hypothalamus, and cortex. Additionally, the hypothalamus, the brain part that regulates sleep and arousal, contains neurons involved in modulating pain. Also, the pineal gland produces a sleep-promoting hormone called melatonin at dusk. Low levels of melatonin may occur in migraines and cluster headaches.

What we offer at Sleep and Brain

At Sleep and Brain, we conduct a detailed clinical history and specialized physical examination to evaluate if a sleep disorder is underlying your headaches. We prudently assess for sleep disorders as exampled below:

Snoring and Sleep-Disordered Breathing
- Morning headaches are a common symptom of sleep apnea. However, snoring by itself may cause morning headaches. Not all people who snore have sleep apnea. Many snorers awaken with headaches.
Insomnia
- Difficulty falling or staying asleep can lead to sleep deprivation, which commonly causes headaches.
Circadian Dysrhythmias
- Individuals with circadian dysrhythmias may experience headaches. Circadian rhythm disorders develop when your body's natural sleep-wake cycle and the standard 24-hour day-night cycle are misaligned. The misalignment may result in insufficient sleep, triggering a headache when you awaken.
Bruxism
- Grinding or clenching during sleep can cause headaches. This forceful movement also leads to tooth wear, muscle pain, and gum damage. Causes of sleep bruxism include having malformed jaws, anxiety, sleep fragmentation, alcohol and stimulating use.

Migraines result, in part, from a dysfunction of the sympathetic nervous system. We may recommend sensitive **home sleep testing** with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.

**Laboratory sleep testing**, performed in your home, may be necessary to evaluate additional sleep disorders. Most individuals with narcolepsy, for instance, experience headaches.

Geodesic Head Web — We offer sophisticated testing to elucidate areas of brain imbalance. A **brain map** pinpoint which brain areas are hyperactive and hypoactive and assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if the brain imbalances support a diagnosis of headaches versus something else like concussion.

Nasal inflammation or structural abnormalities and a small maxilla can increase nasal resistance and reduce nasal airflow. Nasal obstruction is suffocating and triggers a fight-or-flight response, leading to anxiety. The body is not accustomed to being in a chronic state of distress, and, ultimately, anxiety gives way to depression. Nasal obstruction can also affect sleep quality, leading to inattention and distractibilty. Nasal obstruction can also contribute to headaches.

**Rhinomanometry**

Rhinomanometry provides a quantitative measure of nasal airway resistance. It involves the measurement of nasal airflow and the pressure gradient required to achieve that flow, from which we can calculate nasal airway resistance.

**Cone Beam CT**

Radiographic imaging using cone beam computed tomography (CBCT) offers insight into causes and treatment solutions by visualizing anatomy. CBCT provides detailed images of the jaw, teeth, upper airway, nasal cavity, and sinuses. The best clinical outcomes occur when we can see what is happening.

Understanding the cause of you or your child's sleep problems is essential to customize a treatment regime for both the sleep disorder and headache. Treating sleep problems may improve headaches because, as mentioned, disordered sleep symptoms can mimic and exaggerate headache symptoms. We direct treatment toward the sleep disorder as exampled below:

Removing the tonsils, expanding the palate, and starting CPAP can help headaches and disordered sleep symptoms.
Iron and dopamine deficiencies can cause RLS and PLMD. We treat RLS with iron supplements, medication, and non-medication therapies.
Identifying and eliminating the cause of awakenings from sleep
Utilizing light therapy to advance or delay your sleep cycle

In addition to treating an underlying sleep disorder, we institute robust sleep hygiene interventions, as partly described below, to make going to bed a pleasant experience and reduce headaches:

Ensuring your bedroom environment is conducive to sleep
Eliminating sources of sleep interruption like light and noise
Optimizing your diet as food can promote and hinder sleep
Assessing your nighttime habits and rituals

Our scientifically-based **Insomnia Cognitive Behavioral Therapy** is used in conjunction with **Sleeptracker-AI** treat anxiety and insomnia.

A state of hyperarousal, frequently marked by worry, is a critical factor of insomnia. CBT-I reduces negative thoughts about going to bed, a type of anticipatory anxiety that challenges healthy sleep schedules. Even after falling asleep, you may awaken with anxiety in the middle of the night. CBT-I reorients negative thinking and helps you return to sleep when your mind races with worry. We also utilize relaxation techniques as part of our CBT-I to reduce anxiety and make it easier to fall asleep quickly and peacefully. Guided imagery, deep breathing, and mindfulness meditation are just a few approaches to putting your mind at ease and improving your sleep and anxiety.

TMS Migraine Tension Headache — **Brain TMS** has advanced into treating headaches and sleep disorders such as insomnia. We personalize a TMS protocol based on your unique brain map.

Several medication classes treat headaches, including triptans, anticonvulsants, and beta-blockers. However, these medications mitigate symptoms rather than cure the underlying cause. We judiciously use medications to treat an identified underlying cause.

Hypocapnia can cause cerebral vasoconstriction, reducing blood flow to the brain and leading to headaches. This constriction and reduced oxygenation can trigger tension-type headaches or migraines, especially after periods of hyperventilation or disrupted breathing during sleep.