Posted by Dr. Samvat on August 15, 2009 · Leave a Comment
Sleep And Chiropractic
When it comes to treatment , the first pririty is to address the basic fundamental need of the human body which is movement. If you remember from earlier discussions, movement is the primary means of survival within the body relating to reptilian brain. The movement I am talking about is the movement of energy in various forms. From atoms in air to movement within very part of our body. Since we live in an environment where gravity plays an important role, we start with the movement of the body. Body motion depends on its position and its relation ship to its environment . we live in a time where Based on massive compensation of our body to stressors of environment, due to hundreds of factors ( emotional chemicals , Physical, Electromagnetic ) our body no longer has adequate internal resources available to it to revive itself. More and more the body is in need of external intervention for sustaining itself.
When it comes to gravity, skeletal system is most important. Chiropractic has shown most promise to stabilise the human frame. Muscles move the bone. To work efeciently, the body relies on learned patterns to move the structure in relation to the body. Kinesiology , I have found to be most effective to stimulate the working of these patterns ,which we call primitive reflexes. Polaties, Alexanre technique I have found to assist in developing and reeducating the core anti gravity muscles to balance the head on shoulder, on pelvic, on foot and on earth of. Deep breathing exercises and any breathing exercises such as Betyeuoko asiist to balance the movement of air in and out of lung , thereby balancing the respiratory PH. Thought field therapy, or any therppy addressing the lingering emotional issues is useful for REM sleep activity as well as creating freedom in decision making consciously. It is always better to make decision based on desires rather then unknown fears.
Nutritional treatment assist the body to perform the most vital functions until the body has had enough internal resources to carry on its own. Life style modifications such as eating , smoking and drinking, will assist the body to start sending messages of peace and health to our genes activating our healing genes. Sleep management is where body regulate these functions and symptoms such as snoring , insomnia and day time fatique as well as aches and pain is where body start to warn us of troubles ahead.
In this chapter I will discus the role of chiropractic manipulation in treating sleep related problems.
Every thought find its way and manifest as a single muscular contraction, and ultimately effect our structure, hence giving rise to the notion of interrelationship between mental, physical and chemical.
The body is designed to survive in a most hostile environment, however when an abnormal stress is place on the body for a long period of time, It depletes body’s energy reserve and tisuue disintegration begins. This is when we start feeling aches and pains followed by fatique then more severe symptoms , structural instability and organ dysfunction.
Chiropractic is a scientific method of healing which deals primarily with the dysfunction of spinal column and nervous system from an abnormal stress.. A normal spinal column is centered at the top and the bottom in mid line of the body and along a central point through which the centre of gravity passes(93). Normal muscle /Ligament behaviour patterns allow spinal mobility while attempting to maintain spinal stability by keeping the spinal column anatomically and functionally centered. As the integrity of these muscle and ligaments patterns are altered, the posture of the spinal column is changed and it veers off centre loosing its balance. As spinal balance is lost the war of stress, stability, mobility and disease is initiated.
Doctor of chiropractic attempt to restore the function by restoring the balance and stability to the spine and hence increasing the body’s adaptability and survival.
This novel attempt had greater success before the industrialization and modernization of our world. In this age the nervous system does not have the opportunity to develop as planned, leading to poor brain
Integration. A new emerging field in Chiropractic is Chiropractic Neurology developed by Dr. Ted Carrick. This new field looks upon the brain as a central processing unit and any structural instability or organic disfunction as a poor central integrative state of the brain.
It gathers information based on neurological, orthopaedic and chiropractic evaluations to asses the brain hemisphrecity. It then uses a specific chiropractic manipulation (coupling) to improve the brain function. It also utilises many rehabilitation and sensory integration tools ( heat, light, sound, balance, smell and cognitive exercises ) to create a sustainable environment for the body and increase its plasticity. It is a most powerful tool created in chiropractic to explain our clinical observation. Like any system, there are area where there is room for improvement.
Chiropractic is a broad area and there are many divisions and techniques within it. However when looked closely, the fundamental principle behind all its variations is to assist the body to balance itself against gravity. This may be a simple statement yet very powerful. To adapt to gravity structurally is to assist the body’s survival instincts which means proper central integrative state which means proper activation and inhibition within the brain . This leads the body to be able to sleep and allow the innate intelligence to do its work by detoxifying, repairing, restoring , building ,clearing unwanted emotions , building new memory, enhancing cognition and preparing us for a new beginning in the morning. All these can be hindered if the body has problem with gravity and spinal stability.
Static stress has the greatest effect on the health of spine increasing its rate of decay and degeneration. Unfortunately majority of this hidden compromise goes undetected for so many years without being detected. I have found that the first sign of spinal instability is alteration in breathing, then the positioning of the skull on the spine at the level of Occiput C1, C2, followed with changes in sleep patterns. It is only at this stage when the body does not seek assistance, Further neurological, physiological, and biochemical changes settles in. This avoidance is the most harmful because it leads to fixation of abnormal muscular behavioural habit different then originally indented for the body.
What most chiropractors have observed over the last century is initiation of functional short leg, which causes uneven distribution of the weight against gravity. This is coupled with change in breathing, rearrangement of Occiput, C1 ,C3, L3 and Sacrum. In Chiropractic Applied Kinesiology and Sacro Occipital Technigue this pattern is the pattern involved in limiting the movement of Cerebro Spinal Fluid.
Since the main sleep related disorders fall on the category of upper respiratory breathing disorder, The role of tongue becomes very important, My observation as well as research have shown that the tongue play an important role in the structure( posture) and function (neurologicaly) of the body. It plays a vital role in our survival and ability to adapt to gravity and hence effects our perception. Fabio Scoppa has demonstrated that The tongue is capable of perturbing postural balance due both to its connections with the key anatomical
structures, and to other neurophysiological reasons. The hyo-glossus apparatus, owing to its links with the maxillaries, the skull, the cervical spine, the scapula, the pharynx and the larynx, is the true “trait d’union” between the oral and postural functions of the body.
Due to the prevalently transverse arrangement of its fibres,
the tongue may be considered a diaphragm linking the body’s anterior and posterior muscular chains. He claims that the tongue constitutes an excellent example of the intimate and reciprocal interrelation between structure and function. The posture and the morphology of the body as a whole are the result of this
reciprocal relationship (figure 86,89,90)( 94).
There are evidence and general acceptance within various medical fields that the poor breathing or upper respiratory breathing disorder have postural ramifications as well.
American Orthopaedic Association have similar point of view with chiropractic when it comes to posture. Their definition of posture is :
“That state of muscular and skeletal balance which protects the supporting structures of the body against injury and progressive deformity irrespective of attitude in which these structures are working and resting. Under these conditions the muscles will work more efficiently and optimum position is affored for thoracic and abdominal organs.” (95)
The objective method for measuring the angle of spinal curvature and posture is x-ray using the Cobbs method, according to Orthopaedic and Chiropractic measurement. For those concerned with ionising radiation there is a less objective and yet safer technique using plum line. The classification using plum line is outlined in (figure 92).
The postural deformity observed in varying degrees in upper respiratory breathing disorders or any pulmonary weakness is increase in dorsal kyphosis, increased lumbar lordosis or a sway back. These will cause imbalance of the muscular system inhibiting normal movement.
Tattersall and Walshaw (95) indicate that prolong use of accessory muscles of respiration and their ultimate hypertrophy accompanied by a flex position may result in alteration of body posture, increased chest diameter, increased thoracic kyphosis, shoulder elevation and protraction and abdominal flexion. This would lead to shortening of muscle and ligaments and leading to low back pain(fig.91).
In addition to poor anti gravity muscles along spinal column, D Shirley, Hodges, Eriksson, and Gandevia have shown trunk muscle activity and IAP (intra-abdominal pressure) with respiratory efforts modulate spinal stiffness. Diaphragm may augment spinal stiffness via attachment of its crural fibres to the lumbar vertebrae.(96).
Diaphragmatic function is important for every aspect of movement.
Hodges, Butler1,McKenzie and Gandevia have shown with definitive evidence that the human diaphragm is involved in the control of postural stability during sudden voluntary movement of the limbs (97). They have also shown Respiratory activity of the diaphragm and other respiratory muscles are normally co-ordinated with their other functions, such as for postural control of the trunk when the limbs move. The integration may occur by summation of two inputs at the respiratory motor neurons , And increased central respiratory drive may attenuate the postural commands reaching motoneurons. This attenuation can affect the key inspiratory and expiratory muscles and is likely to be co-ordinated at a pre-motoneuronal site (98). The postural compensation as the result of respiratory compromise is more difficult for people with low Back pain.(99).
The ability to keep the head upright is one of the most fundamental activities in the human body. Head control is indispensable, for keeping the body in upright posture, such as in sitting, standing, for transfer activities such as in crawling and walking, and for other activities of daily living. In snoring and sleep apnoea ,
difficulty exists in keeping the head upright due to weakness of the
antigravity muscles, and hypertonicity of the non-antigravity
muscles. The basic understanding of the musculo-skeletal
mechanism of head control is necessary, to attains stability for
keeping the head upright both during sitting , standing , walking and at night in prone or supine position while sleep. (fig. 99).
These muscles participate in raising and keeping the head in upright position. These muscles form a pyramid with wide base when we consider them as a single mass, and thus, can be considered to be a muscle group with more monoarticular characteristics, as compared to longissimus capitis and cervicis which form the muscle group with the more multiarticular characteristics. If the base of origin of these muscles mass is much wider, compared with the length of muscle fibers, then, co-contraction of the muscles on both sides will prevent lateral swing of the head more effectively when the head is extended.
Thus, antigravity extension of the neck in prone position can be
achieved with concomitant contraction of these muscles on both
sides.
Head and neck flexors are another important group of muscles to consider. These muscles participate in raising and keeping the head
upright while preventing the lateral swing of the head and falling
backwards of the head.(fig 100)
Non-antigravity neck muscles are propulsive muscles and do not participate in stability of the head, however they become compromised in individuals with snoring and sleep apnoea.( fig. 101)
These extensors and flexors bring about propulsive locomotion
such as forward propelling in swimming, running and jumping. In
sleep apnoea and snoring, these muscles are hypertonic and cause postural abnormality such as tonic labyrinthine reflex, asymmetric tonic neck reflex, and symmetric tonic neck reflex .
Hyperactivity of these muscles also inhibit activities of the
antigravity flexors and extensors. In older patients, hypertonicity
of these muscles cause degenerative changes of the cervical spine,
thereby subsequently inducing radiculomyelopathy. Appropriate
inhibition of these muscles is essential for treatment of these
deformities and radiculomyelopathy.
Understanding the postural mechanism is important for sleep since an average person can change their position in bed from 25-75 times. Poor postural balance and integrity places a lot of tension on the body and its ability to lay prone, supine, on side and turn . The ideal is to move minimally during sleep probably below 5 times.
Another postural mechanism to consider is the process of turning. Turnover is another fundamental propulsive movement, which requires coordinated activities of the antigravity muscles of
the neck, trunk, and upper and lower extremities. Turnover is
made of four components; rolling of the trunk, adduction and
abduction of the shoulders, supporting activities of the elbows, and
adduction and abduction of the hips. Turnover of the body is firstly
initiated with antigravity flexion and adduction of the hip on the
forward moving side and then that of the shoulder on the same side,
followed with flexion and adduction of the hip on the following
side. Then, adduction and flexion of the shoulder follows, until the
whole body comes to the side position.
Rolling to the side position; Side position is one of the most basic forms of antigravity positions. In turnover to the side position, antigravity flexors work to bring the head and body up to the side.
Concomitant and bilateral contractions of neck flexor muscles flex
the neck frontally and raise the head to the front against gravity in
the supine position. Continuous contractions of the flexor muscles on the proceeding side rotate the head to that side, while raising the head against gravity. Concomitant contractions of these muscles on both sides flex and raise the upper trunk to the front and bring it to the upright from the supine position. Continuous contractions of these flexor muscles on proceeding side rotate the upper trunk to the contracted side, while raising the upper trunk against the lower trunk on proceeding side and then bring the whole trunk to the side(fig 102).
With contractions of iliopsoas, the hip of the proceeding side is
Flexed. The centre of gravity is moved towards the proceeding side,
By kicking and extending the lower extremity on the following side.
With contractions of the adductor longus and brevis, the lower
trunk is pulled upwards to the thigh on the proceeding side.
Continuous contractions of these muscles and consequent transfer of gravity of the trunk turn the body to the side. Now, the lower extremity on the following side is brought over to the floor.Propulsive contractions of the extensors on the proceeding side and a antigravity activities of the extensors on the following side make it possible to bring the body to the prone position. Antigravity trunk flexors and adductors on the proceeding side act and support the body in the prone position at final stage. Unilateral contractions of neck anti gravity extensor muscles on the following side raise the head upright and rotate it progressively into prone position. At the final stage of turnover, bilateral concomitant contractions of neck extensor muscles raise the head upright in prone position. Unilateral contractions of these muscles on the following side raise each upper vertebral segments against the lower ones and rotate them progressively into prone position. At the final stage, bilateral concomitant contractions of these muscles raise the upper trunk against the lower vertebrae. The upper trunk is supported on the upper extremity on the proceeding side with antigravity activities of trunk muscles, and turned into prone posture. Centre of gravity is transferred to the following side, and then, the upper trunk is supported on both the upper arms with adduction movement of these muscles at final stage of turnover(fig 103).
The perplexity of these changes while we sleep is astonishing. Poor muscular coordination causes postural compromise.The postural compromise carries in to the night while asleep. Due to Neuro-chemical compromises, the tongue and jaw muscles play an important role in maintaining a proper posture during sleep which is mostly involved in maintenance of airway opening and easy air flow, a function which is quiet compromised in people with snoring and sleep apnoea .
Miyamoto K, Ozbek MM, Lowe AA, Sjoholm TT, Love LL, Fleetham JA, Ryan CF. have shown mandibular posture during sleep in healthy adults is significantly influenced by sleep stage but not by body position. Mandibular opening progressively increases with the depth of NREM sleep stage, and the mandible is more open in REM sleep than in light NREM sleep (100). The mandibular openness should be minimal. Excess opening which is common with snorers and sleep apnoea causes mechanical closure of the airway further compromising respiratory effort. (figure93).
Postural deviation alters body mechanics putting uneven pressure on joint surfaces leading to inflammation and pain. Inflammation sets in to motion biochemical compromises which can alter the person’s mood and motivation.(93,95,97).
Motivating patients at this stage is challenging. However the first approach should be to modify the diet at night to ensure improvement in sleep cycles, followed by Chiropractic and kinesiological treatment to alter destructive posture and unproductive muscular pattern. This is when the patient feels strong enough and motivated to be invoved ih his /her recovery and rehabilitation.
The survey of around 500 patients suffering from snoring and or snoring apnoea indicated 95% complaints of low back pain as well as neck pain.
Poor anti gravity muscles are very common in poor respiratory function people. Pilates has shown greatest promise in re-educating and toning up the deep core postural muscles.
Spinal vertebral mobilization of T1,,4,6,8,10 and L1 have shown the most improvement in improving respiratory function and improving oxygen saturation rate by around 4%. (from 94% PsO2 to 98%). This improvement is not sunstainable without improving the diaphragmatic function , diet and sleep habits.
Upper cervical manipulation seems to have the greatest impact on improving initiating sleep but there is not enough data to support chiropractic manipulation on its own has a direct effect on snoring and sleep apnoea. However when applied as part of the treatment program, chiropractic manipulation has a great influence.
The scientific evidence explains the cause of upper respiratory breathing disorders (snoring and sleep apnoea) to be reduced inhibition from higher centres of the brain causing excess limbic system activity. This leads to increased activation of muscles fibres keeping them active and muscles unable to rest and therby fatigue under stress. This is what occurs at night. The body uses neck muscles to allow proper positioning of the head for proper air flow. But the muscle responsible for positioning the head becomes hypotonic. When there is no support, then the the mandidular muscles fatigue, mouth start to open,air way starts to close causing snoring by partial closure or apnoea by complete closure.
Head position is an important issue here. The skull is balanced on first cervical vertebra called atlas. Atlas Vertebra allows functional motion to take place within the head. Any alteration in stability, mobility or balance anywhere in the body results in a modification in position of the atlas vertebra as a compensatory action attempting to stabilize the skull again.(93).
If you remember from the section on primitive reflexes, the equilibrium proprioception is an essential part of neural signalling in to the central nervous system. They are head righting reflexes, Visual reflexes and labyrinthine reflexes. They work individually and in relation to each other to allow the body to orient itself to the environment, that is the body position and posture in relation to its external environment and the body parts to the body parts in any given posture be it sitting , lying prone or supine, turning over in bed, standing, walking and runing.. Structurally skull bones move in relation to each other and in relation to atlas , pelvic bones and sacrum.
The joint receptors of the cervical spine , particularly the C1 , C2 and C3 are stimulated when a side lying animal whose its head is oriented with gravity will orient its body to its head. Reduced or diminished input from this area causes disruption in balance , orientation and motor coordination (102). Amalu has reported that by manipulating upper cervical vertebra , he has achieved improvement in symptoms of autism such as irritable bowl syndrome, strabismus , eye contact and increased level of awareness of environment(101).
This positional compromise can be initiated by emotional and /or biochemical stressors as well (figure 86). Uncorrected stress leads to fixed stress, causing further neurological physiological, chemical and structural changes, compounded over years leads to deterioration, degeneration and ultimately cellular and organic death .
Idealy, a patient with minimum to zero spinal stress should exhibit equal leg lengths, level femur heads , odontoid correctly cantered over the sacral base, Appropriate curvature along cervical, dorsal and lumbar curve . These findings can be measured accurately by x-rays or less accurately by plum line. Other factors where we need to focus on is bilateral even weight distribution when standing on two scales, proper TMJ (temporomandibular joint) function , proper cranial motion , minimum inversion of the foot and well balanced muscular patterns in relation to basic primitive reflexes as measured via kinesiological assessment (figure 94). Structurally these factors working together creates a sustainable posture where the body can win its battle against gravity and can work on healing the emotional components of nervous system. Stable structural frame creates a neurological flexibility for the person to initiate changes both emotionally, cognitively and biochemically with minimum resistance.
Functional components of our body can be tested with appropriate neurological assessment to identify the level of balance between the left and right hemispheres and the appropriate functioning of the neurological hierarchy. Biochemical stability can be identified by testing salivary hormones and urinary organic acids as well as The PH. These three factors work together at night to monitor the growth of the body according to its genetic potential.
How do we know if the spine is under stress?
Dr Ward, chiropractor with the assistance of Clint Fulknerson, an Aerospace research engineer along with many other scientist in early 1970’s developed a mathematical formulation to compute the projected spinal stress factor which is equal to patient’s height times the functional short leg divided by the walk width (figure 95)
Do we all need this level of stability and freedom of movement within our body and mind? It is not necessary for our immediate survival. But fundamental for expressing our humanity according to our genetic and spiritual blue print. Body can be regarded as a gift to us to unwrap to discover ourselves, and our symptoms are only the lights along the path guiding us toward the understanding of the choices we have made along the way. At night our unconscious mind or subconscious mind communicate to us regarding where we are with our choices via dreams as some philosophers argue. Some scientist also look at dreams as part of our survival where the mind process what we have taken in through five senses during the day and attempts to create meaning out of them . The dream represent the dreamers conscious state of awareness as . A body trapped in reptilian survival mood will have active negative dreams ( This accounts for more then 80 % of population ).A mind engulfed in limbic emotional state of mind experience dreams of change and resistance to change where the dreamer is in act of war, killing, being killed, or being chased . Nightmares are predominant with these individuals. A mind preoccupied with learning and growth will have dreams of discoveries, flying and spiritual nature type dreams.
You may tell yourself, woo.. what a great adventure or how do I have time to do all these? I answer my clients by telling them that this has always been the plan for our evolution in this planet. It was never meant to be hard. We have a great skill as humans called habit. Habits can be good or they can unproductive. A good colleague of mine Gita Belin uses an analogy which makes sense to me. We all have unproductive skills that we are not aware of, called unconsciously unskilled behaviour say Mrs Belin. Majority of ailments I see in people belong to this category and these are expressed in our muscle patterns detected by kinesiologists, structural patterns detected by chiropractors , biochemical patterns detected by nutritional therapists or energetic patterns detected by acupuncturists and homeopaths. After attending some educational sessions and discussions with our primary health practitioners, we move in to consciously unskilled way of behaviour. We are now aware of physical consequences of our action and trust the practitioner to help us to help and heal ourselves. Remember the healer reside within you. Through having regular appropriate therapy and lifestyle modifications we move in to consciously skilled pattern of behaviour.
As we commit ourself to our health and growth , we will recognise that we have choices in all aspects of our life and productive choices lead to health , happiness, vitality and longevity. This is where we move in to unconsciously skilled pattern of behaviour designed to assist us to express our humanity with a great effortless power.
Regular assessment allows your health practitioner to identify the unconsciously unskilled patterns limiting your progression.
This is also dependent on your health practitioners state of awareness of the changes which are necessary to harness growth and healing.
mandibular posture during sleep in healthy adults is significantly influenced by sleep stage but not by body position. Mandibular opening progressively increases with the depth of NREM sleep stage, and the mandible is more open in REM sleep than in light NREM sleep. Miyamoto K, Ozbek MM, Lowe AA, Sjöholm TT, Love LL, Fleetham JA, Ryan CF, Mandibular posture during sleep in healthy adults.
Arch Oral Biol. 1998 Apr;43(4):269-75
The aggravating effect of the supine body position on breathing abnormalities during sleep was recognized from the earliest studies on sleep breathing disorders. Most of the anatomical and physiological correlates of this phenomenon appear to be due to the effect of gravity on the upper airway. Although few articles have been published on this topic, it has been shown in a large population of obstructive sleep apnoea (OSA) patients that more than half of them are Positional Patients, i.e. they have at least twice as many apnoeas/hypopnoeas during sleep in the supine posture as in the lateral position. This positional phenomenon is influenced by factors such as Respiratory Disturbances Index (RDI), Body Mass Index (BMI), age and sleep stages. The sleep supine posture not only increases the frequency of the abnormal breathing events but also their severity. This sleep posture also has a detrimental effect on snoring, as well as on the optimal CPAP pressure. Positional Therapy, i.e. the avoidance of the supine posture during sleep, is a simple behavioural therapy for many mild to moderate OSA patients. Unfortunately, only a few studies, including only a few patients, have investigated this form of therapy. Although the results of these studies are promising, the lack of a reliable long-term evaluation of its efficacy is perhaps an important reason why this form of therapy has not been widely accepted. Since mild to moderate OSA patients are the majority of the OSA patients and since without treatment, a large percentage of them will develop a more severe form of the disease, a thorough evaluation with a major emphasis on the long-term effectiveness of this form of therapy is urgently needed. Oksenberg A, Silverberg DS, The effect of body posture on sleep-related breathing disorders: facts and therapeutic implications, Sleep Med Rev. 1998 Aug;2(3):135-7.
Sleep And Chiropractic
When it comes to treatment , the first pririty is to address the basic fundamental need of the human body which is movement. If you remember from earlier discussions, movement is the primary means of survival within the body relating to reptilian brain. The movement I am talking about is the movement of energy in various forms. From atoms in air to movement within very part of our body. Since we live in an environment where gravity plays an important role, we start with the movement of the body. Body motion depends on its position and its relation ship to its environment . we live in a time where Based on massive compensation of our body to stressors of environment, due to hundreds of factors ( emotional chemicals , Physical, Electromagnetic ) our body no longer has adequate internal resources available to it to revive itself.
“More and more the body is in need of external intervention for sustaining itself.”
When it comes to gravity, skeletal system is most important. Chiropractic Care has shown most promise to stabilise the human frame. Muscles move the bone. To work efeciently, the body relies on learned patterns to move the structure in relation to the body. Kinesiology , I have found to be most effective to stimulate the working of these patterns ,which we call primitive reflexes. Polaties, Alexanre technique I have found to assist in developing and reeducating the core anti gravity muscles to balance the head on shoulder, on pelvic, on foot and on earth of. Deep breathing exercises and any breathing exercises such as Betyeuoko assist to balance the movement of air in and out of lung, thereby balancing the respiratory PH.
Nutritional treatment also assists the body to perform the most vital functions until the body has had enough internal resources to carry on its own.
So, how exactly does the role of Chiropractic manipulation work in treating sleep related problems?
Sleep management is where body regulate these functions and symptoms such as snoring , insomnia and day time fatique as well as aches and pain is where body start to warn us of troubles ahead.
The body is designed to survive in a most hostile environment, however when an abnormal stress is place on the body for a long period of time, It depletes body’s energy reserve and tisuue disintegration begins. This is when we start feeling aches and pains followed by fatique then more severe symptoms, structural instability and organ dysfunction.
Holistic Chiropractic is a scientific method of healing which deals primarily with the dysfunction of spinal column and nervous system from an abnormal stress. A normal spinal column is centered at the top and the bottom in mid line of the body and along a central point through which the centre of gravity passes(93). Normal muscle /Ligament behaviour patterns allow spinal mobility while attempting to maintain spinal stability by keeping the spinal column anatomically and functionally centered. As the integrity of these muscle and ligaments patterns are altered, the posture of the spinal column is changed and it veers off centre loosing its balance. As spinal balance is lost the war of stress, stability, mobility and disease is initiated.
Doctors of Chiropractic Care attempt to restore the function by restoring the balance and stability to the spine and hence increasing the body’s adaptability and survival.
This novel attempt had greater success before the industrialization and modernization of our world. In this age the nervous system does not have the opportunity to develop as planned, leading to poor brain integration. A new emerging field in the Chiropractor field is Chiropractic Neurology developed by Dr. Ted Carrick. This new field looks upon the brain as a central processing unit and any structural instability or organic disfunction as a poor central integrative state of the brain.
It gathers information based on neurological, orthopaedic and chiropractic evaluations to asses the brain hemisphrecity. It then uses a specific chiropractic manipulation (coupling) to improve the brain function. It also utilises many rehabilitation and sensory integration tools (heat, light, sound, balance, smell and cognitive exercises ) to create a sustainable environment for the body and increase its plasticity. It is a most powerful tool created in chiropractic to explain our clinical observation. Like any system, there are area where there is room for improvement.
Chiropractic Care is a broad area and there are many divisions and techniques within it. However when looked closely, the fundamental principle behind all its variations is to assist the body to balance itself against gravity.
This may be a simple statement yet very powerful. To adapt to gravity structurally is to assist the body’s survival instincts which means proper central integrative state which means proper activation and inhibition within the brain . This leads the body to be able to sleep and allow the innate intelligence to do its work by detoxifying, repairing, restoring , building ,clearing unwanted emotions , building new memory, enhancing cognition and preparing us for a new beginning in the morning. All these can be hindered if the body has problem with gravity and spinal stability.
Static stress has the greatest effect on the health of spine increasing its rate of decay and degeneration. Unfortunately majority of this hidden compromise goes undetected for so many years without being detected. I have found that the first sign of spinal instability is alteration in breathing, then the positioning of the skull on the spine at the level of Occiput C1, C2, followed with changes in sleep patterns. It is only at this stage when the body does not seek assistance, Further neurological, physiological, and biochemical changes settles in. This avoidance is the most harmful because it leads to fixation of abnormal muscular behavioural habit different then originally indented for the body.
What most chiropractors have observed over the last century is initiation of functional short leg, which causes uneven distribution of the weight against gravity. This is coupled with change in breathing, rearrangement of Occiput, C1 ,C3, L3 and Sacrum. In Chiropractic Applied Kinesiology and Sacro Occipital Technigue this pattern is the pattern involved in limiting the movement of Cerebro Spinal Fluid.
Since the main sleep related disorders fall on the category of upper respiratory breathing disorder, The role of tongue becomes very important, My observation as well as research have shown that the tongue play an important role in the structure (posture) and function (neurologicaly) of the body. It plays a vital role in our survival and ability to adapt to gravity and hence effects our perception. There are evidence and general acceptance within various medical fields that the poor breathing or upper respiratory breathing disorder have postural ramifications as well. American Orthopaedic Association have similar point of view with chiropractic when it comes to posture.
The American Orthopaedic Association definition of posture is :
“That state of muscular and skeletal balance which protects the supporting structures of the body against injury and progressive deformity irrespective of attitude in which these structures are working and resting. Under these conditions the muscles will work more efficiently and optimum position is offered for thoracic and abdominal organs.”
The ability to keep the head upright is one of the most fundamental activities in the human body. Head control is indispensable, for keeping the body in upright posture, such as in sitting, standing, for transfer activities such as in crawling and walking, and for other activities of daily living.
Snoring and Sleep Apnoea
In snoring and sleep apnoea ,difficulty exists in keeping the head upright due to weakness of the antigravity muscles, and hypertonicity of the non-antigravity muscles. The basic understanding of the musculo-skeletal mechanism of head control is necessary, to attains stability for keeping the head upright both during sitting , standing , walking and at night in prone or supine position while sleep. (fig. 99).
These muscles participate in raising and keeping the head in upright position. These muscles form a pyramid with wide base when we consider them as a single mass, and thus, can be considered to be a muscle group with more monoarticular characteristics, as compared to longissimus capitis and cervicis which form the muscle group with the more multiarticular characteristics. If the base of origin of these muscles mass is much wider, compared with the length of muscle fibers, then, co-contraction of the muscles on both sides will prevent lateral swing of the head more effectively when the head is extended.
Thus, antigravity extension of the neck in prone position can be achieved with concomitant contraction of these muscles on both sides. Head and neck flexors are another important group of muscles to consider. These muscles participate in raising and keeping the head upright while preventing the lateral swing of the head and falling backwards of the head.(fig 100) Non-antigravity neck muscles are propulsive muscles and do not participate in stability of the head, however they become compromised in individuals with snoring and sleep apnoea.( fig. 101) These extensors and flexors bring about propulsive locomotion such as forward propelling in swimming, running and jumping. In sleep apnoea and snoring, these muscles are hypertonic and cause postural abnormality such as tonic labyrinthine reflex, asymmetric tonic neck reflex, and symmetric tonic neck reflex .
Hyperactivity of these muscles also inhibit activities of the antigravity flexors and extensors. In older patients, hypertonicity of these muscles cause degenerative changes of the cervical spine, thereby subsequently inducing radiculomyelopathy. Appropriate inhibition of these muscles is essential for treatment of these deformities and radiculomyelopathy.
Understanding the postural mechanism is important for sleep since an average person can change their position in bed from 25-75 times. Poor postural balance and integrity places a lot of tension on the body and its ability to lay prone, supine, on side and turn . The ideal is to move minimally during sleep probably below 5 times.
Another postural mechanism to consider is the process of turning. Turnover is another fundamental propulsive movement, which requires coordinated activities of the antigravity muscles of the neck, trunk, and upper and lower extremities. Turnover is made of four components:
- Rolling of the trunk
- Adduction and abduction of the shoulders
- Supporting activities of the elbows
- Adduction and abduction of the hips
The perplexity of these changes while we sleep is astonishing. Poor muscular coordination causes postural compromise.The postural compromise carries in to the night while asleep. Due to Neuro-chemical compromises, the tongue and jaw muscles play an important role in maintaining a proper posture during sleep which is mostly involved in maintenance of airway opening and easy air flow, a function which is quiet compromised in people with snoring and sleep apnoea .
Miyamoto K, Ozbek MM, Lowe AA, Sjoholm TT, Love LL, Fleetham JA, Ryan CF. have shown mandibular posture during sleep in healthy adults is significantly influenced by sleep stage but not by body position. Mandibular opening progressively increases with the depth of NREM sleep stage, and the mandible is more open in REM sleep than in light NREM sleep (100). The mandibular openness should be minimal. Excess opening which is common with snorers and sleep apnoea causes mechanical closure of the airway further compromising respiratory effort. (figure93).
Postural deviation alters body mechanics putting uneven pressure on joint surfaces leading to inflammation and pain. Inflammation sets in to motion biochemical compromises which can alter the person’s mood and motivation.(93,95,97). Motivating patients at this stage is challenging. However the first approach should be to modify the diet at night to ensure improvement in sleep cycles, followed by Chiropractic and kinesiological treatment to alter destructive posture and unproductive muscular pattern. This is when the patient feels strong enough and motivated to be invoved ih his /her recovery and rehabilitation.
The survey of around 500 patients suffering from snoring and or snoring apnoea indicated 95% complaints of low back pain as well as neck pain.
Poor anti gravity muscles are very common in poor respiratory function people. Pilates has shown greatest promise in re-educating and toning up the deep core postural muscles.
The scientific evidence explains the cause of upper respiratory breathing disorders (Snoring and Sleep Apnoea) to be reduced inhibition from higher centres of the brain causing excess limbic system activity. This leads to increased activation of muscles fibres keeping them active and muscles unable to rest and therby fatigue under stress. This is what occurs at night. The body uses neck muscles to allow proper positioning of the head for proper air flow. But the muscle responsible for positioning the head becomes hypotonic. When there is no support, then the the mandidular muscles fatigue, mouth start to open,air way starts to close causing snoring by partial closure or apnoea by complete closure.
Uncorrected stress leads to fixed stress, causing further neurological physiological, chemical and structural changes, compounded over years leads to deterioration, degeneration and ultimately cellular and organic death
Functional components of our body can be tested with appropriate neurological assessment to identify the level of balance between the left and right hemispheres and the appropriate functioning of the neurological hierarchy. Biochemical stability can be identified by testing salivary hormones and urinary organic acids as well as The PH. These three factors work together at night to monitor the growth of the body according to its genetic potential.
As we commit ourself to our health and growth , we will recognise that we have choices in all aspects of our life and productive choices lead to health , happiness, vitality and longevity. This is where we move in to unconsciously skilled pattern of behaviour designed to assist us to express our humanity with a great effortless power.
To Find your nearest Chiropractor and Sleep Treatment Centres, see our locations below…
Contact Us
Email: info@sleep4health.com.au
Melbourne
Centre For Integrative Health
(East St Kilda) 03 9527 1550
Adelaide
The House of healing
(Dulwich) 08 8431 9288
Integrated Health Services
(Unley) 08 8431 9288
NSW
Casuarina Beach Recreation Club 02 6674 9987
Gold Coast
Naturalvibranthealth 07 5562 5333
Melbourne Chiropractor and Sleep Treatment Centre
- Centre For Integrative Health (East St Kilda)
- 03 9527 1550
Adelaide Chiropractor and Sleep Treatment Centre
- The House of Healing
- 08 8431 9288
New South Wales Chiropractor and Sleep Treatment Centre
- Casuarina Beach Recreation Club
- 02 6674 9987
Gold Coast Chiropractor and Sleep Treatment Centre
- Natural Vibrant Health
- 07 5562 5333
Or for more information on Help with Sleep or Chiropractic Care to make an appointment please call your nearest Centre above, or email us: info@sleep4health.com.au
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One-third of world population are dangerously sleep-deprived, making them vulnerable to illnesses ranging from digestive problems and depression through to potentially fatal diseases caused by compromised immune function. Since 1910, the amount of sleep we get has steadily decreased by a massive 22 per cent, dropping from nine hours to just seven hours per night.
The purpose of this website is to help you find all the information you are looking for on sleep disorders. This includes information on topics like snoring, sleep apnea, night terrors, adult nightmares, insomnia treatment, sleep walking, sleep talking, sleep deprivation, and Australian Sleep Clinics. You will also learn more about Sleep Help, the Sleep Stages, and just how it ties into Holistic Chiropractic Care.
A message to parents: With the help of this site, you can start learning about Childrens Sleep Solutions that can help you make sure your child get the sleep they need to grow and stay healthy. It is important to understand your child’s changing sleep needs and habits as they grow. This Sleep4Heath site will cover many Children Sleep Issues including things like childrens nightmares, childrens learning difficulties, sleep apnoea children, sleep walking children, and children sleep patterns. More About Sleep for Children.
When it comes time to sleep you don’t have to struggle and suffer – This site can empower you to maker better choices that will positively affect your sleep. Some of these include breaking bad habits and will take time, others my need to include the help of a Sleep Specialist, but this site can certainly help you get there, and you will find mountains of information here on the site for free. Like the Top 10 Tips How to Sleep Better
Dr Reza Samvat BSc, DC, Dip Acup (USA)