Headaches and Poor Sleep: Could It Be Sleep Apnea?

Quick Takeaways:

• Morning headaches are common in people with sleep apnea and may be caused by low oxygen levels and repeated sleep disruptions during the night.¹
• These headaches often feel like pressure on both sides of the head and usually improve after treating sleep apnea.
• Continuous positive airway pressure (CPAP) therapy may reduce or eliminate headaches by keeping the airway open and maintaining steady oxygen levels.⁸
• Adopting new habits — such as sleeping on your side, maintaining a healthy weight and managing stress — can further support better sleep and, therefore, fewer headaches.^{19, 20, 21}
  
  

 Waking up with a pounding headache is a painful way to start your day. Having a lot of headaches can make it hard to focus at work, enjoy time with loved ones or simply get through your day.

 If your headaches mostly happen in the morning, they may be a symptom of sleep apnea. Sleep apnea is a condition that causes your breathing to stop and start many times while you’re sleeping. These interruptions can cause oxygen drops, which can cause frequent headaches. ² Understanding this connection between morning headaches and sleep apnea is an important first step toward understanding what might be causing your symptoms.

Headaches and sleep

Headaches tied to sleep issues can feel different depending on the cause. Sleep apnea headaches typically occur in the morning and are among the most common concerns from people living with sleep apnea. ^1,6 These headaches often feel like a pressing sensation on both sides of your head and may be accompanied by grogginess, fatigue or difficulty concentrating.

It's believed that sleep apnea-related headaches may occur due to the lack of oxygen that occurs when your breathing stops during sleep. Besides morning headaches, sleep apnea can also cause cluster headaches, tension headaches and even migraines (intense, throbbing headaches often accompanied by sensitivity to light, sound or nausea). ²² The good news is when people are diagnosed with sleep apnea and receive treatment, they may notice fewer morning headaches. ⁸

Why sleep apnea can lead to headaches

How sleep apnea affects the body

Sleep apnea causes breathing to stop and restart many times throughout the night.²³ These interruptions can make it harder for your body to get enough oxygen. During normal sleep, average blood oxygen levels are typically 96%. ³ For people with sleep apnea, these levels can drop significantly, sometimes falling lower than 88%.³ When your oxygen drops, it can cause several physical responses, including:

• Low oxygen levels (intermittent hypoxia). When the amount of oxygen in your blood drops, your brain senses the threat and activates your nervous system to wake you up, often so briefly you won't remember it. This cycle repeats throughout the night, causing people with sleep apnea to wake up feeling tired despite thinking they received a full night of rest.

• Repeated sleep disruptions and poor-quality sleep. Each time your breathing pauses and oxygen dips, your brain starts to wake up. Fragmented sleep prevents you from spending enough time in the deep, restorative sleep stages your body needs to repair itself and regulate essential functions like blood pressure, inflammation and pain sensitivity.

• Pressure changes in the head caused by breathing interruptions. When your airway is blocked and you struggle to breathe, pressure builds up in your chest and head. These pressure changes may contribute to headache pain, especially in the morning after a night of disrupted sleep.

• Stress on the nervous system (autonomic dysregulation). Sleep apnea puts your autonomic nervous system (the system that controls heart rate, blood pressure, and other automatic functions) under constant stress. This stress can trigger inflammatory responses and changes in blood vessel function that may lead to headaches.

•  Vascular and inflammatory changes may trigger headaches. Research shows that sleep apnea is associated with increased inflammation throughout the body and may affect how blood vessels function, potentially making you more likely to have headaches and migraines. ²⁸
  

   

  Types of headaches linked to sleep apnea

  Not all headaches feel the same, so understanding the differences can help you identify your headache type. While sleep apnea may not be the cause, it has been connected to several types of headaches ¹, including:

• Morning headaches. Waking up with a headache can be a common problem for people with sleep apnea. Morning headaches impacted almost 65% of individuals with sleep apnea in one study.¹ They typically occur shortly after waking up and last about 30 minutes, with pressure or tightness felt on both sides of the head. Morning headaches from sleep apnea are often accompanied by grogginess or not feeling rested.

• Migraines. People with sleep apnea may experience migraines more often or more intensely. Research indicates that 16% of people with sleep apnea also experience migraines.¹ Managing sleep apnea may help reduce how often some people have migraines.

• Tension-type headaches. These headaches feel like a band of pressure around your head and are the most common headache type overall. Sleep apnea and poor sleep quality can cause tension headaches or make them worse. About 19% of people with sleep apnea may experience tension-type headaches.²⁴

• Cluster headaches. These are less common but intense headaches that occur in groups or "clusters" over weeks or months. While research on the connection between sleep apnea and cluster headaches is limited, some evidence suggests a possible association with sleep-disordered breathing.⁷ 
  

How common are headaches in people with sleep apnea?

Headaches are a common symptom in people living with sleep apnea. Research suggests that approximately 1 in 3 people with sleep apnea experience headaches. ¹ This high rate shows how significant the connection between these two conditions might be.

Certain factors can make headaches from sleep apnea more likely. Things like age, gender, body weight, and high levels of stress can all play a role.⁸ These and other risk factors may increase your chances of having headaches, potentially even making them more frequent or severe.

For example, people living with excess weight and/or obesity may face higher risks for sleep apnea and headaches, partly because excess weight can narrow the airway and increase inflammation. Furthermore, morning headaches tend to be more common among those with certain health issues, including musculoskeletal diseases, high blood pressure, heart disease and thyroid disease.⁹

Recognising and diagnosing sleep apnea–related headaches

What makes sleep apnea headaches different?

People living with sleep apnea are more likely to have headaches.⁷ However, since sleep apnea headaches often don't feel different than a normal headache, many people may not recognise them as a symptom of sleep apnea.

A few ways to tell sleep apnea headaches apart from other types of headaches include: ²⁵

• Timing. Sleep apnea headaches are usually the worst in the morning, within the first 30 minutes after you wake up. If your headaches consistently happen at this time and improve as the day goes on, ask your doctor if sleep apnea could be the cause.
• Location and feeling. Headaches related to sleep apnea often feel like pressure or a pressing sensation on both sides of your head rather than a throbbing pain.
• Duration. Morning headaches from sleep apnea typically last from a few minutes to a couple of hours after waking. They may improve as you become more alert and your blood oxygen levels stabilise.
• Other symptoms. Headaches may be accompanied by other sleep apnea signs, like excessive daytime sleepiness, difficulty concentrating, dry mouth upon waking or gasping for air during the night (which your bed partner might notice).

• How doctors distinguish them from other headaches. Your doctor will consider the timing, pattern, and any other symptoms you may have to determine if sleep apnea could be causing your headaches.

How doctors diagnose sleep apnea

If you’re experiencing headaches that may be a symptom of sleep apnea, it’s important to talk to your doctor about how you’re feeling. Your doctor may ask a few questions to help assess your risk for sleep apnea.

If your doctor thinks you may be at risk of sleep apnea, they will prescribe a sleep test. A sleep test is more than just a tool for diagnosing sleep apnea — it paints a better picture of your health by collecting information like oxygen levels, heart rate, brain waves and breathing patterns as you sleep.

Sleep tests ²⁹can be done in a few different ways, depending on what your doctor thinks is best. Today, 60–70% of sleep tests are done at home, using devices that monitor sleep-related patterns while you sleep in your own bed. Your doctor may recommend an in-lab sleep test if you have a more complex medical history and may benefit from comprehensive sleep monitoring. These types of sleep tests are usually conducted overnight in a lab, where a trained lab technician can monitor your sleep.

Some of the information a sleep test collects while you sleep includes:

• Apnea-hypopnea index (AHI). AHI is a key measurement from a sleep study that counts how many times per hour your breathing stops (apnea) or becomes very shallow (hypopnea). Your AHI score determines the severity of your sleep apnea. Fewer than 5 events per hour is considered normal, 5 to 15 is mild sleep apnea, 15 to 30 is moderate and more than 30 is severe.¹⁰

• Oxygen desaturation index. This measures how many times per hour your blood oxygen level drops below a certain threshold, usually 90%.¹¹ Frequent oxygen drops indicate severe sleep apnea and may impact headache severity.

• Arousal index and sleep fragmentation. Your sleep test shows how often you partially wake up (or "arouse") throughout the night. Sleep fragmentation is the breaking up of your sleep into many small pieces, and a key reason sleep apnea causes daytime symptoms like headaches and fatigue.

• Sleep efficiency and sleep stages. Sleep efficiency measures the percentage of the time you spend in bed that you actually sleep. Your sleep test also tracks how much time you spend in different sleep stages (light sleep, deep sleep, and rapid eye movement (REM) sleep). Sleep apnea disrupts restorative deep and REM sleep.

•  Research on the sleep apnea–headache link  Research shows a growing body of evidence linking sleep apnea to headaches. Studies indicate that people with sleep apnea may experience headaches and migraines more often than those without sleep apnea.⁷

Brain imaging studies suggest that people with migraines may have differences in brain structure and function compared to those without migraines. Furthermore, people with chronic migraines may be more likely to experience sleep apnea.¹²

Researchers are exploring biomarkers of sleep apnea¹³ to better understand how continuous positive airway pressure (CPAP) therapy may support heart health.

Biomarkers are things in your blood or body that can show how healthy you are or if something is wrong. Researchers are also exploring how genetics may increase the chance of a person developing sleep apnea, heart disease, and migraines.

Treating sleep apnea may help reduce headache symptoms. Research shows that some adults with sleep apnea who start CPAP therapy report fewer morning headaches and migraine frequency. In one study, 72% of people with severe sleep apnea reported improvement in morning headaches .¹⁴

CPAP therapy and its benefits

Continuous positive airway pressure (CPAP) therapy is a highly effective treatment for sleep apnea ²⁶ and may help reduce morning headaches and improve migraine symptoms in some people. ⁸ CPAP therapy is designed to help people with sleep apnea breathe consistently throughout the night. It works by delivering a steady stream of pressurised air through a mask you wear while you’re sleeping.

By maintaining consistent airflow, CPAP helps oxygen levels stay stable and reduce sleep disruptions. Other related benefits and results of CPAP therapy include:

• Evidence suggests that CPAP therapy may help reduce morning headaches. Research indicates that some people with sleep apnea who use CPAP report noticeable improvements in morning headaches. One study found that headaches improved or resolved in nearly half of participants who used CPAP consistently.⁸

• Typical timeframe for sleep apnea improvement. When used as directed, some people with sleep apnea may experience symptom relief after their first night of using CPAP.¹⁵ However, for others, it can take some time to experience improvements. Talk to your doctor if you have concerns about your progress.

• Consistent CPAP use is important for results. CPAP can only work if used how your doctor prescribed it. Consistent nightly use is important for maintaining stable oxygen levels and quality sleep throughout the night. One study showed that 78% of those who regularly used CPAP saw improvement in their headaches compared to those who didn’t.¹ 

•  Other therapy options and their role.  While continuous positive airway pressure therapy is the most common treatment, other positive airway pressure therapies exist.²⁷ Bilevel positive airway pressure (BiPAP) delivers a higher level of pressure during inhalation and a lower pressure during exhalation, which some people find more comfortable. Automatic positive airway pressure (APAP) adjusts pressure automatically based on your breathing patterns.

•  Adjusting therapy for best results. Your doctor may adjust your CPAP pressure settings based on your sleep study results and how you respond to therapy. Your doctor or equipment provider can help you try different CPAP masks to find your preferred fit.
  
  

Other treatments that may help 

• Oral appliances. These custom-made devices are worn in your mouth during sleep and gently move your lower jaw forward to help keep your airway open. For people with mild to moderate sleep apnea who prefer an alternative to CPAP, oral appliances may help reduce sleep apnea symptoms like headaches.¹⁶
• Surgical treatment for sleep apnea. Surgery may be an option¹⁷ to address physical blockages in your airway, depending on the cause of your sleep apnea. Ask your doctor whether surgery might be a possible approach for improving your sleep apnea headaches.
• Positional therapy (changing sleep position). Sleep apnea often becomes worse when sleeping on your back. Positional therapy involves training yourself to sleep on your side, which may help reduce breathing pauses and support healthier oxygen levels.¹⁸ Positional therapy alone may not fully treat sleep apnea, but it may be helpful for some people with mild sleep apnea and may ease symptoms like headaches.
• Oxygen therapy. Supplemental oxygen may be prescribed alongside other sleep apnea treatments to help maintain healthy oxygen levels during sleep.
• Preventive migraine treatments for people with sleep apnea. Your doctor may recommend preventive migraine treatments, such as medications, to help reduce migraine frequency or severity. Managing your sleep apnea may also have a positive impact on your overall headache symptoms, which your doctor can monitor.
• Short-term headache medications and interactions with sleep apnea. Over-the-counter pain relievers can help manage immediate headache pain. Keep in mind that these medicines address the symptoms, not the underlying cause. Talk to your doctor about which pain medications are safe for you, especially if you have sleep apnea. Some medications can affect breathing or sleep quality.  
  
  

Lifestyle and holistic approaches

• Weight management strategies. Maintaining a healthy weight may help reduce the severity of sleep apnea symptoms, including headaches. Research shows that weight loss, though not a cure for sleep apnea, is associated with improvements in sleep apnea severity.¹⁹
• Better sleep habits and routines. Going to bed and waking up at consistent times, keeping your bedroom cool and dark, avoiding screens before bed, and limiting caffeine and alcohol in the evening are all good sleep habits that can improve overall sleep quality.
• Exercise programs that support both conditions. Regular physical activity can help reduce sleep apnea severity and improve sleep quality and overall health, potentially reducing headaches. Research suggests a 28% decrease in apnea-hypopnea index (AHI) scores in the group that added an exercise program.²⁰
• Diet considerations. A healthy, balanced diet may help support sleep quality and headache management. Avoid food that can cause headaches, such as those high in caffeine, artificial additives, or monosodium glutamate (MSG).
• Stress management, relaxation techniques, and cognitive behavioural therapy (CBT). Deep breathing, meditation, yoga, or progressive muscle relaxation can help you reduce stress, relax, and fall asleep. Cognitive behavioural therapy is often used to help manage insomnia and may also benefit people living with sleep apnea.²¹

This article is for educational purposes only and should not replace medical advice. If you have recurring headaches or migraines, consult your doctor for diagnosis and treatment.

Are you or a loved one frequently waking up with headaches? It could be a symptom of sleep apnea. Take a sleep assessment to learn more about your sleep.

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