Headache Treatment


Wednesday, August 31, 2011

Sleep Retraining with Chronic Headache

Sleep Retraining

Many patients with chronic headache of all types, but especially those with migraine, commonly experience insomnia. Research on brain changes in migraine headaches indicates that insomnia is part of the condition of migraine; that is, if you have headaches long enough, you will have trouble sleeping.

Poor sleep is much more than an inconvenience. Deep sleep is necessary for interrupting pain cycles.

All too often, patients with headache and insomnia will begin to take sleep medications which lose effectiveness over time. When this occurs, we often recommend sleep retraining.

Sleep retraining is a technique you manage yourself. It does not require pills, office visits, or special equipment. And, it is the most effective way to develop natural sleep patterns for almost all patients with headache and insomnia.

How do I do it?

The easy way that works-

1) Stay up all night.

2) Stay in bed one hour the next night.

3) Stay in bed two hours the next night.

4) Stay in bed three hours the next night.

5) Stay in bed four hours the next night.

6) Keep increasing sleep each night.

Frequently asked questions:

1) How do I choose my time to awake?

-Any time you like. Many people choose 7AM. Set your alarm clock.

2) Can I nap during the day?


3) Can I sleep late on weekends?


4) What should I do if I get off schedule?

-Restart the sleep restriction program.

5) How do I stop the sleep medications?

- Medications intended only for sleep (Ambien, zolpidem, Lunesta) can be stopped when you stay up the first night. Some medications may help with sleep and are actually used to prevent headaches, such as certain anticonvulsant medications and antidepressants, and these should be continued (such as Limbitrol, Elavil, amitriptyline, Lyrica, gabapentin).

6) I was in the bed for one hour the second night and did not sleep at all. Is this OK?

-Yes. The important part is that you gave yourself the opportunity to sleep for one hour. Eventually your body will start to naturally use the time you allow yourself in bed to achieve sleep.

7) What if I’m too sleepy to stay awake until the next night?

-The important part is that you set your alarm clock for the same time each morning; increase the time you allow yourself in bed progressively over time; and do not nap during the day. The exact schedule isn't important, and you can write yourself an easier one.

8) What if my headaches get worse?

-Withdrawal of sleep medicine may be associated with some symptoms similar to withdrawal of alcohol or other addictive substances. If the headaches are unusual in any way or persist longer than three days after withdrawal make an appointment to be re-evaluated.

9) I just can’t tolerate the schedule, it’s too strict.

-It’s fine to stretch out the schedule, just start by restricting your sleep, and progressively lengthen the time in bed.

10) I did the sleep restriction program and slept well for two weeks, then I had trouble sleeping again. What should I do?

-Some people will need to stay up once a week, once a month, once each season, or from time to time, to “re-set their brain clock”. You may only need to stay up for ½ night or a few hours.

11) Anything else I can do to help sleep?

-No lights or TV at night, stop caffeine, and keep the room cool at night. Staying active during the day. A progressive exercise program keeps you awake during the day and prepares your body to sleep that night.