According to the American Academy of Sleep Medicine, about 30 percent of adults have the symptoms of insomnia.
About 10 percent of adults have insomnia severe enough to cause problems during the day, and fewer than 10 percent of adults are likely to have chronic insomnia. When you take into account that most patients with musculoskeletal disorders suffer with insomnia, chances are that up to 90 percent of your patients suffer from some degree of sleeping trouble.
Our office conducted an informal survey of our patients to find out how many suffer from insomnia.
We surveyed 221 patients, and 198 said that they had experienced some degree of insomnia in the last six months. Of the nearly 200 patients reporting insomnia, 174 considered their symptoms chronic and have tried medications that had intolerable side effects or did not work. Thus there is likely a whole population of patients currently in your care that suffer with a condition that you can help them with.
The nature of insomnia
Insomnia is difficulty falling asleep or staying asleep when a person has the chance and desire to do so. People with insomnia can feel dissatisfied with their sleep and usually experience one or more of the following: fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or at school.
Insomnia can be characterized based on its duration. Acute insomnia is brief and often the result of life circumstances. Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months.
More than just an inconvenience, insomnia poses considerable health risks. Consider the following:
- Average number of fatal crashes caused by drowsy driving each year: 1,550
- Percentage of healthcare workers who have had a near-miss accident at work as the result of fatigue in the last year: 39
- Percentage of health workers who report worsening a patient’s condition because of fatigue: 19
- Percentage of law enforcement workers who report having taken unnecessary risks while tired: 44
- Percentage of U.S. regional pilots reporting they sometimes nod off in the cockpit: 80
- Relationship stress: Disruption of a bed partner’s sleep due to a sleep disorder may cause significant problems in a relationship
- Poor quality of life: Sufferers might be unable to participate in activities that require sustained attention, like going to the movies
- Occupational injury: Excessive sleepiness more than doubles the risk of sustaining an occupational injury
- Automobile injury: The National Highway Traffic Safety Administration estimates that each year drowsy driving is responsible for at least 100,000 automobile crashes, 71,000 injuries, and 1,550 fatalities
- Several major disasters have been linked in part with too little sleep in the workplace: Three Mile Island, Chernobyl, and the Exxon Valdez
Sleep-deprived drivers are just as dangerous as drunk drivers. In one study, people who drove after being awake for 17 to 19 hours performed worse than those who had a blood alcohol level of 0.05 percent. (A blood alcohol level of 0.08 percent is considered legally intoxicated in many states.)
Studies show an increased mortality risk for those reporting fewer than six or seven hours of sleep per night. One study found that reduced sleep time is a greater mortality risk than smoking, high blood pressure, and heart disease.
Sleep disturbance is also one of the leading predictors of institutionalization in the elderly, and severe insomnia triples the mortality risk in elderly men. Remarkably, sleep loss may also be a contributing factor to obesity.
John Winkelman, MD, PhD, medical director of the Sleep Health Center at Brigham and Women’s Hospital, says, “What most people do not realize is that better sleep habits may be instrumental to the success of any weight management plan.”
Sleep disorders always accompany chronic pain and fibromyalgia. In 1975, two Canadian physicians and researchers, Harvey Moldofsky, MD, and Hugh Smythe, MD, suspected sleep disorders as a factor in fibromyalgia. They conducted sleep studies and concluded that patients not only had sleep abnormalities but also had dysregulation of normal body circadian rhythms affecting periods of wakefulness too. Circadian rhythms are primarily controlled by brainwaves.
In the long term, the clinical consequences of untreated sleep disorders are large indeed. They are associated with numerous, serious medical illnesses, including:
- High blood pressure
- Heart attack
- Heart failure
- Psychiatric problems, including depression and other mood disorders
- Attention Deficit Disorder (ADD)
- Mental impairment
- Fetal and childhood growth retardation
- Injury from accidents
- Disruption of bed partner’s sleep quality
- Poor quality of life
The medical approach
The medical profession has no real cure for insomnia. The best it can offer are medications to help manage the condition. Some of the medi- cations include over-the-counter sleeping aids, non-benzodiazepine hypnotics, benzodiazepine hypnotics, and antidepressants.
Some of the general side effects of these medications include:
- Respiratory problems
- Increased depression
- Significantly increased risk for automobile accidents and falls
Drugs prescribed for insomnia can cause memory loss (sometimes called “traveler’s amnesia”), sleepwalking, sleep driving, eating while asleep, and other odd mood states. Among patients who were prescribed one to 18 sleeping pills per year, the risk of death was 3.6 times higher than among similar participants who did not take the medications.
QEEG analysis and neurofeedback
Several parts of the brain have been implicated in the etiology of insomnia. Recent research, using quantitative electroencephalogram (QEEG), neuroimaging techniques and the study of the microstructure of sleep, suggests a state of CNS hyperarousal with a biological basis.
QEEG analysis involves an analysis of brainwave patterns at 12 different sites in the brain. The analysis is painless and noninvasive, providing valuable information regarding patterns that may be associated with increased predisposition to insomnia. In many cases, these dysregulated patterns can be corrected with neurofeedback, resulting in the complete and permanent alleviation of insomnia.
There are several different brainwave patterns associated with insomnia disorders; however, the most common pattern is elevated magnitudes of Beta brainwaves coupled with decreased magnitudes of Delta and Theta. The Beta brainwave resonates between 12 and 30 Hz and is normally produced at high magnitudes when the brain is involved in external thought, critical reasoning, and problem solving.
In some individuals, the brain becomes dysregulated and begins producing high magnitudes of Beta most of the time. The brain map below illustrates this type of brainwave dysregulation:
This type of dysregulation is typically associated with insomnia as well as migraines, anxiety, and chronic pain syndromes.
Neurofeedback therapy is a method of exercising the brain that guides dysregulated brainwave patterns back to normal, organized patterns. By doing this, the brain is able to operate efficiently and properly. Chiropractors are increasingly adding neurofeedback to their offices to address serious neurological disorders that present in the chiropractic setting.
In the case of Beta dysregulation that causes insomnia, neurofeedback training can teach the individual how to lower the magnitude of the beta waves that are being produced, thus normalizing the pattern and alleviating the insomnia.
Neurofeedback therapy has no serious side effects, and it has been shown effective in managing many neurological conditions including anxiety, panic attacks, ADHD, learning disorders, Asperger’s syndrome, PTSD, TBI, chronic pain, and insomnia.
Guy Annuziata, DC, BCN, is one of only 25 chiropractors who are board certified in neurofeedback. He is the founder and developer of BrainCore Neurofeedback Therapy—the only QEEG-based neurofeedback system specifically designed for the chiropractic profession. He can be reached through braincoredoctor.com.