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Breathing and sleep

Disturbed sleep and morning headaches

Broken or unrefreshing sleep, sometimes with headaches on waking, which in ALS/MND can be a sign that breathing changes during sleep.

Still being checked

What this is

Breathing muscles work hardest when you lie down and relax, so night-time breathing often changes before daytime breathing does. That makes poor sleep and a headache on waking worth reporting as breathing symptoms rather than only as sleep problems. Sleep can also be broken by pain, cramps, saliva or needing help to move, and each of those has something that helps it.

What people often describe

  • Waking several times and not knowing why
  • A headache in the first hour after waking that clears through the morning
  • Feeling you have slept without feeling rested
  • Falling asleep during the day when you did not use to
  • Needing more pillows, or sleeping more upright than you used to

Important distinctions

  • Night-time breathing changes often show up as poor sleep before they show up as breathlessness during the day. If you are breathless when lying flat, start there.

  • Tiredness that a night of sleep does not fix is a different problem from sleep that is broken. Both are common, and telling your team which one you have helps them look in the right place.

What may help

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Practical and self-management

Things people do themselves, or with whoever is helping them.

  • Sleep habits and a comfortable room

    Good sleep habits and a comfortable room. Worth doing alongside the rest rather than instead of it, because they will not fix a breathing cause.

    Discuss with

    Compass explains

Medicines

Named here only where a guideline names them for this problem.

  • Reviewing the medicines you already take

    Some medicines disturb sleep and some make daytime sleepiness worse. A review is often the quickest thing to try, and it matters more here because sedating medicines carry more weight when breathing muscles are weak.

    • Tell your team about any night-time breathing or sleep symptoms before a new medicine is started, rather than afterwards, and ask how the choice takes your breathing into account.

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    Compass explains

Equipment

Devices and physical aids.

  • Non-invasive ventilation

    Where breathing during sleep is the cause, breathing support is what changes it. Where bulbar or cognitive problems are severe, a trial is considered only if it is likely to improve sleep-related symptoms or correct a build-up of carbon dioxide.

    Highlighted: shows the sources for this statement

    Discuss with

    Compass explains

  • Adjustable profiling bed

    Supportive bedding, an adjustable bed and help changing position, so that comfort is not what is waking you.

    Discuss with

    Compass explains

Procedures

Things done in a clinical setting, usually after a referral.

  • A sleep assessment

    The test that answers whether breathing during sleep is behind this. NICE lists disturbed sleep, morning headaches and daytime sleepiness among the symptoms teams monitor for breathing changes.

    Highlighted: shows the sources for this statement

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    Compass explains

When to get this looked at sooner

Disturbed sleep, morning headaches and daytime sleepiness are on the list of breathing changes worth telling your team about, rather than waiting for the next scheduled review.

Highlighted: shows the sources for this statement

Who may help

Where Compass explains this

Questions

Cards

Other problems

Words explained

About this page

This page lists options that are used for this problem and says where each one comes from. It is not a ranking, it is not a recommendation, and it is not personalised to you. What suits you is a decision for you and your care team.

Evidence for this page

The sources behind the statements on this page, and where to find them. Compass does not decide which option is right for anyone.

  1. Statement 1 of 3. Where breathing during sleep is the cause, breathing support is what changes it. Where bulbar or cognitive problems are severe, a trial is considered only if it is likely to improve sleep-related symptoms or correct a build-up of carbon dioxide.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      A restriction rather than a permission. Where bulbar or cognitive problems are severe, NICE says to consider a trial ONLY IF the person may benefit from an improvement in sleep-related symptoms or correction of hypoventilation.

      “Consider a trial of non-invasive ventilation for a person who has severe bulbar impairment or severe cognitive problems that may be related to respiratory impairment only if they may benefit from an improvement in sleep-related symptoms or correction of hypoventilation.”

      1.15.18

      Link checked August 2026

    • Supports this. Guidelines for the physiotherapy management of MND — Irish Motor Neurone Disease Association · Clinical guideline · 2014

      An MND physiotherapy guideline reports that breathing support has been shown to improve symptoms including headaches, restlessness and poor quality sleep.

      “Assistive devices such as NIV have been shown to improve hypercapnic symptoms such as headaches, restlessness, nightmares and poor quality sleep, and therefore improve QOL in patients with MND (Lou et al. 2010).”

      Section 3.4e.2 Evidence, FF

      Link checked August 2026

  2. Statement 2 of 3. The test that answers whether breathing during sleep is behind this. NICE lists disturbed sleep, morning headaches and daytime sleepiness among the symptoms teams monitor for breathing changes.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      NICE tells teams to monitor a listed set of symptoms and signs to detect respiratory impairment. Disturbed sleep, morning headaches and daytime sleepiness are among them.

      “Monitor the symptoms and signs listed in table 1 to detect potential respiratory impairment.”

      1.15.7

      Link checked August 2026

  3. Statement 3 of 3. Disturbed sleep, morning headaches and daytime sleepiness are on the list of breathing changes worth telling your team about, rather than waiting for the next scheduled review.

    • Supports this. NICE MND guideline — NICE · Clinical guideline

      Republished from the Compass answer "How do I get symptoms reviewed and treated?", where this statement is already mapped to this source.

      “Monitor the symptoms and signs listed in table 1 to detect potential respiratory impairment.”

      1.15.7

      Link checked August 2026