I was thinking about something last night while I was lying in bed trying to adjust my sleep apnea mask so that it wouldn't annoy the nerves in my left cheek.

My cluster headaches and sleep apnea were both diagnosed in 2010 -- although I have suffered from both for years. Although many people suffer from sleep apnea, mine is a problem because my O2 sats drop to about 80%.  While going through the sleep study process, I distinctly remember thinking that it would be so nice if the CPAP machine blew oxygen into my nose instead of just plain old air.  You know how sometimes you crave something  -- like oranges, for instance, if your body needs vitamin C?  I was wondering last night if I somehow knew back then that my brain really wanted some straight oxygen to help with my cluster headaches.

Anyway, I just think it's ironic that I get three daily cluster headaches; the beast appears between 10AM and 11:30AM, and at 12:30AM and 4AM like clockwork.  I can't help but wonder if there is some connection between my apnea and the cluster headaches.  Of course, as we all know, there may not be a connection at all!    It's just interesting that they both have to do with oxygen -- one with a deprivation of oxygen and one with using it as a treatment.

The one thing that really stinks is that the apnea mask is difficult to use since it lays across my cheek.  It's nearly impossible to find a spot where it's not aggravating a nerve while keeping the make from leaking.     I have a feeling that surgery is imminent to correct the soft palate issue so that I won't have to use the mask.  Not a big deal.  Definitely better than having something laying against the nerves in my cheek and below my ear!   

My question is this:  do any other clusterheads happen to have sleep apnea?

Curr Treat Options Neurol. 2010 Jan;12(1):1-15.

Sleep and headache.
Rains JC, Poceta JS.

Center for Sleep Evaluation, Elliot Hospital, One Elliot Way, Manchester, NH, 03103, USA, jrains@elliot-hs.org.

Abstract
OPINION STATEMENT: Headache has been linked to a wide range of sleep disorders that may impact headache management. THERE ARE NO EVIDENCE-BASED GUIDELINES, BUT THE AUTHORS BELIEVE THAT LITERATURE SUPPORTS THE FOLLOWING CLINICAL RECOMMENDATIONS:

1. Diagnose headache according to standardized criteria. Specific diagnoses are associated with increased risk for specific sleep and psychiatric disorders. 2. Collect sleep history in relation to headache patterns. Screening questionnaires and prediction equations are cost-effective. 3. Rule out sleep apnea headache in patients with awakening headache or higher-risk headache diagnoses (cluster, hypnic, chronic migraine, and chronic tension-type headache); patients with signs and symptoms of obstructive sleep apnea warrant polysomnography and treatment according to sleep medicine practice guidelines. There is no evidence for suspending conventional headache treatment in suspected or confirmed cases of sleep apnea. Treatment of sleep apnea with CPAP may improve or resolve headache in a subset of patients. The impact on sleep apnea headache of other treatments for sleep apnea (eg, oral appliances, surgery, weight loss) is largely untested. At a minimum, sedative-hypnotic drugs should be avoided in suspected apneics until the sleep apnea is treated. 4. Among patients with migraine and tension-type headache, insomnia is the most common sleep complaint, reported by one half to two thirds of clinic patients. Patients who suffer from chronic migraine or tension-type headache may benefit from behavioral sleep modification. Pharmacologic treatment may be considered on a case-by-case basis, with hypnotics, anxiolytics, or sedating antidepressants used to manage insomnia, tailoring treatment to the symptom pattern. 5. Individuals with chronic headache are at increased risk for psychiatric disorders. Assessment for depression and anxiety may be warranted when either insomnia or hypersomnia is present. Psychiatric symptoms affect the choice of sedating versus alerting versus neutral pharmacologic agents for headache. 6. All headache patients, particularly those with episodic migraine and tension-type headaches, may benefit from inclusion of sleep variables in trigger management.

PMID: 20842485 [PubMed]
=============
Headache. 2003 Mar;43(3):282-92.
Erratum in:
Headache. 2004 Apr;44(4):384.

Clinical, anatomical, and physiologic relationship between sleep and headache.

Dodick DW, Eross EJ, Parish JM, Silber M.

Department of Neurology, Mayo Clinic, Scottsdale, Ariz. 85259, USA,

The intimate relationship between sleep and headache has been recognized for centuries, yet the relationship remains clinically and nosologically complex. Headaches associated with nocturnal sleep have often been perceived as either the cause or result of disrupted sleep. An understanding of the anatomy and physiology of both conditions allows for a clearer understanding of this complex relationship and a more rational clinical and therapeutic approach. Recent biochemical and functional imaging studies in patients with primary headache disorders has lead to the identification of potential central generators which are also important for the regulation of normal sleep architecture. Medical conditions (e.g. obstructive sleep apnea, depression) that may disrupt sleep and lead to nocturnal or morning headache can often be identified on clinical evaluation or by polysomnography.

In contrast, primary headache disorders which often occur during nocturnal sleep or upon awakening, such as migraine, CLUSTER HEADACHE, chronic paroxysmal hemicrania, and hypnic headache, can readily be diagnosed through clinical evaluation and managed with appropriate medication. These disorders, when not associated with co-morbid mood disorders or medications/analgesics overuse, seldom lead to significant sleep disruption. Identifying and classifying the specific headache disorder in patients with both headache and sleep disturbances can facilitate an appropriate diagnostic evaluation. Patients with poorly defined nocturnal or awakening headaches should undergo polysomnography to exclude a treatable sleep disturbance, especially in the absence of an underlying psychological disorder or analgesic overuse syndrome. In patients with a well defined primary headache disorder, unless there are compelling historical or examination findings suggestive of a primary sleep disturbance, a formal sleep evaluation is seldom necessary.

PMID: 12603650
============================================

Cephalalgia. 2005 Jul;25(7):488-92.

Investigation into sleep disturbance of patients suffering from cluster headache.

Nobre ME, Leal AJ, Filho PM.

Department of Neurology, Universidade Federal Fluminense, Niterói, Brazil. menobre@rjnet.com.br

The new discoveries relating to cluster headache (CH) encouraged the study of the relationship of the hypothalamus to respiratory physiology and its comorbidity with sleep apnoea. The question is whether the apnoeas are more frequent during REM sleep and the desaturations could be involved as triggers of the cluster attacks. Furthermore, could the connection with the hypothalamus, already proved, be responsible for an alteration in the structure of REM sleep and a chemoreceptor dysfunction. We set out to analyse when polysomnography investigation is necessary in patients with CH. We studied 37 patients suffering from episodic CH, 31 (83.8%) men and six (16.2%) women. For the control group, we selected 35 individuals, 31 (88.6%) men and four (11.4%) women.

There was a greater percentage of obstructive sleep apnoea (OSA) in patients with CH (58.3%) compared with the control group (14.3%) and with the general population (2-4%). In cases of pain during sleep, the majority is deflagrated during the REM phase, following a desaturation episode. A stratified analysis of the apnoea/hypnoea index relating to body mass index (BMI) and age showed that patients with CH have 8.4 times more chance of exhibiting OSA than normal individuals (P < 0001). This risk increases to 24.38 in patients with a BMI > 25 kg/m(2) and increases to 13.5 in patients > 40 years old. Surprisingly, the risk decreases sharply in patients with a BMI < 25 kg/m(2) and who are < 40 years old. Due to the fact that polysomnography is a complex, costly and sometimes difficult examination, we suggest, in concordance with the results, that it should be carried out routinely in patients with CH that exhibit a BMI of > 25 kg/m(2) and/or in patients who are > 40 years of age.

Publication Types:
Clinical Trial
Controlled Clinical Trial
PMID: 15955035 [PubMed]
=====================================

Headache. 2006 Oct;46(9):1344-63.
Headache and sleep disorders: review and clinical implications for headache management.

Rains JC, Poceta JS.

Center for Sleep Evaluation, Elliot Hospital, Manchester, NH 03103, USA.

Review of epidemiological and clinical studies suggests that sleep disorders are disproportionately observed in specific headache diagnoses (eg, migraine, tension-type, cluster) and other nonspecific headache patterns (ie, chronic daily headache, "awakening" or morning headache). Interestingly, the sleep disorders associated with headache are of varied types, including obstructive sleep apnea (OSA), periodic limb movement disorder, circadian rhythm disorder, insomnia, and hypersomnia. Headache, particularly morning headache and chronic headache, may be consequent to, or aggravated by, a sleep disorder, and management of the sleep disorder may improve or resolve the headache. Sleep-disordered breathing is the best example of this relationship. Insomnia is the sleep disorder most often cited by clinical headache populations. DEPRESSION AND ANXIETY ARE COMORBID WITH BOTH HEADACHE AND SLEEP DISORDERS (ESPECIALLY INSOMNIA) AND CONSIDERATION OF THE FULL HEADACHE-SLEEP-AFFECTIVE SYMPTOM CONSTELLATION MAY YIELD OPPORTUNITIES TO MAXIMIZE TREATMENT. This paper reviews the comorbidity of headache and sleep disorders (including coexisting psychiatric symptoms where available). Clinical implications for headache evaluation are presented. Sleep screening strategies conducive to headache practice are described. Consideration of the spectrum of sleep-disordered breathing is encouraged in the headache population, including awareness of potential upper airway resistance syndrome in headache patients lacking traditional risk factors for OSA. Pharmacologic and behavioral sleep regulation strategies are offered that are also compatible with treatment of primary headache.

Publication Types:
Review
PMID: 17040332 [PubMed]
======================================

Cephalalgia. 2008 Feb;28(2):139-43. 
Refractory chronic headache associated with obstructive sleep apnoea syndrome.

Mitsikostas DD, Vikelis M, Viskos A.

Athens Naval Hospital, Neurology Department, Athens, Greece. dmitsikostas@ath.forthnet.gr

The aim was to investigate the comorbidity of chronic refractory headache with obstructive sleep apnoea syndrome (OSAs). Seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography. Patients diagnosed with OSAs (respiratory disturbance index > 10) began continuous positive airway pressure (C-PAP) treatment and were followed up for >or= 6 months. Twenty-one cases of OSAs were identified (29.2% of the total investigated, 13.7% of the women and 66.6% of the men). Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent (nine and six of the 21 cases, respectively). In one case (1.4% of the total sample, 4.7% of all the men), the criteria for hypnic headache were fulfilled. Multivariate regression analysis revealed that age, male gender and body mass index were associated with OSAs. C-PAP treatment improved both sleep apnoea and headache in only a third of the cases. Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed.

PMID: 17999682 [PubMed]
=====
=====

Curr Pain Headache Rep. 2009 Apr;13(2):160-3.

Cluster headache and obstructive sleep apnea: are they related disorders?
Graff-Radford SB, Teruel A.

The Pain Center, Cedars-Sinai Medical Center, 444 South San Vicente, #1101, Los Angeles, CA 90048, USA. graffs@cshs.org

Abstract
Patients with cluster headache (CH) have a higher prevalence of sleep apnea, and a possible relationship between these two conditions has been proposed. Although patients suffering from CH attacks often wake up from sleep, sleep apnea has been suggested to be a trigger or an associated abnormality in CH. It has been proposed that regulation of the hypothalamus may be responsible for sleep apnea, and that similiarly CH is generated in the hypothalamus. However, there is evidence that CH and obstructive sleep apnea are not causal, but rather parallel processes both generated in the hypothalamus. The exact role that sleep apnea plays in the perpetuation or precipitation of CH is still to be determined. This paper discusses the proposed pathophysiological mechanisms of these two entities and the possible relationship between CH and sleep apnea.

PMID: 19272283 [PubMed]

I don't get sleep apnea, although my partner does. So I'm not sure how that helps or confuses things. She does claim that I snore, although I've never heard it myself.

Last night was her very first night with a CPAP machine, so looking now at the bedside tables, she has her CPAP mask and I've my non-rebreather mask. Now it'll be quite a sight when we're both using them together!

I'm really hoping that it'll make a huge difference to her sleep, although last night wasn't great for her as it obviously takes a bit of getting used to. If anyone has any hints or tips I'd love to be able to pass them on to her.

Mike NZ wrote on Mar 18^th, 2011 at 4:34pm:

My only piece of advice is to use a nasal pillow system as soon as possible. When I look back on the first couple of years (I started with a full nose/mouth mask, then went to a nasal mask, then finally to a nasal pillow system), it's amazing I stuck with it. Now I won't even lay back in an easy chair if there's a chance I'll fall asleep. I go to where my CPAP is. I rely on it that much.

My CPAP doc always gives me the proverbial prize for being her most compliant CPAP patient. I average over 7 hours per day on it.

I had a sleep study test done last night and they said I have sleep apnea and need a cpap machine.  I got to try one one and use it for half of my sleep last night.  I felt so alive and good when I woke up.  I have to wait for my dr to get the report and a followup apt to get my cpap.  I can't wait.
     I certainly can relate to nights spent on the couch due to snoring and stopping breathing.  Drives Ted crazy.  He is the one who mandated that I get the study done.  It will be nice to get my bed back.

If I understood what Bob posted, then CHers display a much higher percentage for sleep apnea than does the general population, but whether or not the two have a causal relationship or a parallel relationship is still unknown? So should we all engage in sleep studies? Curious that the last study was in 2009. Bob, any more recent studies? Color me curious. lance

I too use the nasal pillow cpap mask.  Interesting that CH and sleep apnea originate in the same part of the brain Hyp...

but I see more evidence of a stronger relationship  (in me at least) between disturbed sleep schedules (I have to pull all-nighters from time to time, and often only get 3-4 hours of sleep due to work) and seasonal changes than anything.

Welcome to the board Mike. I did many years on shift work, changing from days to nights or nights to days, while on cycle, was an a$$ kicker for me!

Sorry to hear the beast is back, you got your oxygen and other meds at the ready?

Joe