Migraine and the Importance of Good Sleep Hygiene

Methought I heard a voice cry ‘Sleep no more! Macbeth does murder sleep’, the innocent sleep, Sleep that knits up the ravell’d sleeve of care, The death of each day’s life, sore labour’s bath, balm of hurt minds, great nature’s second course, chief nourisher in life’s feast,” – Macbeth Act II, Scene II by William Shakespeare 

Sleep and sleeplessness echo across William Shakespeare’s works. The word “sleep” appears at least once in each of his plays and the plays with the most uses of the word “sleep” (including stage directions) are Macbeth (23), Richard III (19), and A Midsummer Night’s Dream (18).” – Smith, Sarah C. 2016. “Turn His Sleep to Wake:” Sleeplessness in Macbeth. Master’s thesis, Harvard Extension School. 

A wise man the bard! William Shakespeare knew how important sleep was to a healthy life. He called it the ‘balm of hurt minds’, the ‘chief nourisher in life’s feast’! Indeed, in Elizabethan times, poor sleep practices were often thought to be the causes of physical and psychological illnesses so even back then good sleep hygiene was recognised as extremely important.  

Today, that is still the case, and although it doesn’t necessarily cause ailments, bad sleep hygiene can exacerbate or contribute to illness and makes it more difficult to cope with.  

According to the American Migraine FoundationPeople living with migraine are between 2 and 8 times more likely to experience sleep disorders, compared with the general public. Those living with chronic migraine report having almost twice the rates of insomnia as those with less frequent headaches. These higher-than-normal rates are due to migraine comorbidities and some migraine lifestyle factors that make good sleep harder to achieve.”   

So basically… your body needs sleep, and getting a consistent and adequate amount of sleep can provide the basis for healthier living and fewer migraine attacks 

Why is sleep so important?

Healthy sleep is necessary for everyone to function properly. Our bodies need long periods of sleep, not just rest – to rejuvenate, to grow, to heal and repair, and to synthesize hormones. (Listen to Dr. Sabina Brennan’s fascinating Podcast on how melatonin works – link is below after tips) Sleep is also essential for us to properly absorb the information we’re picking up constantly when we’re awake. Our brain is like a massive computer which captures everything we see, hear, smell, taste, experience, etc and even some things that we’re completely unaware of. We can’t process all of that information straight away so it’s held to one side until the brain gets time to filter it, sort it into the relevant folders and put it away in the filing cabinets of our memories for when it’s needed. Sleep helps us to do this. While we’re asleep the brain is busy sorting all of our experiences between long-term memory, short-term memory and filtering out what’s needed and not needed (spam folder).

Scientists believe that this may help to explain why children need more sleep than adults. Children learn languages, social skills, fine motor skills, etc., very quickly as they grow. We’ve often called children sponges and said that childhood is the best time to learn a language, well this may be why they require so much more sleep than the rest of us, they have so much more information to process. They’ve also been known to take a stretch in height when they sleep for a long period of time, such as during a cold. Researchers have also shown that after adult people sleep, they tend to retain information and perform better in memory tests.

To get to this stage however, we need to reach what’s called REM Sleep – REM sleep is important to your sleep cycle because it stimulates the areas of your brain that are essential for learning and retaining memories. “REM stands for Rapid Eye Movement. During this cycle of your sleep, your eyes will move and dart quickly beneath your eyelids. Usually, REM sleep happens 90 minutes after you fall asleep. The first period of REM typically lasts 10 minutes. Each of your later REM stages gets longer, and the final one may last up to an hour. Your heart rate and breathing quickens. You can have intense dreams during REM sleep, since your brain is more active. Babies can spend up to 50% of their sleep in the REM stage, compared to only about 20% for adults.” WebMD

I can’t help but wonder if dreams are sometimes something the brain puts on to distract us while the brain is sorting things, like us putting the TV on to distract the kids while we’re making dinner!

What happens if we don’t get enough good sleep?

Missing a night here and there is not a major problem, but consistently missing or losing out on sleep can have some major consequences…

  • We may experience memory problems, or they may get worse, we can’t concentrate or remember something from the day before because it wasn’t put away in the correct folder
  • Pain feels stronger and we’re less able to cope with it
  • Over time, depression can sneak in and spread
  • We run the risk of high blood pressure, obesity, diabetes, a weakened immune system
  • We look and feel terrible with dark circles under our eyes and aged skin
  • We over-eat, and we eat and drink the wrong things – such as energy drinks to help us make it through the day. The main ingredient in many of these drinks is caffeine!
  • We can become irritable and even angry as time goes by
  • It kills the sex drive, although having no energy, being sleepy, and increased irritability or snippiness may also have something to do with it!
  • We become careless and cause accidents because we can’t concentrate and we drift off or even doze at the wrong time – as in behind the wheel of a car

Looking at all of this, it’s no wonder that sleep deprivation is allegedly used by some as a torture technique.

So how do I practice good Sleep Hygiene? 

There are some tips to help answer this below, but first, have a look at a chart from the US National Sleep Foundation on how many hours we’re supposed to get per night. Of course, this is the ideal, but how many of us are getting anywhere close to what we’re supposed to be getting? 

Click on chart for larger version

So on with the tips 

  • Try to go to bed and get up at the same time each day, even (unfortunately) at the weekends or on days off, as this helps your circadian rhythm to keep working properly 
  • Spend some time outside in fresh air and in natural daylight, as this also helps with your circadian rhythm. It also exposes you to vitamin D which helps your immune system, keeps your bones strong and is said to reduce depression – although if you’re from here in Ireland you may need some extra help with this – discuss vitamin supplements with your doctor!
  • Make your bedroom as restful as possible, like making sure it’s dark enough, quiet, has comfortable bedding and has the minimum amount of technology (TV only)
  • Turn off technology or stop using screens about two hours before bedtime. The blue light from phones, TVs, and computers disrupts the body’s natural rhythm
  • Exercise before dinner instead of before bed 
  • Stop smoking as nicotine is a stimulant and suppresses melatonin which is released to tell your brain that it’s time to get ready for sleep
  • Avoid caffeine and/or alcohol before bed, in fact try to avoid caffeine as early as possible before you go to bed. Caffeine has a half-life of about 5 hours which means it takes that long for your body to eliminate half of the caffeine you’ve ingested.
  • Unwind Early – Take a warm bath, or if you don’t have a bath have a soothing foot bath, put on your pjs, have a cup of tea (non-caffeinated), read a book, dim the lights earlier than usual  
  • Keep your mind quiet – try gentle mindfulness or meditation exercises before bed, or use breathing exercises to help you to fall asleep fast  
  • Don’t count sheep – it’s a myth and can end up being more annoying rather than soothing! 
  • If you’re suffering from Hormonal migraine and/or Menopausal related migraine, insomnia may come with it. It might be worth asking your doctor about low-dose contraceptives or antidepressants, or even looking at putting you on a course of melatonin
  • If nothing helps and you’ve tried everything, then you can speak to a medical expert about other medication or supplements that may help, or you could see about seeing a psychotherapist or counsellor for cognitive behaviour therapy and other aids to sleep 

For some really fascinating information on how sleep works, as well as great tips for good sleep hygiene, listen to Dr. Sabina Brennan’s excellent Podcast Superbrain – Booster 7 – Sleep, Dreams and Covid-19 

Can sleep directly affect migraine?

According to a recent study undertaken in South Korea, yes it can. They concluded that “poor sleep quality can directly increase the headache-related impact in both patients with migraine and Tension Type Headache (TTH) as well as indirectly by increasing the headache frequency and severity in patients with migraine”.  They also theorise that “Poor sleep quality may contribute to alterations in the neuro-endocrine stress response system and metabolic activity during sleep, resulting in impaired daytime function” This refers to the release of hormones as mentioned above and in Dr. Brennan’s podcast!

Unfortunately the most common time for migraine to occur is early in the morning. People are vulnerable during the early morning because most OTC pain killers wear off in about 4-8 hours, especially if they’re being overused. Many people will be asleep too when the attack begins and may miss the best time to take migraine specific medications such as triptans, making them less effective. 

Obviously you can’t take triptans preventatively, however, if you do take triptans then have them beside you in your room in case you do wake up and need them. You can take a triptan along with one paracetamol, one ibuprofen and one motilium if you experience nausea if you need to, once you’ve okayed this with the doctor. See the 8 DAY PLAN created by the Migraine Clinics in Dublin to help you juggle your acute medication.

If you suffer chronically and take a preventative medication, but experience migraine overnight or upon waking, then it might be worth speaking to your doctor about trying various timings with your medication. Maybe taking them closer to your regular bedtime will help to see you through the night.

Much of helping medication to work for you (both acute and preventative) is about timing. If you can get the timing right for you then your medication may work more effectively. This timing however differs for everyone and like spotting triggers can be one of the more difficult things about having migraine.

If you do experience migraine through the night or wake up with them, then it might be worth taking a look at your food intake. 5 – 8 hours (if you get that long) is a long time for a migraineur to go without eating, we’re told not to go longer than a couple of hours without eating during the day, so if we’re not eating for at least 5 – 8 hours then this may be a trigger for night-time or morning migraine. It might be worth experimenting with having something to eat about an hour or half an hour before bed to tide you over. However, it should be something light like a bowl of cereal or some cream crackers (no cheese, as it can cause nightmares as well as being a trigger for some migraineurs), nothing too heavy as this will sit in your stomach all night and could be very uncomfortable, making your sleep even worse!

There are some other headache disorders that are linked to sleep – the most common are; 

Hypnic Headache 

Hypnic headache is a rare, primary headache disorder characterized by frequently occurring headaches that happen only during sleep. Sometimes known as “alarm clock” headaches because they occur at night and awaken the person from a sound sleep, these headaches can last between 15 minutes and 4 hours. Although these headaches usually occur without any other symptoms, some people report migraine-like symptoms like nausea, light or sound sensitivity that accompany their headache. Believe it or not, this is the one time when it is sometimes recommended to drink a cup of coffee before bedtime, as caffeine has been known to reduce or keep hypnic headache at bay 

Cluster Headache 

Cluster headaches are another primary headache that may develop during sleep.  These excruciatingly severe attacks often develop within an hour of falling asleep.  The pain tends to be most severe in, around or behind one eye, they can last from 20 minutes to 3 hours and are associated with drooping of theyelid, redness or tearing of the eye, or running or stuffiness of the noson the side of the pain. 

For more detailed information on the relationship between sleep and migraine see an earlier post from our website 

Here are some resources for Brain Health, Sleep and Sleep Deprivation