What's new about sleep?

Journal of the American Chiropractic Association, Sep 2001

Without the daily restorative of sleep, life takes on a raw edge -a feeling that millions know all too well. Chiropractic, in combination with complementary and alternative therapies, has proven effective in diagnosing sleep disorders and delivering treatments that offer the promise of a better night's sleep.

Traditional Chiropractic and Chiropractic Neurology

"Sleep disorders are prevalent and often disabling, but most are diagnosable and effectively treatable using chiropractic applications," says Frederick R. Carrick, DC, PhD, DACAN, DABCN, DACNB, FACCN, and president of the ACA Council on Neurology. "Sleep is one of the most important functions of the brain. The ability of the nervous system to regulate sensory input is considered a prerequisite to sleep. Specific areas of the brain change in their function to prevent transmission of sensory information that might keep us awake. Patients suffering from pain or other sensory conditions that contribute to a continual activation of the brain may have difficulty sleeping."

Because sleep disturbances are a nervous system-modulated event, the whole system needs to be considered. "Insomnia, for example, includes looking at blood glucose levels and oxygen delivery systems that affect the central state of all nerve cell functions, especially the brain," says neurology specialist Gail Henry, DC, DABCN, DACNB. "We need to determine whether the brain is hyper-excitable and cannot settle down to sleep. Or perhaps the person has poor fuel delivery to where the brain is more depressed, and he or she cannot get enough sleep. We need to address anything that will affect the central state of the brain." Research into the nature of sleep has helped doctors see that it is more than the passive absence of wakefulness, as once perceived. "Today, we understand that we live in three completely different states of being: wakefulness, non-rapid eye movement (NREM) sleep, and rapid eye movement (REM) sleep," Dr. Carrick explains. "The control and expression of these states of being are complex, with no single specific area in the nervous system in control of all aspects. Rather, they are the result of dynamic interactions among multiple neurological networks and environmental factors. Almost all portions of the nervous system are active across all three states of being at different levels -so that an individual with a neurological problem has a high probability of suffering from a sleep disorder."

Insomnia is the most common of all sleep-related problems. According to the NIH, insomnia has three classifications: transient (short-term, lasting only a few weeks), intermittent (on-andoff transient insomnia), and chronic (frequent and lasting a month or more). Dr. Carrick reports that insomnia affects up to 40 percent of the general population yearly and is a significant cause of morbidity and mortality. It tends to be persistent and has been associated with painful musculoskeletal conditions that may result in sleepiness, irritability, and feelings of misery. Depending on the individual, insomnia can mean difficulty falling asleep, waking up-often with difficulty falling back to sleep, waking too early in the morning, or poor-quality sleep.

"Insomnia is not defined by the total time the patient sleeps, but by the inability to obtain sleep good enough to result in feeling rested," Dr. Carrick explains. "The total sleep requirement is different for all individuals and is largely between four and 10 hours. An individual who sleeps only four hours and feels rested would not have insomnia, whereas a sleeper who equires eight hours might have insomnia if he/she is not rested."

Sleep apnea is also controlled by the brain stem. According to the NIH, 12 million Americans suffer from sleep apnea and can stop breathing hundreds of times a night for a minute or longer. Sometimes, the problem is caused by an obstruction in the airway. At other times, the brain fails to signal the muscles to breathe. Eventually, the brain does signal breath resumption, but the sleep is fragmented and of poor quality. The American Sleep Apnea Association reports that overweight males over 40 are particularly at risk, though it can strike any demographic. The consequences of untreated sleep apnea include high blood pressure, memory problems, weight gain, headaches, and impotence. It can also cause job impairment and accidents. "With sleep apnea, you are looking at how the areas of the brain stem are functioning when the brain is not conscious," Dr. Henry adds. "These functions are ordinarily autonomic, which means the brain doesn't have to be on guard. But with sleep apnea, we would evaluate patients to find out why they're not getting that brain stem control at night and do appropriate therapeutics to address it."

Chiropractors evaluate sleep complaints with a meticulous sleep history and physical examination with particular attention to the neurologic, cardiopulmonary, and psychological functions. "Chiropractors are often the clinician of choice for the pain patient. As such, they are very experienced in the diagnosis and treatment of sleep disorders associated with a variety of conditions that contribute to them," Dr. Carrick continues. "Many patients do not tell their doctors that they suffer from sleep disorders, but it is very common for patients to advise their chiropractors that they sleep much better after being treated for a variety of conditions not usually associated with sleep deprivation. Chiropractic treatment in general is a good alternative for those individuals who do not feel rested and who do not wish to take prescription drugs to assist them in obtaining quality sleep." Traditional chiropractic can offer relief to people suffering sleep disorders through mechanical manipulation. For example, manipulation can improve chest wall mechanics, so that people breathe better for improved oxygenation. It can also help people with spasms and pain and joint dysfunction of the neck, shoulders, and back by decreasing pain and restlessness while increasing spinal cord reflexes that improve blood flow.