A new article in Cephalgia discusses the comorbidities of sleep and headache. It is well established that the two most commmon causes of "Morning Headache" are TMJ disorders and Sleep Apnea. There is an excellent paper fron the National Heart Lung and Blood Institute on the relation of these two disorders. The paper "CCARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS" can be found at
www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf
The article in Cephalgia stated
Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa."
The two primary sleep disorders associated with headache in my experience are sleep apnea and maintenance insomnia. Maintenance insomnia is usually the result of sleep apnea/ UARS (upper airway resistance syndrome) or restless legs (periodic leg movements in sleep PLMS)
Patients pesenting with severe stree frequently have sleep onset insomnia. Chronic pain frequently leads to stress(cortisol) disorders.
Treatment of Sleep Apnea is considered the Gold Standard for Sleep Apnea but most patients do not tolerate treat and abandon it completely (up to 60%) or more commonly use it only a few hours a night which is leaves significant residual disease and risks of cardiovascular disease, excessive daytime sleepiness, tiredness, headaches and migraines.
An excellent alternative treatment for sleep apnea is an oral appliance (http://www.ihatecpap.com) It is extremely effective for Upper Airway Resistances Syndrome, Snoring Arousals, and mild to moderate sleep apnea. It has been shown to be effective in severe sleep apnea but is usually not effectively in the morbidly obese. Morbidily obese patients with headaches and migraines are probably CPAP candidates but oral appliance therapy can be used if they do not tolerate CPAP.
Treatment of Sleep Disordered Breathing can be remrkably effective in treating many types of headaches, especially morning headaches. Oral Appliances are preferred by the majority patients over CPAP when they are offered a choice. A side effect of oral appliance therapy is bite changes. Exercises taught to patients can prevent most changes but many patients chose not to do the exercises. The reason is that when the jaw is advanced for 8 hours it "heals" in this new position frequently eliminating headaches and migraines. While dentists treating sleep apnea with oral appliances usually try to prevent bite changes dentists treating patients for TMJ disorders (TMD) chronic tension headaches and migraines actually welcome bite changes.
Daytime headaches are very effectively treated with a different type of oral appliance called a neuromuscular orthotic. If the headaches are eliminated a second phase of treatment can make these changes permanent. Understanding that TMD and Sleep Apnea are different faces of the same structural/developmental disorder.
Another pertinent and timely study J Headache Pain. 2011 Aug 17. "Clinical features of headache patients with fibromyalgia comorbidity." looks at chronic heqdaches and fibromyalgia comorbidities with tension headache, chronic daily headacahe and migraine. These are
Cephalalgia. 2011 Apr;31(6):648-53. Epub 2011 Jan 10.
Headaches and sleep problems among adults in the United States: findings from the National Comorbidity Survey-Replication study.
Lateef T, Swanson S, Cui L, Nelson K, Nakamura E, Merikangas K.
Source
National Institute of Mental Health, USA. TLateef@cnmc.org
Abstract
BACKGROUND:
Several studies have demonstrated an association between headache and disturbed sleep. None have examined this association across the headache spectrum. Our goal was to determine whether migraine and migraine with aura differ from nonmigraine headache in terms of associated insomnia complaints or severity of sleep problems.
METHODS:
A probability sample of US adults was used. A structured interview administered by trained interviewers was used. Diagnostic criteria for migraine and migraine with aura were based on the International Headache Society classification. The presence or absence of four forms of sleep disturbance associated with an insomnia diagnosis was ascertained.
RESULTS:
There was a significant association between frequent severe headache, including migraine with and without aura, and disordered sleep. Adults with headache reported more frequently difficulty initiating sleep (odds ratio [confidence interval] = 2.0 [1.6-2.5]), difficulty staying asleep (2.5 [2.1-3]), early morning awakening (2.0 [1.7-2.5]) and daytime fatigue (2.6 [2.2-3.2]) and also were more than twice as likely to report three or more of these symptoms(2.5 [2-3.1]) compared to the individuals without headache.
DISCUSSION:
Adults with severe headache are at significantly higher risk of also suffering from sleep problems, when compared with the general population, regardless of specific headache type. Optimal treatment of headache must include investigation for sleep disorders and vice versa.
PubMed abstracts below:
Comment in * Cephalalgia. 2011 Apr;31(6):643-4.
J Headache Pain. 2011 Aug 17. [Epub ahead of print]
Clinical features of headache patients with fibromyalgia comorbidity.
de Tommaso M, Federici A, Serpino C, Vecchio E, Franco G, Sardaro M, Delussi M, Livrea P.
Source
Neurophysiopathology of Pain Unit, Neurological and Psychiatric Sciences Department, Medical Faculty, Policlinico General Hospital, Aldo Moro University, Neurological Building, Piazza Giulio Cesare 11, 70124, Bari, Italy, m.detommaso@neurol.uniba.it.
Abstract
Our previous study assessed the prevalence of fibromyalgia (FM) syndrome in migraine and tension-type headache. We aimed to update our previous results, considering a larger cohort of primary headache patients who came for the first time at our tertiary headache ambulatory. A consecutive sample of 1,123 patients was screened. Frequency of FM in the main groups and types of primary headaches; discriminating factor for FM comorbidity derived from headache frequency and duration, age, anxiety, depression, headache disability, allodynia, pericranial tenderness, fatigue, quality of life and sleep, and probability of FM membership in groups; and types of primary headaches were assessed. FM was present in 174 among a total of 889 included patients. It prevailed in the tension-type headache main group (35%, p < 0.0001) and chronic tension-type headache subtype (44.3%, p < 0.0001). Headache frequency, anxiety, pericranial tenderness, poor sleep quality, and physical disability were the best discriminating variables for FM comorbidity, with 81.2% sensitivity. Patients presenting with chronic migraine and chronic tension-type headache had a higher probability of sharing the FM profile (Bonferroni test, p < 0.01). A phenotypic profile where headache frequency concurs with anxiety, sleep disturbance, and pericranial tenderness should be individuated to detect the development of diffuse pain in headache patients.
PMID:
21847547
[PubMed - as supplied by publisher]
Showing posts with label sleep apnea TMD. Show all posts
Showing posts with label sleep apnea TMD. Show all posts
Monday, August 22, 2011
Monday, July 5, 2010
ARE CHRONIC HEADACHES AND SLEEP DISORDERS INTER-RELATED?
A new article "Increased Prevalence of Sleep Disorders in Chronic Headache: A Case-Control Study" in the June 2010 issue of Headache addresses this issue. The article (pubmed abstract below) concludes that "Patients with chronic headache had a high prevalence of sleep complaints. Insomnia may thus represent an independent risk factor for headache chronification. Recognition of sleep disorders, alone or in association with depression or anxiety, may be useful in episodic headache patients to prevent chronification."
This recognition of the relation of sleep disorders and chronic headache and migraine is similar to information reported by the NHLBI, National Heart Lung and Blood Institue. The article "Cardiovascular and sleep related consequences of temporomandibular disorders" details the relation of TMJ disorders and sleep apnea. Patients with sleep disorders are prone to chronic headache and headache and TMJ patients are prone to sleep disorders. Are these merely different symptom patterns of the same disorder.
Patients with sleep apnea have a small airwy when awahe that is protected by the neuromuscular system. As sleep moves o deeper phases this neuromuscular compensation fails. Sleep apnea and/or snoring then results. Clenching and Brusism occur when arousal occurs from apnea. Is bruxism and clenching a isease or pathology or is it how the body protects us from airway collapse during sleep?
It appears that sleep apnea is a TMJ disorder that is related to functional development of the oral structures and the airway.
Breastfeeding of infants and early orthodontic expansion may be the best hope of raising a generation of children with healthy cpmpetent airways. This may also be he est method of preventing developmental ADD, ADHD, and other behavioral disordes. A generation of healthier children will increase inteligence and reduce medical expenses on a yearly basis for a lifetime.
Can early treatment of sleep disorders prevent or eliminate lifetime of headaches, migraines. TMJ disorders and other medical disorders. An article in Cranio by Shimshak et al showed a 300% increase in medical expenses in every field of medicinein patients diagnosed with TMJ disorders.
Additional information on sleep apnea can be found at www.ihatecpap.com.
Headache. 2010 Jun 21. [Epub ahead of print]
Increased Prevalence of Sleep Disorders in Chronic Headache: A Case-Control Study.
Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, Grimaldi D, Cortelli P, Montagna P.
From the Department of Neurological Sciences, University of Bologna, Bologna, Italy.
Abstract
Objectives.- The aim of our study was to investigate the prevalence of sleep disorders in chronic headache patients and to evaluate the role of psychiatric comorbidity in the association between chronic headache and sleep complaints. Background.- The prevalence of sleep disorders in chronic headache has been seldom investigated, although from the earliest description chronic headache has been associated with sleep disturbances. On the contrary, mood disorders are commonly associated with both sleep disturbances and chronic headache - each of which are, in turn, core features of mood disorders. Therefore, it may be important to discriminate between sleep problems that can be attributed to a comorbid psychiatric disorder, and those specifically associated with headache. Only a few studies investigating the association of chronic headache with sleep difficulties have also taken into account to consider the possible role of anxiety and depression. Patients and Methods.- A total of 105 consecutive patients with daily or nearly daily headache and 102 patients with episodic headache, matched by age, sex, and type of headache at onset, underwent a structured direct interview about their sleep habits and psychiatric diseases. Results.- In total, 80 out of 105 patients with chronic headache received a diagnosis of medication overuse headache, 21 patients were classified as chronic migraine and 4 as chronic tension-type headache without drug overuse. Patients.- Patients with chronic headache showed a high prevalence of insomnia, daytime sleepiness, and snoring with respect to controls (67.7% vs 39.2%, 36.2% vs 23.5%, and 48.6% vs 37.2%, respectively). Forty-five patients with chronic headache (42.9%) had psychiatric comorbidity (anxiety and/or depressive disorders), vs 27 episodic headache patients (26.5%). Multivariate analysis disclosed that low educational level, lower mean age at headache onset, and insomnia are independently associated with chronic headache. Conclusions.- Patients with chronic headache had a high prevalence of sleep complaints. Insomnia may thus represent an independent risk factor for headache chronification. Recognition of sleep disorders, alone or in association with depression or anxiety, may be useful in episodic headache patients to prevent chronification.
PMID: 20572880 [PubMed - as supplied by publisher]
This recognition of the relation of sleep disorders and chronic headache and migraine is similar to information reported by the NHLBI, National Heart Lung and Blood Institue. The article "Cardiovascular and sleep related consequences of temporomandibular disorders" details the relation of TMJ disorders and sleep apnea. Patients with sleep disorders are prone to chronic headache and headache and TMJ patients are prone to sleep disorders. Are these merely different symptom patterns of the same disorder.
Patients with sleep apnea have a small airwy when awahe that is protected by the neuromuscular system. As sleep moves o deeper phases this neuromuscular compensation fails. Sleep apnea and/or snoring then results. Clenching and Brusism occur when arousal occurs from apnea. Is bruxism and clenching a isease or pathology or is it how the body protects us from airway collapse during sleep?
It appears that sleep apnea is a TMJ disorder that is related to functional development of the oral structures and the airway.
Breastfeeding of infants and early orthodontic expansion may be the best hope of raising a generation of children with healthy cpmpetent airways. This may also be he est method of preventing developmental ADD, ADHD, and other behavioral disordes. A generation of healthier children will increase inteligence and reduce medical expenses on a yearly basis for a lifetime.
Can early treatment of sleep disorders prevent or eliminate lifetime of headaches, migraines. TMJ disorders and other medical disorders. An article in Cranio by Shimshak et al showed a 300% increase in medical expenses in every field of medicinein patients diagnosed with TMJ disorders.
Additional information on sleep apnea can be found at www.ihatecpap.com.
Headache. 2010 Jun 21. [Epub ahead of print]
Increased Prevalence of Sleep Disorders in Chronic Headache: A Case-Control Study.
Sancisi E, Cevoli S, Vignatelli L, Nicodemo M, Pierangeli G, Zanigni S, Grimaldi D, Cortelli P, Montagna P.
From the Department of Neurological Sciences, University of Bologna, Bologna, Italy.
Abstract
Objectives.- The aim of our study was to investigate the prevalence of sleep disorders in chronic headache patients and to evaluate the role of psychiatric comorbidity in the association between chronic headache and sleep complaints. Background.- The prevalence of sleep disorders in chronic headache has been seldom investigated, although from the earliest description chronic headache has been associated with sleep disturbances. On the contrary, mood disorders are commonly associated with both sleep disturbances and chronic headache - each of which are, in turn, core features of mood disorders. Therefore, it may be important to discriminate between sleep problems that can be attributed to a comorbid psychiatric disorder, and those specifically associated with headache. Only a few studies investigating the association of chronic headache with sleep difficulties have also taken into account to consider the possible role of anxiety and depression. Patients and Methods.- A total of 105 consecutive patients with daily or nearly daily headache and 102 patients with episodic headache, matched by age, sex, and type of headache at onset, underwent a structured direct interview about their sleep habits and psychiatric diseases. Results.- In total, 80 out of 105 patients with chronic headache received a diagnosis of medication overuse headache, 21 patients were classified as chronic migraine and 4 as chronic tension-type headache without drug overuse. Patients.- Patients with chronic headache showed a high prevalence of insomnia, daytime sleepiness, and snoring with respect to controls (67.7% vs 39.2%, 36.2% vs 23.5%, and 48.6% vs 37.2%, respectively). Forty-five patients with chronic headache (42.9%) had psychiatric comorbidity (anxiety and/or depressive disorders), vs 27 episodic headache patients (26.5%). Multivariate analysis disclosed that low educational level, lower mean age at headache onset, and insomnia are independently associated with chronic headache. Conclusions.- Patients with chronic headache had a high prevalence of sleep complaints. Insomnia may thus represent an independent risk factor for headache chronification. Recognition of sleep disorders, alone or in association with depression or anxiety, may be useful in episodic headache patients to prevent chronification.
PMID: 20572880 [PubMed - as supplied by publisher]
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