When it comes to treatment, the first priority is to address the basic fundamental need of the human body which is movement. Movement is the primary means of survival within the body relating to reptilian brain. The movement we're talking about is the movement of energy in various forms. From atoms in air to movement within very part of your 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 relationship 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.
When it comes to gravity, skeletal system is most important. Chiropractic care has shown most promise to stabilize the human frame. Muscles move the bone.
To work efficiently, the body relies on learned patterns to move the structure in relation to the body also known as kinesiology. To be most effective to stimulate the working of these patterns ,which we call primitive reflexes.
Pilates and Alexander technique 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 Buteyko 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?
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 tissue disintegration begins. This is when we start feeling aches and pains followed by fatigue 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 center of gravity passes. Normal muscle /Ligament behavior 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 center losing its balance. As spinal balance is lost the war of stress, stability, mobility and disease is initiated.
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 dysfunction as a poor central integrative state of the brain.
It gathers information based on neurological, orthopedic and chiropractic evaluations to asses the brain hemisphrecity. It then uses a specific chiropractic manipulation (coupling) to improve the brain function. It also utilizes 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. Experts 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 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 behavioral habit different than 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 Technique this pattern is the pattern involved in limiting the movement of Cerebral 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 (neurologically) 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 Orthopedic Association have similar point of view with chiropractic when it comes to posture.
The American Orthopedic 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 Apnea
In snoring and sleep apnea, 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.
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. 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 apnea. These extensors and flexors bring about propulsive locomotion such as forward propelling in swimming, running and jumping. In sleep apnea 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 causes 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 anti-gravity 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 apnea.
A study by Miyamoto K. et al. showed mandibular posture during sleep in adults is significantly influenced by sleep stage but not by body position. Mandibular opening gradually increases with the depth of NREM sleep stage, and the mandible is more open in REM sleep stage than in light NREM sleep. The mandibular openness should be minimal. Excess opening which is common with snorers and sleep apnea causes mechanical closure of the airway further compromising respiratory effort.
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. 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 involved in his /her recovery and rehabilitation.
The survey of around 500 patients suffering from snoring and or snoring apnea 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 apnea) to be reduced inhibition from higher centers of the brain causing excess limbic system activity. This leads to increased activation of muscles fibers keeping them active and muscles unable to rest and thereby 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 mandibular muscles fatigue, mouth start to open, air way starts to close causing snoring by partial closure or apnea 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 recognize 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 behavior designed to assist us to express our humanity with a great effortless power.