Of these disorders, insomnia is the most common with almost everyone having at least one episode in any given year. It is either initiating insomnia (while attempting to go to sleep with a duration greater than 20 minutes) or maintenance insomnia (awaking after sleep onset and having difficulty returning to sleep).

Obstructive sleep apnea occurs in 24% of adult men and 9% in adult women. The pathology is the upper airway collapsing during sleep. This syndrome usually causes excessive daytime sleepiness and there are numerous associated symptoms and risks including socially disruptive snoring, depression, decreased cognitive functioning, personality changes, gastroesophageal reflux, hypertension, and diabetes with an increased risk of stroke and heart attacks. Almost 70% of these sleep apnea patients are over their ideal body weight, however, 30% are at or below their ideal body weight and are usually associated with a deficient facial bony structure or larger soft palate.

When one receives less sleep than genetically determined to require, it produces a state of sleep deprivation, which usually causes excessive daytime sleepiness. This can be due to voluntary schedule changes, sleep disruption of any cause including pain.

Working with Chiropractic Patients

Musculoskeletal pain, specifically neck and back discomfort, is one of the most common causes of insomnia and insufficient sleep. Since chiropractic care is the best, natural, way to relieve musculoskeletal pain, you are perfectly positioned to be a sleep expert for your patients...and most of them will have or have had a sleep disorder.

As has been reviewed, sleep is a complex interaction between intrinsic and extrinsic influences. A number of sleep disorders are treatable and avoidable with proper and frequent chiropractic evaluations and treatments.

This may be facilitated by a chiropractor working in synergy with a psychiatrist, sleep specialist, pain specialist and even a massage therapist.

For aftercare, daily exercise, stretching and range of motion exercises, can great facilitate a restful night. However, this activity should be performed at leas five hours before going to sleep to prevent delaying sleep onset. Soaking in a warm bath can also improve sleep onset.

You should also talk to your patients about improving their sleep environment. Ask them about external noise, and if feasible, suggest that can significantly reduce this noise with double pane, or in extreme cases, triple pane glass windows. Inquire about the external light that enters the room at night and if this is an issue, find out what, if any draperies they are using. Draperies are far better at blocking external light than are blinds. And they should avoid the use of a television in the bedroom.

But the most important correctable variable is their mattress.

What Are They Sleeping On?

Human beings sleep lying down. The apparatus or bed where the body resides can have a profound impact on the quality of sleep and the musculoskeletal system.

When musculoskeletal pain exists or when the bed is uncomfortable, there are many changes that occur: delayed sleep onset (insomnia), more superficial non-REM sleep, reduced delta sleep and less REM sleep, increased arousals with sleep fragmentation and overall lowered sleep efficiency. These sleep changes result in excessive daytime sleepiness, decreased cognitive function and a reduced state of well being, which lowers work efficiency and increases the risks of automobile and work related accidents.

The author completed a randomized, crossover study over a six-month period evaluating the sleep architecture and sleep efficiency using a memory foam mattress, an air mattress, and a co-polymer gel mattress.

The results revealed that the study subjects had the best sleep efficiency using the gel mattress. The substance has been shown to provide a better support to the body and alleviates pressure points.

Sleep is a state of being that encompasses one third of our life's time and is essential for restoring both our mind and body. Understanding normal sleep, sleep disorders and the benefits of chiropractic care on sleep, may shape another chapter to your medical practice.

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Dr. Robert J Troell, MD, FACS, is a quadruple board certified physician, Stanford trained in both Otolarngology/Head and Neck Surgery and Sleep Medicine. He was a clinical professor for seven years at the first sleep clinic in the United States, the Stanford Sleep Disorders Center. Additionally, he was the first surgeon board certified in Sleep Medicine in the U.S. His first medical and surgical practice was with colleagues Robert Riley, Nelson Powell and Kasey Li, considered the premier group in the world at the time for upper airway reconstructive surgery. Dr. Troell currently practices in Las Vegas and Laguna Beach, Calif.