Enabling Restorative Sleep to Help Patients Reach Their Goals

Many of the patients we see each day are sleep deprived and looking for ways to get a solid night’s rest.

“Are you sleeping well?” It’s a question we ask all the time to gauge how a patient’s pain and discomfort are affecting their lives. But even when pain isn’t a factor, many of the patients we see each day are sleep deprived and looking for ways to get a solid night’s rest.

A third of people who receive chiropractic adjustments say their sleep improves immediately, according to the National Sleep Foundation. But even after experiencing immediate short-term relief, there are still several steps patients can – and should – take to improve their sleep quality and their long-term health and wellness. Here’s how you can help empower your patients to make sleep a priority:

Establish Authority and Build Trust

If a patient is new to chiropractic care, familiar mainstream sources like Harvard Health  — which recommends adjustments “to relieve pain, improve function and help the body heal itself” — may offer helpful insights. The American College of Physicians has also issued low back pain chiropractic treatment guidance.

But how exactly do we motivate patients to get the sleep they need to recover from their daily activities and restore their optimal functions? Becker’s Spine Health offers some recommendations you may find familiar, as well helpful new insights:

• Candidly discuss why behavior change is critical to their well-being (starting with in-clinic active therapies)
• Emphasize their personal ability to affect change in their lives
• Allow them to define and drive specific wellness goals
• Encourage small, gradual goals instead of immediate lifestyle revamps
• Always follow-up — whether in-clinic or via email, inquire about and support those goals and progress

Engage with Education

It’s easy to get patients to share their sleepless night sagas when they’re still reeling from sleep deprivation — viscerally experiencing the loss of optimal function, immune response, alertness, positive mood and sex drive. As soon as some function is restored, however, they may lose motivation to follow up on their long-term goals.

This may be an opportune moment to explain their circadian rhythm and the value of quality sleep. Doctors know this, but most patients underestimate the need for consistent sleep. If they want to fully recover from the exertion and stress of their day, they’ll need to get at least 7 hours of sleep — ideally, the same 7 hours every night. It may help for them to envision the electrical oscillations we call brain waves traveling over their scalp from the prefrontal region to the back region at incrementally increasing speed throughout the night as their sleep deepens.

National Library of Medicine

And those brain waves alternate between 5 light and deep sleep stages to activate their metabolism. Defining metabolism as “all the chemical processes you need to function” seems clear and urgent enough, but breaking it down by function may be helpful:

• Waste Disposal (who would want to miss out on that?)

Proper sleep allows our “flushing” glial cells to eliminate plaque, toxins and other waste. Our glymphatic system is easier to understand when compared to a layer of piping that surrounds the brain’s existing blood vessels.

Our cerebrospinal fluid or CSF plays a key role in cleansing our brain tissue, carrying away waste products away from and nutrients to our brain tissue.

Like a canopy of tree branches along a forested street can create a channel above the roadway, glial cells use their “end feet” to form a network of conduits around the outsides of arteries and veins inside our brain.

Those end feet are filled with structures called aquaporins, which pump CSF into the brain along the channels that surround arteries, then wash through brain tissue before collecting in channels around veins and draining toxins out of the brain.

• Powerhouse Construction (they can control their energy levels)

Mitochondria are the powerhouses inside every one of our cells — they create 90% of the energy our organs need to function by taking in nutrients, breaking them down, then creating energy rich molecules. When inadequate, low quality sleep damages our mitochondria, they produce less energy and cause dysfunctions of our heart, brain, muscles, and lungs. Are energy powerhouses can’t be built without restorative sleep.

• Happy Hormone Factory (remind them wellness means feeling good)

If we don’t get enough sleep, we can’t produce the right levels of hormones to regulate our appetite, stress response and mood. Besides the growth hormone for growth and tissue repair, ghrelin and leptin for appetite regulation and cortisol for stress, happy hormone dopamine is produced in their pineal gland as they sleep, regulating their circadian rhythm.

When your patients don’t get enough sleep their levels of prolactin may get out of balance, weakening their immune system, disrupting concentration and stimulating carbohydrate cravings.

• New Neuron Hang Out (better focus and productivity is priceless)

When dopamine and oxytocin flow, neurons connect! These rapid connections help us learn, concentrate, remember, and take in the world — but they need to take breaks regularly.

When we sleep, our brain’s synapses — the connections among neurons — shrink so they can rest and prepare for the next day’s new input. Without this nightly reset, our synapses could become overloaded and burned out, like an electrical outlet with too many appliances plugged in to it.

Even with all this information, the top concern for your patients is probably simple: Can chiropractic help with my sleep problems? To answer that question, they’ll need to understand exactly what’s disrupting their sleep and their daily functions.

Identify Disruptors of Restorative Sleep

Although countless factors may be disrupting your patients’ sleep, it may be best to limit your explanation to these most common ones:

• Pain-Induced Insomnia

The National Library of Medicine and the National Sleep Foundation have published decades worth of research demonstrating that chronic pain is a common contributor to poor sleep.

The Neuropsychopharmacology Journal found that pain and discomfort can lower the body’s threshold for pain, leading to insomnia, which affects over a third of Americans.

The Journal of Sleep Medicine and Disorders published studies linking insomnia and spinal misalignments.

However, because it is the clinical manifestation of many other sub-clinical issues DCs typically also screen for:

• Circadian rhythm disruptors
• Substance use (prescription and non-prescription drugs)
• Psychiatric conditions
• Thyroid dysfunction

Making sure these conditions aren’t contributing to insomnia is critical, as they may need to be resolved before treating any misalignments.

• Apnea

More than 22 million Americans live with some form of momentary apneas — 10-20 second pauses in inhalation — several times every hour. That’s long enough to lower oxygen levels in their blood, alerting their brain to wake up the rest of their body to restart the breathing cycle.

Obstructive sleep apnea (OSA) — soft tissues inside the mouth and throat relaxing during sleep and blocking the upper airway—is the most common. Such disruptions (sometimes 30 per night) make it impossible to get restorative sleep and can, with time, contribute to other serious health conditions.

Once we’ve ruled out the other root causes, we can perform high-velocity, low-amplitude manipulation (HVLA) to address any joint dysfunctions causing pain. Patients may immediately feel pain relief and muscle relaxation, as subluxation adjustment has been shown to resolve insomnia by balancing dopamine and serotonin levels.

Benefits of Chiropractic Adjustments

As the spine shifts positions after years’ worth of falls and traumas, it brings your spinal cord with it, affecting various areas of the body.

For decades, The National Library of Medicine has been publishing studies demonstrating how chiropractic for neck pain, chiropractic for shoulder pain and back pain chiropractic can promote the following benefits for patients with sleep disorders:

• Relieving pain and discomfort: it’s difficult to fall asleep when you’re uncomfortable
• Easing muscle tension: any body part that’s too tense and restless to relax will have trouble falling asleep
• Stimulating circulation: low circulation can make you too cold for sleep
• Promoting proper breathing: the proper posture that alignment encourages can promote healthy breathing to strengthen the soft tissues that cause snoring and apneas

Explaining How Chiropractic Care Targets the Root Cause of Sleeplessness

Delivering an adjustment to a misaligned joint can reduce pain and relieve tight, tense muscles immediately, often leading patients to think they’re all better. That’s when they need to be reminded of the root cause of their pain.

They need to understand how chiropractic realignment can correct neck curvature, mitigating that interference to improve sleep quality and even alleviate snoring (which can lead to apnea).

Misalignments and muscle tension can also increase cortisol production, so releasing nerve pressure can help naturally lower your cortisol levels. For the latest research demonstrating these functions you may want to peruse these findings:

• The Journal of Manipulative and Physiological Therapeutics found electrical muscular activity was reduced by 25% post adjustment
• The Journal of Manipulative Physiotherapy demonstrated that chiropractic adjustments significantly improve sleep for insomnia patients
• The Journal of Sleep Medicine and Disorders documented how adjustments promote dopamine and serotonin balancing for anxiety management
• The Annals of Vertebral Subluxation Research described how corrective care and dietary modification can resolve long term obstructive sleep apnea

To delve deeper into wellness-promoting chiropractic trends check out our Trends That Can Help You Grow Your Practice post.

*examples only; consult your state’s insurance billing regulations

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