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.
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.
What does Sympathetic Dominance mean?
The autonomic nervous system is divided into two nervous systems. These two nervous systems counteract each other. One speeds you up, the other slows you down.
- It is the sympathetic nervous system that speeds you up.
- It is the parasympathetic nervous system that slows you down.
A state of Sympathetic Dominance means you are being sped up. The sympathetic nervous system responds quickly to a stimulus. It is responsible for your fight or flight decision-making processes in times of stress. This could be stress at the workplace, personal stress, or other things that could present emotion toil through aggravation or worry.
These are the signs and symptoms of Sympathetic Dominance (your body reacting to constant stress).
- Insomnia and sleep disorder
- Acidic foods upset the stomach
- Anxious feeling
- Cold hands and feet
- Cold sweats.
- Cuts heal slowly.
- Dry mouth, eyes, and nose.
- Easily raised fever
- Elevated pulse addressed.
- Excessive emotionalism.
- Extreme sensitivity to lights and sounds.
- Eyes stare really blinking.
- Failure to calm down startles easily.
- Gags easily.
- Gets chilled often, extremities cold and clammy.
- Lump in throat.
- Nervous or sour stomach and reduced appetite.
- Neuralgia like pains.
- Pulse speeds up after eating.
Many problems in the patients we see are caused by a structural stress or problem in the cervical spine. Typically this problems is a loss of the natural cervical curve causing pressure, compression and decreased nerve impulses in the vagus nerve. Problems include your adrenaline system being too high and then ultimately you end up getting circadian dysrhythmias where your body doesn’t know if it’s night time it’s daytime.
- When you have increased intracranial pressure in the brain, the brain senses this pressure is too high because the brain knows that the cerebrospinal fluid is not draining out of the brain normally. The body then through autoregulation (a system in which blood vessels manage blood flow) dilates the blood vessels in the brain so now all the sudden the speed of the blood flow to the arteries in the brain might be twice normal increasing pressure.
What are we seeing in this image?
Let’s start with the caption: Typical nervous system imbalance.
When there is a greater amount of sympathetic nervous system activity (your body is in a state of stress awareness) than parasympathetic (your body’s attempt to bring itself down from stress awareness) and this is occurring over a long period of time, systematic inflammation, neuropathic pain, and other long-term health problems occur.
Below we see a see-saw
On one side of the see-saw, we see sympathetic overdrive a constant state of:
- Fight or Flight
- Tissue breakdown
- Chronic inflammation
And on the other side of the see-saw, we see decreased parasympathetic activity
- Reduced ability to relax
- Reduced ability to repair and restore damaged tissue
- Reduce the ability for health to be restored
The Long terms effects of sympathetic overdrive
- Small fiber neuropathy can cause symptoms of burning pain, shooting pain, allodynia (over-sensitization to pain and pain from stimuli that should not cause pain), and hyperesthesia (over sensation of the skin).
- Neuropathy pain
- Inflammatory physiology
- Chronic disease
The Long terms effects of decreased parasympathetic activity
- Damage or impacts on nerve tissue health
- Reduced state of calmness or peace
- Reduced ability to have restorative health.
Blood velocity measurements
In patients that we assess and suspect that blood flow velocity is a concern, we offer testing to help confirm our assessments. Motion transcranial Doppler examination is a test where we ask the patient to go through a series of neck and head movements to assess if blood flow and velocity is impacted in the different ways the patient holds their head. We do this because, in some patients, they can be laying down at night, no specific worrying thoughts and anything that should keep them awake, yet they cannot go to sleep or if they do go to sleep they wake up in the middle of the night and cannot go back to sleep because their heart is racing.
What we do measure their blood velocities while they’re laying down in the various positions. In many people we find that certain positions will cause a rapid increase in blood velocity causing their brain to be in “hyper-alert” and causing them the inability to go to sleep or return to sleep. This of course will cause insomnia. In this “hyper-alert” state, you can have too much adrenaline and the vagus nerve and the parasympathetic nervous system cannot calm you down you will be in a state of stress.
Blood velocity – when you are going too fast sleep is disturbed
In this section, I will be touching on the phenomena of accelerated blood velocity.
Let’s focus on sleep apnea. Many people who contact our center tell us about the many conditions that they face including sleep apnea. Sleep apnea in and of itself is not the main symptomology these people suffer from but one among many.
Sleep apnea causes people to have altered or paused or halted breathing during sleep. Many people are diagnosed with obstructive sleep apnea (something is blocking the airways or the airways themselves are narrowed by an inflammatory problem.) Then there is central sleep apnea. In central sleep apnea, the same symptoms of problem breathing during sleep are said to be caused by a communication problem (neurology) between the brain and the respiratory system or nerves and muscles.
In the image, we will focus on sleep apnea (as it can be caused by cervical spine instability). Explanation notes are given below.
Carbon dioxide reactivity (C02 reactivity) to help assess anxiety and potential for panic attacks.
This is a measure of the amount of Carbon dioxide in the blood and brain. Why is this important? Because it has to do with levels of stress and can predict future problems in people who have too much carbon dioxide in the blood and brain. There was a recent study which gives dramatic evidence to the problem of Carbon dioxide reactivity. Published in the Journal of the American Medical Association (4) and produced by researchers at the Departments of Psychology, The University of Texas at Austin, Southern Methodist University, and University of Wisconsin-Milwaukee, researchers examined soldiers before their deployment into war zones to try to predict who would suffer from post-traumatic stress syndrome.
Fear and panic
Many patients we see suffer from anxiety disorders, fear disorders, and disorders that make their heart race and their blood flow accelerate. When the researchers subjected the soldiers to a CO2 challenge (C02 was introduced at 35% levels into their system) the results of this increased C02 were similar to that seen in civilian or non-military subjects.
- The 3 most frequently reported physical reactions to the CO2 challenge were:
- feelings of faintness,
- and breathlessness—all expected reactions to acute hypercapnia (the excessive buildup of carbon dioxide in the bloodstream – something that happens during sleep in patients with disturbed sleep patterns).
- Soldiers’ reacted differently to fear and panic. Some had no fear (32%) to panic (11%), with the average soldier reporting mild fear. This is in sharp contrast to those observed for patients with panic disorder, who report extreme fear, with more than 60% experiencing panic in response to the CO2 challenge.
Hypoxia is simply you are oxygen deprived or oxygen-starved. This drop-in oxygen level is not typically caused by carbon dioxide reactivity nor is Hypoxia usually considered a primary condition but rather the result of breathing or respiratory disorders or problems related to compression of injury to the cervical spine.
Internal jugular vein stenosis
We have been helping people with “mystery symptoms” and “mystery diagnosis” for approaching three decades. When we sit in the examination room with new patients, even after a careful screening process to assess their candidacy for the treatments we offer, we still sometimes get the look of confusion in patients’ eyes when we suggest a problem that has not been suggested to them before. Sometimes such is the case with internal jugular vein stenosis. I have a very extensive article on the problems of internal jugular vein stenosis. Please see Symptoms and conditions of cervical spine compression causing internal jugular vein stenosis.
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.
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