Circadian rhythm disruption, structural sleep apnea and insomnia caused by cervical instability

Ross Hauser, MD.

The problems of a patient getting good restorative sleep are problems as old as the pain itself. People in pain, probably like yourself, don’t sleep because they cannot find that “right” pain-free position in bed or on the couch. They get up frequently in the middle of the night because of pain, they are prescribed sleep medication to help get them into a deeper sleep. As you are reading this article you are likely very educated in the cause and effect of lack of sleep on pain and pain-causing lack of sleep.

This article is not about addressing the pain caused by sleep disorders, this article is about addressing the structural causes, i.e., cervical instability is causing sleep disorders as a cause not only of pain but as neurologic-like and psychiatric symptoms. So as cervical instability can cause neck pain that makes it difficult to sleep, it can cause more issues that even as your neck pain is resolved through conservative care or surgery, the problems of sleep and a sense of “racing” metabolism remains behind.

Now let’s touch on psychological stress. There is a lot of stress in the world and while stress and anxiety can cause you to lose sleep or get no sleep at all, cervical instability can as well. In this article I want to explain the neurology, the problems of the nervous system and how cervical instability causes problems with sleeping, and, how your neck problems are causing sleeping problems not just from pain, but by altering your stress and anxiety levels on the neurologic level.

Sleep problems in cervical instability patients: structural sleep apnea and insomnia

In this video Ross Hauser, MD various reasons why a person’s structural neck problems can cause sleep apnea and insomnia, as well as what primary causes are reversible. This article has explanatory notes and supportive research.

What are we seeing in this image?

Potentially reversible causes of structural sleep apnea.

Many people that we see ask: “Do I have sleep apnea?” or, they’ve already been diagnosed with sleep apnea and they want to know “What can I do?”

Traditional sleep apnea, as explained in this article, decreases the airway space within the mouth. This can be caused by large tonsils, an enlarged tongue or the person’s jaw configuration. When we see these people they have usually been prescribed various appliances or  CPAP.

There are other causes of sleeplessness:

• Abnormal Weight: Being overweight can narrow the airflow space
• Altered tongue position
• Abnormal oropharynx: Enlarged tonsils, altered neurology, altered tongue position.
• Abnormal Jaw: TMJ and cervical instability.
• Abnormal Head and Neck or cervical spine instability

Circadian Rhythm Dysfunction and the Sleep-Wake Cycle

The human body functions through a 24-hour cycle called the Circadian rhythm. The most well-known part of the circadian rhythm is the sleep-wake cycle. Every organ of your body and the various tissues including the brain have a certain time of day where they function maximally and other times for instance at night time that they power down and go to sleep. What determines the circadian rhythm cycle are nighttime and daytime.  In other words, at daybreak, your adrenal gland starts producing hormones to get you up and get you going. The stress hormone in your body that controls when you wake up and when you go to sleep is called cortisolTherefore hormone production of the adrenal gland is supposed to be maximum in the morning and supposed to be minimal at night time.

This is why cell phones shouldn’t be used for prolonged periods at night time because all that blue life tells our bodies that it’s morning instead of night time then their body starts making hormones to wake us up. So easily confused is our circadian rhythm.

But beyond blue light, the circadian rhythm can also be impacted by cervical instability.

• Cervical instability can cause venous obstruction and obstruct the internal jugular vein.
• Internal jugular vein obstruction can block the cerebrospinal fluid that’s going to cause increased intracranial pressure that can injure the pineal gland and cause decreased melatonin and circadian dysrhythmias.

These are two simple sentences that outline a very complex problem. Let’s get a little more complex.

• The superior cervical ganglia is a ganglion, a nerve bundle that sits at the C2 and C3 levels in the cervical spine. The superior cervical ganglia are involved in the autonomic nervous system. Therefore compression on this nerve bundle by the cervical spine can cause autonomic nervous system dysfunction.
• The sympathetic ganglia basically control the blood supply to the brain including a gland called the pineal gland so the pineal gland is kind of the Main gland that is involved with a circadian rhythm

There is a science to your sleep disorders. Let’s follow it to see if you can get some answers to your sleep disruption being connected to your cervical spine instability.

What are we seeing in this image?

The inextricable relationship between circadian rhythm, sleep deprivation, cervical instability, and chronic health problems.

What are we seeing in this image?

In the next section we are going to talk about the scientific and medical reasoning behind the disruption of the circadian rhythm. Part of the circadian dysrhythmias can be traced to obstruction of arteries and veins in and out of the brain. Cervical instability can cause these dysrhythmias and in part, the accumulation of cerebrospinal fluid in the brain.

In the image below we see the brain “plumbing” that is the in and out of fluids. described as a “backed-up toilet.” Obstruction of arteries and veins, both into and out of the brain, caused by cervical instability ultimately result in an accumulation of cerebrospinal fluid in various parts of the brain, including the frontal lobe. This can destroy brain neurons and tissue.

The importance of the pineal gland in the maintenance of cerebrospinal fluid

We are going to start with a study published in the journal Medical Hypotheses in 2016. (1) It comes to us from The University of Texas Health Science Center, San Antonio. Previously there had been speculation of the importance of the pineal gland in the maintenance of cerebrospinal fluid. In this study, the pineal gland is suggested to be an important part of the formation and reabsorption of cerebrospinal fluid.

Let’s first better understand the pineal gland. Anna Aulinas, MD, PhD. wrote in internet-based book Endotext, (2) housed at the National Center for Biotechnology Information, U.S. National Library of Medicine that: “The main function of the pineal gland is to receive information about the state of the light-dark cycle from the environment and convey this information to produce and secrete the hormone melatonin. The rhythmic production of melatonin, secreted only during the dark period of the day, is extensively used as a marker of the phase of the internal circadian clock. (Your levels of Melatonin helps doctors understand deficiency). Melatonin itself is used as a therapy for certain sleep disorders related to circadian rhythm abnormalities and for the alleviation of jet lag.

Returning now to The University of Texas Health Science Center study we can understand the connection between the pineal gland, melatonin, and cerebrospinal fluid.

The researchers wrote: “Pineal melatonin can be either released into the bloodstream or directly enter into the cerebrospinal fluid of the third ventricle via the pineal recess. (The ventricles of the brain, and there are four of them, are filled with cerebrospinal fluid. The routine flushing of the cerebrospinal fluid in the ventricles helps bring nutrients in and waste out.)

The pineal gland is an essential player for CSF production

The Texas researchers hypothesized that rather than the peripheral circulatory (the routine blood flow method of the getting “stuff” into and out of the brain) melatonin circadian rhythm serving as the light/dark signal, it is the melatonin rhythm in the cerebrospinal fluid of the third ventricle that serves this purpose. This is due to the fact that melatonin circadian rhythm in the cerebrospinal fluid is more robust in terms of its extremely high concentration and its precise on/off peaks. . . (further they also) hypothesize that the pineal gland is an essential player for cerebrospinal production. (The researchers) feel it participates in both the formation and reabsorption of the cerebrospinal.

Now let’s jump to Dr. Hauser’s discussion at 3:50 of the video:

• Cervical instability can cause a cervical venous obstruction which can lead to:
• Cerebrospinal flow blockage can lead to increased intracranial pressure which can:
• Injure the pineal gland
• and cause Circadian dysrhythmia

The connection between brain drainage, cerebrospinal fluid, the pineal gland, melatonin production and disruption of circadian rhythm disruption and ultimately sleep problems as a neck structure problem continues as we now discuss the impact on the vagus nerve.

Will Melatonin help this?

Let’s look at an August 2021 study in the journal Biomedicines (3). It comes from university research teams in Pakistan and Germany. It provides us with up-to-the-moment assessments of the science understanding the structural causes of why you do not sleep. Here is what the researchers said:

“Preclinical as well as human studies indicate that melatonin is essential for a physiological sleep state, promotes analgesia (reduction in pain) and is involved in immunometabolic signaling by regulating neuroinflammatory pathways.”

Explanation: Immunometabolic signaling regulating neuroinflammatory pathways. Simply this is all about inflammation. Immunometabolic is the immune and metabolic system guiding the immune, inflammation response.

“Experimental and clinical neuromodulation studies for chronic pain treatment suggest that neurostimulation therapies such as spinal cord stimulation, vagus nerve stimulation and dorsal root ganglion stimulation have an impact on circulating inflammatory mediators in blood, cerebrospinal fluid and saliva.”

Explanation: Different times of neurostimulator devices including vagus nerve stimulation have been shown to improve the patient’s situation. The question they then ask is will Melatonin supplementation take this farther? The answer, the researchers suggest, is not conclusive when it comes to Melatonin supplements.

Here is what they wrote:

“In addition to a poor sleep, several chronic pain associated co-morbidities encompass obesity and related metabolic disorders such as hypertension, diabetes, atherosclerosis, cardiovascular pathologies and mood alterations (anxiety, depression, cognitive decline, pain catastrophizing). Notably, sleep deprivation was found to promote body weight gain in the long-term. . .

The adjunctive administration of melatonin to act synergistically with neurostimulation therapies for chronic pain management has yet to be evaluated in further clinical controlled pain trials applying either invasive and/or non-invasive approaches. Preliminary clinical findings support the idea to apply and assess the adjunctive impact of melatonin on chronic pain and associated co-morbidities, first to mention a pathological sleep pattern and pre-existing metabolic-related diseases. From the preclinical perspective it appears to be reasonable to probe the value of complementary melatonin intake.”

In simplest terms, it may work, it may not work, there is no conclusive evidence.

Vagopathy

The problems of sleep disorders are deep. In the above research, the vagus nerve is discussed as an important player. At our center we see many patients with cervical spine disorders or dysstructure (the structure of the patient’s neck is broken). This causes a loss of the natural curvature of the cervical spine. In this image there is a left to right comparison being illustrated in two patient’s neck curves. On the left is a normal cervical curve. The focus is on the correct position of the vagus nerve. The vagus nerve will be discussed below. In the abnormal curve demonstrated on the right, the vagus nerve is being stretched and compressed. It is this stretching and compression that can lead to the neurological-like, cardiovascular-like, psychological-like symptoms that many of our patients suffer from.

What are we seeing in this next image?

A visual description of how compression in the cervical spine can lead to problems of cervical spine neurology, among them, problems of circadian rhythm disruption, disrupted CSF flow, and sleep disorders

Here we see that the carotid sheath, containing the internal carotid artery, internal jugular vein, and vagus nerves (plural because there is one on each side of your body running through your left-side neck and its right side neck).  All of these vital structures lay on top of the C1 Atlas. When the Atlas or C1 starts “wandering” out of place it takes the carotid sheath with it, stretching the arteries, veins, and the glossopharyngeal nerve and vagus nerve or compressing the arteries, veins, and glossopharyngeal nerve, and vagus nerve. When there is compression there can be symptomology. The person is now suffering from “neurologic-like” symptoms among them, sleep disruption.

What are we seeing in this image? 

We see the head in four positions. The head is in its normal position than in the next three positions moves to the unnatural positions of “forward head postures.” The head goes from MILD cervical instability to MODERATE cervical instability to SEVERE cervical instability. As the caption reads. Forward head posture creates tension and stretches both the spinal cord and vagus nerve.

The Vagus nerve and vagopathy

A brief overview of the Vagus nerve. As mentioned above we have two vagus nerves – one on each side of the neck. The vagus nerve provides 75% of the total input for the parasympathetic nervous system. (That is the system mentioned above that calms you down and “de-stresses” you).

The health of the body is determined by the ability of these two vagus nerves to accurately, quickly, and effectively assess everything going on from moment to moment. The vagus nerves assess everything we eat, say, hear, think, and do and help the body make the proper adjustments for vigorous optimal health. With healthy vagus nerves, the overall nervous system is stronger, faster, calmer, and better equipped to handle stress. Strong vagus nerves are correlated with energy, mental alertness, intelligence, and vibrant functioning of the human body.

Poor vagus functioning, called vagopathy or vagal tone, precedes illness. It also perpetuates illness and makes recovery from diseases difficult. Low vagus nerve function has four main manifestations in the human body that increase the risk for almost all human diseases: chronic inflammation, elevated oxidative stress, sympathetic dominance, and coagulopathy.

Vagopathy caused by cervical instability (causing a change in the cervical spine curve) can result in compression and alter the signals of the vagus nerve.

• Vagopathy is the result of the “facedown lifestyle” looking at screens and phones all day, traumatic injury, hypermobility syndromes, and degenerative wear and tear. The subsequent neck instabilities these problems cause is “vagopathy” (the destruction of the vagus nerve). The resulting compression and altered signals of the vagus nerve can lead to a condition called sympathetic dominance. This is a situation where a person feels stressed all the time. This is more than phycological stress, this can be a structural stress.

Ross Hauser, MD discusses how the face-down lifestyle due, cell phone addiction, and cervical instability can cause insomnia and problems with a person’s circadian rhythm.

Any of the treatments or guidelines presented here will not overcome uncorrected poor posture (a cervical spine that has lost its natural curve)  or poor dietary and lifestyle habits. If a person is continually sleep-deprived, stressed-out, nutritionally starved (a coffee and doughnut diet), and types on a computer all day, treatments will not be effective other than prolonged and increased painkiller use to suppress pain syndromes and medications to suppress the neurologic-type symptoms discussed above. Even then, the point of non-responsiveness to these medications may be reached.

Our treatment methods

On our website, we have published very extensive articles on solving the various problems discussed above.

In our article Cervical Curve Correction – Caring Cervical Realignment Therapy, we describe Caring Cervical Realignment Therapy (CCRT) or what we call “Curve Correction” which combines individualized protocols to objectively document degrees of spinal instability and cervical dysstructure and re-establish normal biomechanics and encourage restoration of lordosis. Curve Correction can be a beneficial treatment in providing long-term pain relief and symptom resolution in patients looking to avoid spinal surgery or who have already failed surgery.

In my article Cervical Myelopathy – Cervical Degenerative Disc Disease – Cervicovagopathy – Cervical Dysstructure Broken neck structure, I discuss treatments for the progression of degenerative or impact injury that will eventually distort the cervical spine and cause some people many neurologic-like, cardiovascular-like, and psychological-like issues including problems with sleep.

1 Tan DX, Manchester LC, Reiter RJ. CSF generation by pineal gland results in a robust melatonin circadian rhythm in the third ventricle as an unique light/dark signal. Medical hypotheses. 2016 Jan 1;86:3-9. [Google Scholar]
2 Aulinas A. Physiology of the pineal gland and melatonin. Endotext [Internet]. 2019 Dec 10. [Google Scholar]
3 Chaudhry SR, Stadlbauer A, Buchfelder M, Kinfe TM. Melatonin Moderates the Triangle of Chronic Pain, Sleep Architecture and Immunometabolic Traffic. Biomedicines. 2021 Aug;9(8):984. [Google Scholar]
4 Telch MJ, Rosenfield D, Lee HJ, Pai A. Emotional reactivity to a single inhalation of 35% carbon dioxide and its association with later symptoms of posttraumatic stress disorder and anxiety in soldiers deployed to Iraq. Archives of general psychiatry. 2012 Nov 1;69(11):1161-8. [Google Scholar]

4242

• Surgery
• NSAIDs
• Cortisone Shots
• R.I.C.E.