Sleep Disorders

Part One - Headaches and Sleep Apnea

Headaches come in all shapes and sizes, from tension headaches caused by excessive stress or even excitement to the devastating pain of cluster headaches to debilitating and recurrent migraine headaches. Headaches have one thing in common. They make you miserable.

What causes headaches? As mentioned above, stress is one cause. Allergies, sinusitis, head colds can all bring on a headache. Some medications also can cause headaches.

Another cause of headaches is sleep apnea. Sleep apnea is a dangerous disorder that can cause high blood pressure, strokes and heart attacks. It's also the most common cause of excessive daytime sleepiness, weight gain, impotency and, yes, headaches.

If you awaken in the morning feeling unrested, and if your throat is dry or sore, or, if you wake most mornings suffering from a dull headache that's hard to shake, then you may be a victim of sleep apnea. Other symptoms are loud snoring, excessive daytime sleepiness, jerking awake during the night and unrefreshing sleep.

If you suspect that you may be suffering from sleep apnea, talk to your doctor about having a sleep study. There are ways to treat the disorder. The most common treatment is the CPAP machine and mask. Sometimes surgery is the answer. Much depends on the severity of the disorder.

The dull morning headache may not be the only headache brought on by sleep apnea. People with this disorder are not getting the deep, relaxing sleep they need, and sleep deprivation is also a cause of headaches.

Part Two - Headaches and Sleep Deprivation

Sleep deprivation has reached epidemic proportions in America, and probably around the world. Work, recreation and social activities have eaten into the hours once reserved for sleep.

Not too many years ago, the majority of people slept at least eight hours a night, and sometimes more. Now the majority of people sleep five or six hours a night, and some much less.

According to the Department of Behavioral Biology at Walter Reed Army Institute of Research, sleep deprivation impairs alertness, cognitive performance, and mood. Sleep deprivation also causes a general feeling of malaise and headaches.

Sometimes these headaches are dull and persistent and may last all day. At other times, there may be sharp pains that shoot up from the base of the skull to the temples and even to the forehead. Whichever headache strikes, it is a warning signal telling you that you need more sleep!

According to Cornell University psychologist and sleep expert James Maas: "We've become a nation of walking zombies. More than half the adult population of the United States is carrying a substantial sleep debt." And most of those people are walking around, only half awake, with throbbing headaches.

Isn't it time we made up our minds to improve the quality and quantity of sleep we get? Isn't it time to improve the quality of our lives? Get rid of the daytime sleepiness. Shake those persistent headaches by getting more sleep.

Some headaches are caused by sleep disorders such as sleep apnea.


Grinding of Teeth (Bruxism) During Sleep Associated with Other Disorders

The condition is known as sleep bruxism, an oral habit characterized by rhythmic activity of the jawbone muscles that cause a forced contact between dental surfaces during sleep. It has been linked to headaches, joint discomfort and muscle aches, premature loss of teeth, and sleep disruption for both the person with bruxism as well as his or her bed partner.

Study Methodology

The study, carried out in the three European countries, aimed to document the prevalence of sleep bruxism in the general population, the risk factors associated with the disorder, and its links to other health-related and sleep-related issues.

Prevalence is the estimate of a disease as a whole in a given population in a given time. It is usually based on a set of criteria for that disease that can be utilized in a questionnaire administered on a large scale. It does not require clinical evaluations.

The International Classification of Sleep Disorders (ICSD) suggests the following as minimal criteria for sleep bruxism: the presence of teeth grinding during sleep and, at least one of the following associated features – abnormal tooth wear, muscular discomfort, or sound associated with the tooth grinding. The participants in the study were divided into one of three groups: those who met the ICSD criteria, those with tooth-grinding alone, and those without tooth grinding.

Participants were interviewed by phone, with interviews averaging 40 minutes in length. The information gathered was entered into a Sleep-EVAL system, a software system designed to conduct epidemiologic studies on sleep, sleep habits, and mental disorders in the general population. Validation of the data was conducted at Stanford University’s Sleep Disorder Center in Palo Alto, California and the Regensburg University Sleep Disorders Center in Germany.

Tooth grinding during sleep is classified as one of the parasomnias by the ICSD. It is found most often in non-REM sleep stages, mostly in stage 2, although it can occur in REM sleep.

Study Findings

Tooth grinding which occurred at least weekly during sleep was reported by 8.2% of the participants. More than 54% of those with tooth grinding reported some related problem, including 23% who said they needed dental work because of the grinding and 8% who claimed discomfort of their jaw muscles upon awakening. More than 23% said the grinding was loud enough for bed partners to hear it. The total, then, for all those in the study population who met the ICSD criteria was 4.4%, suggesting that bruxism is the third most common form of parasomnia following talking in one’s sleep and snoring.

Snoring, breathing pauses during sleep, and obstructive sleep apnea were significantly more frequent in the sleep bruxism group and the tooth-grinding alone group than in the rest of the participants. The sleep-bruxism group reported significantly more frequent episodes of nocturnal awakenings, morning headaches, and a subjective sense of blocked breathing and choking during sleep. Obstructive sleep apnea showed a prevalence of 4.8% in the sleep-bruxism group, 3.4% in the tooth-grinding alone group, and only 1.4% in the non-tooth-grinding group.

The relationship between obstructive sleep apnea and sleep bruxism is usually related to an arousal response. The ending of an apneic event may be accompanied by a number of mouth phenomena, such as snoring, gasps, mumbles, and tooth grinding.

Sleep bruxism was also associated with daytime sleepiness. About one third of the bruxism group reported being sleepy during the day. There was no significant association with other sleep disorders, such as insomnia, restless legs syndrome, or periodic limb movement disorder.

Mental disorders, mainly anxiety disorders and hallucinations, were also significantly related to tooth grinding during sleep. About 69% of those with sleep bruxism related their condition to aggravation, stress, or anxiety. Daily use of alcohol, tobacco, or caffeine was also associated with sleep bruxism.

Researchers also noted that bruxism was unrelated to gender and decreased significantly with age. The highest prevalence was observed in the 19- to 44-year-old group, at 5.8%.


Evaluating Sleep Disorders with a Polysomnogram

What is a polysomnogram?

A polysomnogram is a sleep study in which measurements are used to identify different sleep stages and classify various sleep problems. During the study, the activities that go on in your body during sleep (brain waves, muscle movements, eye movements, breathing through your mouth and nose, snoring, heart rate and leg movements) are monitored by small metal discs (electrodes) applied to your head and skin with an adhesive. Flexible elastic belts placed around your chest and abdomen measure your breathing. The level of oxygen in your blood and your heart rate are monitored by a clip placed on your index finger or earlobe. As you sleep, you may also be videotaped for later review of any abnormalities observed during the study. A sleep technician will let you know if this is done.

Why do I need a sleep study?

In order to fully understand your sleep and any problems with it, it is necessary to look at various brain activities and body systems and their relationships throughout the night. After the study, the recordings will be interpreted and treatment recommendations will be made if evidence of a sleep disorder is found.

Will I be able to sleep in a strange environment with all of the equipment attached to me?

When many people enter a sleep center, they expect the room to be cold, bright and impersonal. However, at most sleep centers, the surroundings are homey and comfortable like a hotel room. The technical equipment and technicians will be in a room separate from your sleeping room, and the electrode wires will be gathered in a kind of ponytail behind your head so that you will be able to roll over and change positions almost as easily as you would at home.

On the day of the sleep study, it is important to avoid caffeine (coffee, tea, cola and chocolate) after 2:00 p.m., and try not to nap. Before coming to the sleep center, wash and dry your hair, and do not apply hair sprays, oils or gels.

While the electrodes may feel strange on your skin at first, most people do not find them uncomfortable or an obstacle to falling asleep. The sleep specialist is aware that your sleep at the center may not be exactly like your sleep at home. This is taken into consideration and usually does not interfere with obtaining the necessary information.

Before coming to the center, you should pack an overnight bag as you would for an overnight stay at a hotel or a friend's house. You may wish to include your own pillow and some extra clothing. If you have special needs, advise the sleep center personnel so they can accommodate you.

Should I take my medications as usual?

It is important for your sleep professional to know if you are taking any prescribed or over-the -counter medications, since some of these can affect sleep and the interpretation of the sleep study. Sometimes certain medications need to be discontinued gradually prior to a sleep study so that the results can be correctly interpreted. However, do not discontinue any prescription medication without first consulting with your health care provider.

What happens after my sleep study?

You will probably have a follow-up visit with your health care provider to discuss the results and recommendations for treatment.

Sleep study results are not generally discussed over the telephone because of their complex nature. Therefore, to fully understand the results of your sleep study, what they mean and any recommendations that are made, you should meet with your health care provider face-to-face.