Headaches and Sleep: Could It Be Sleep Apnea?

• 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 may improve with sleep apnea treatment.

• Continuous positive airway pressure (CPAP) therapy may help reduce headaches by keeping the airway open and maintaining steady oxygen levels. 8

• Healthy habits — such as maintaining a healthy weight and managing stress — can support better sleep and fewer headaches. 19, 20, 21

Waking up with a pounding headache is a painful way to start your day. Frequent headaches can make it hard to focus, enjoy time with loved ones, or get through daily activities.

If your headaches mostly happen in the morning, they may be linked to sleep apnea. Sleep apnea is a condition where your breathing repeatedly stops and starts while you sleep. These interruptions can lower oxygen levels and disrupt your sleep, which may contribute to headaches. 2 Understanding this connection is an important step toward finding relief.

Headaches tied to sleep problems can feel different depending on the cause. Sleep apnea headaches often happen in the morning and may feel like a pressing sensation on both sides of the head. You may also feel groggy, tired, or have trouble concentrating.

These headaches may be linked to drops in oxygen when breathing pauses during sleep. In addition to morning headaches, sleep apnea has been associated with migraines, tension headaches, and cluster headaches. 22 Many people notice fewer headaches after managing their sleep apnea.

Sleep apnea causes breathing to stop and restart many times during the night. This can make it harder for your body to get enough oxygen. During normal sleep, oxygen levels are usually around 96%, but in people with sleep apnea, they can drop below 88%. 3

These changes can lead to:

• Low oxygen levels: When oxygen drops, your brain briefly wakes you up to restart breathing. This can happen many times a night, even if you don’t remember it.

• Interrupted sleep: Frequent wake-ups prevent deep, restful sleep, which your body needs to recover and regulate functions like pain and inflammation.

• Pressure changes: Struggling to breathe can create pressure changes in your head that may contribute to morning headaches.

• Stress on the body: Sleep apnea can strain your nervous system, affecting heart rate, blood pressure, and inflammation.

• Inflammation and blood vessel changes: These changes may increase your risk of headaches and migraines.

Sleep apnea has been connected to several types of headaches:

• Morning headaches: These often happen shortly after waking and may feel like pressure on both sides of the head. In one study, about 65% of people with sleep apnea experienced them. 1

• Migraines: These are intense, throbbing headaches often paired with nausea or sensitivity to light and sound. Sleep apnea may increase how often they occur.

• Tension-type headaches: These feel like a tight band around your head. Poor sleep can trigger or worsen them.

• Cluster headaches: These are less common but very painful headaches that occur in cycles. Some research suggests a possible link to sleep apnea. 7

Headaches are common in people with sleep apnea. Research suggests about 1 in 3 people with the condition experience them. 1

Certain factors may increase your risk, including age, body weight, stress, and other health conditions like high blood pressure or heart disease. 9

Sleep apnea headaches can be hard to identify because they may feel like other types of headaches. However, some signs may help:

• Timing: Often occur in the morning, within 30 minutes of waking.

• Feeling: Usually a dull, pressing pain on both sides of the head.

• Duration: Can last from a few minutes to a few hours.

• Other symptoms: Daytime sleepiness, trouble concentrating, dry mouth, or gasping during sleep.

If you have frequent headaches, your doctor may evaluate you for sleep apnea. This often includes a sleep test, which tracks your breathing, oxygen levels, and sleep patterns.

Sleep tests can be done at home or in a lab. Many people now use home tests, while in-lab studies are used for more complex cases. 28

A sleep test may measure:

• Apnea-hypopnea index (AHI): The number of breathing interruptions per hour. This helps determine severity.

• Oxygen levels: How often oxygen drops during sleep.

• Sleep interruptions: How often you wake up during the night.

• Sleep stages: How much time you spend in light, deep, and REM sleep.

Research shows a growing connection between sleep apnea and headaches. People with sleep apnea may experience headaches and migraines more often than those without it. 7

Treating sleep apnea may help reduce headache symptoms. Some people report fewer morning headaches after starting CPAP therapy.

CPAP therapy is a common and effective treatment for sleep apnea and may help reduce headaches. 8 It works by delivering steady air pressure through a mask to keep your airway open while you sleep.

Other benefits may include:

• More stable oxygen levels during sleep

• Fewer sleep interruptions

• Better overall sleep quality

Consistent use is key. Some people notice improvements quickly, while for others it may take time. Talk to your doctor if you have concerns.

Other PAP options include BiPAP and APAP, which adjust airflow differently to improve comfort.

While CPAP is the most common treatment, other options may include:

• Oral appliances: Devices that help keep your airway open during sleep.

• Surgery: In some cases, procedures may help remove airway blockages. 17

• Positional therapy: Sleeping on your side may reduce symptoms. 18

• Oxygen therapy: May be used in certain situations to support breathing.

Healthy habits can also support better sleep and fewer headaches:

• Weight management: Maintaining a healthy weight may reduce sleep apnea severity. 19

• Sleep habits: Keep a consistent sleep schedule and create a comfortable sleep environment.

• Exercise: Regular activity can improve sleep and overall health.

• Diet: Eat a balanced diet and avoid foods that may trigger headaches.

• Stress management: Techniques like meditation or cognitive behavioral therapy (CBT) can help reduce stress and improve sleep. 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.

• Source: Tripakornkusol V et al Phenotypes of headache in patients with obstructive sleep apnea https://pmc.ncbi.nlm.nih.gov/articles/PMC11807175/

• Source: National Heart Lung and Blood Institute Symptoms of sleep apnea https://www.nhlbi.nih.gov/health/sleep-apnea/symptoms

• Source: Talwar A et al Overnight pulse oximetry https://pmc.ncbi.nlm.nih.gov/articles/PMC7065557/

• Source: American Heart Association Obstructive sleep apnea and cardiovascular disease https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000000988

• Source: Pergolizzi JV et al Sleep and cluster headache https://pmc.ncbi.nlm.nih.gov/articles/PMC7648820/

• Source: Johnson KG et al CPAP and headaches https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2012.02251.x

• Source: Ohayon MM Morning headaches prevalence https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/216451

• Source: American Medical Association Sleep apnea severity https://qpp.cms.gov/docs/QPP_quality_measure_specifications/CQM-Measures/2023_Measure_277_MIPSCQM.pdf

• Source: Kong D et al Oxygen desaturation index https://pmc.ncbi.nlm.nih.gov/articles/PMC10250969/

• Source: Torres Ferrus M Migraine and sleep apnea https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-01111-8

• Source: Montesi SB Biomarkers of sleep apnea https://pmc.ncbi.nlm.nih.gov/articles/PMC3418859/

• Source: Seo MY Improvement of morning headache with PAP https://pmc.ncbi.nlm.nih.gov/articles/PMC10480153/

• Source: Djonlagic I First night CPAP effects https://pmc.ncbi.nlm.nih.gov/articles/PMC5238960/

• Source: Park JW Oral appliance and headaches https://www.nature.com/articles/s41598-021-82041-6

• Source: Maurer JT Surgical treatment sleep apnea https://pubmed.ncbi.nlm.nih.gov/20842037/

• Source: Ravesloot MJ Positional therapy https://jcsm.aasm.org/doi/full/10.5664/jcsm.6622

• Source: Hudgel DW Weight management sleep apnea https://pubmed.ncbi.nlm.nih.gov/30215551/

• Source: Mendelson M Exercise and sleep apnea https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00073/full

• Source: Sweetman A CBT and sleep apnea https://pmc.ncbi.nlm.nih.gov/articles/PMC7231124/

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