Last month our scheduled speaker had to cancel, and the meeting became a Talk It Over Night. It was a great opportunity for headache sufferers to share experiences and learn from each other about coping with headaches. The November meeting will be more of the same, as again we had a speaker cancellation and could not come up with a substitute. Dr. Michael Stein will be there to facilitate the discussion and answer questions. Join us in the Ball Auditorium at John Muir Medical Center on Tuesday, November 10th, from 7:30 to 9:00 pm. For more information, call (925) 938-5252.

Certainly every headache sufferer knows that impaired sleep habits can temporarily worsen or provoke headaches. Migraine sufferers are well aware of the analgesic effects of a good night’s sleep, and people with tension-type headaches benefit from ergonomic pillows which help support the head in a stress free position. In addition to these obvious effects of sleep on headaches, obstructive sleep apnea can play a significant role in worsening headaches.

Obstructive sleep apnea is a common disorder affecting over 5% of the general population in the United States. Although people with relatively normal body weight may have obstructive sleep apnea, the typical person with this condition is more than 20% above ideal weight for age and height. Obesity may contribute to fatty infiltration of the neck and soft tissues of the upper airway, resulting in narrowing of the upper part of the pharynx continuous with the nasal passages (the nasopharynx). The most common cause of obstructive sleep apnea is anatomic narrowing of the upper airway, which may become worse in certain positions, for example, when a person is lying on his or her back.

In particular, the soft tissues of the pharynx, adenoids, and sometimes the tongue may become so large as to block the flow of air in and out of the lungs. Because these tissues are positioned at the top of the entrance to the air passages to the lungs, enlargement of any of the tissues in this area can create an abnormal valve which may be one-way or two-way. For example, if a person lying down attempts to take a deep breath during sleep, the airway may be unable to open adequately and thus block the influx of air despite the person’s respiratory muscles moving appropriately. The result is a failure to breathe, or apnea. With repeated attempts to breathe, however, an inhaled breath finally occurs, but the act of exhaling this air also meets resistance at the upper airway, resulting in an abnormally prolonged breath. As air remains in the lungs, oxygen is removed and carbon dioxide remains.

Under normal circumstances, this carbon dioxide is exhaled. In obstructive sleep apnea, however, carbon dioxide is ineffectively eliminated and can result in elevated levels of carbon dioxide, not only in the lungs, but also in the bloodstream. Simultaneously, impaired delivery of oxygen to the lungs occurs, due to a decreased number of successful breaths as well as the interference of excess carbon dioxide. The resulting decreased oxygen (hypoxia) and increased carbon dioxide (hypercarbia) chemically stimulates blood vessels in the brain and can trigger head-aches in many people.

• Noisy snoring

• Pauses in breathing after snoring

• Brief awakenings

• Difficult to rouse from sleep

During the Day

• Excessive daytime sleepiness

• Morning headache

• Inattentiveness

• Decline in school or work

Other

• Obesity

• Adenoid and/or tonsil enlargement

• Typical abnormalities on sleep studies

Obstructive sleep apnea is most commonly diagnosed by testing in an inpatient sleep laboratory. Overnight measurements of airflow in and out of the nose, respiratory muscle effort, as well as oxygen level, and sometimes carbon dioxide level are used to determine whether apnea is due to obstruction of the airway or other causes.

Obstructive sleep apnea can sometimes be treated by simple and nonsurgical methods. In many people, weight loss can result in decreased size of the swollen tissues and eliminate the symptoms without the need for surgery or medications. Many people also respond well to Continuous Positive Airway Pressure (CPAP), a face mask that is worn at night during sleep and fits snugly over the mouth and nose. This device delivers higher pressure airflow which can help "push open" the part of the upper airway causing the obstruction. Although initially it can be difficult to get used to wearing such a device during sleep, the incentive is great for most people, as this form of treatment can also prevent the need for surgery. Finally, some people may need to be referred to a head and neck surgeon to surgically remove a portion of the excess soft tissue.

Excerpted from the Spring 1998 issue of NHF Headlines, a publication of the National Headache Foundation.

• Honestly evaluate your thoughts and feelings about headaches. If you can accept headaches as a chronic medical condition that can be managed, but for which a cure does not yet exist, you will have more realistic expectations of what can be done (and must be done) to deal with your condition. Feelings of anger, depression and frustration will be less likely to complicate the clinical picture.

• Make a commitment to develop and maintain good health habits. This includes regular sleep hours and a healthy diet.

• Use medications wisely. Medicine is a very important part of treatment, but only one part of comprehensive management of severe, persistent headaches. Keep informed about the proper use of medicine, the dangers of overuse, and the possible side effects. This knowledge will help you work with your physician to make wise decisions about your care—balancing pain relief, general health and quality of life.

• Reduce internal tensions by regular use of relaxation exercises. Relaxation training is often powerful when assisted by the use of biofeedback equipment and techniques.