Which discipline in health care has taken the front-row approach to sleep wellness and the importance it has to the patient's overall health? I suggest no specific doctor (other than the sleep specialist who prescribes Ambien and C-Pap machines) has made this a key emphasis in health care. Chiropractic is the perfect profession to take sleep wellness and run with it. We deal with overall health, utilize a wellness model of health, and understand better than any other profession how health is a factor of wholeness, rather than one specific entity. Yet only a fraction of our profession educates or understands the importance of sleep from a physiological stance and how closely sleep relates to chiropractic philosophy and science. Let's change all that now.
Chiropractic & Sleep Wellness: A Natural Connection
If part of the chiropractic philosophy is to promote healthy cellular regeneration and maintain balance in systemic homeostasis, then sleep should be one of the most integral factors assessed when taking history and as part of patient education. During our awake hours, our system runs primarily under sympathetic nervous system control, which is the catabolic time of the day when tissues are being degraded and broken down. This is the period of biochemical control when hormones such as cortisol are most prevalent; as well as C-reactive proteins and cytokines, which break down damaged tissues used for functioning.
During the deeper stages of sleep, the system switches over to parasympathetic control, and the anabolic phase starts to renew and rebuild cellular tissue. This is the period of biochemical control during which growth hormone is released for rebuilding; and when cycles of chemical balancing and glial cells in the brain are refreshed, stabilizing the neurons.
What can be taken from this physiological understanding? Ultimately, the body stays imbalanced chemically, functionally and structurally when sleep is deprived or insufficient. The cytokines and CRP lead to massive cell damage and inflammation – primary causes of type 2 diabetes, heart disease, brain and neuronal loss, depression, inflammatory disease and even weight gain. Illness can be a direct or indirect cause of the body simply not having the time to repair cells, eliminate toxins (also done during sleep), and complete the emotional processing that is often interrupted during awake hours.
Evaluating Patients' Sleep Quality in Your PracticeSeven in 10 Americans are sleep deprived, primarily due to causes such as chronic pain, alcohol use, stimulant medication or caffeine, stress, respiratory conditions such as apnea, or simply just a poor sleeping environment. How can you assess this in your patients?
We need to inquire about time of sleep, quality of sleep and ask related questions when taking the patient history; understand medications that disturb sleep; know what supplements promote sleep (and which do the opposite); and educate the patient on the importance of training the mind for sleep when retiring for the evening. Each of these steps be a significant topic and article of their own, so I encourage you to some simple research when you have a patient who isn't responding to care as you are accustomed to.
Making Sleep Support Recommendations
Many patients ask us, "What type of mattress and pillow should I be using?" Chiropractors need to learn to ignore traditional mattress marketing, as there is no greater gimmick industry. Doctors should do their due diligence in recognizing and understand the physics of how the body is maintained during the regenerative period of sleep. The pillow and mattress combination should be designed to allow the bony pressure points to be absorbed, relieving any form of neurovascular compression – most commonly experienced in the shoulders and hips. In addition, the mattress needs to create some degree of support to allow the spine to maintain the curvatures and angles we chiropractors are working hard to restore and maintain during the restorative time of sleep, regardless of the patient's sleep position. Many manufacturers state that they offer these, but very few truly deliver.
Case Study: Better Sleep = Better Patient Outcomes
Betsy returned to the chiropractor after a long pregnancy, approximately 5 months after the birth of her daughter. During her pregnancy, she had experienced some sciatica and sacroiliac pain that was relieved with chiropractic adjustments and light stretching. She returned complaining of multiple symptoms: headaches, nausea, severe depression, shoulder pain, swelling in both thumbs and right knee pain. The obstetrician had told her it was the normal effect of hormones postpartum.
The chiropractor decided to do a more thorough evaluation and history including diet, exercise and sleep history. Nothing was conclusive in the diet and exercise history to reflect the symptoms presented, but the sleep analysis revealed she hated her mattress because it was sagging in the middle and she was always fighting to stay on her side. As a result, her hips and shoulders would hurt all night, causing tossing and turning. Her 5-month-old still required some nightly nursing and did not sleep well through the night, which only disturbed Betsy's sleep more.
When asked how many hours of deep sleep and restful sleep she was getting, her reply was none to a half hour of deep sleep and less than 5 hours of restful sleep.
The chiropractor educated her briefly on how the hormonal balance and emotional processing were being affected, and a new mattress was prescribed along with neuro-linguistic programming to achieve deeper sleep. Within a week, Betsy's inflammation was gone, she no longer was considering prescription antidepressants while still nursing, and almost all of her musculoskeletal symptoms had been relieved. Simply put, her body was able to balance and repair itself both physically and biochemically with only one simple suggestion. On top of that, the chiropractor was able to increase his revenue through the commissions on the mattress and NLP programs, and the patient now refers every friend who has symptoms of postpartum depression or sleep deprivation.
Implementing Sleep Wellness: Simple Steps You Can Take
When implementing a sleep wellness model into your office, there are a few simple steps you can take to maximize the benefit to the patient and increase your revenue at the same time:
In our fight to be recognized as primary care doctors, we need to strengthen our stance at understanding health as a whole. Continuing to look at a cause of dis-ease, rather than chasing the symptom(s), is the key to wellness. Our knowledge and understanding of all the body systems and how they work synergistically is the key to good doctoring. Sleep should be an integral part of that analysis and evaluation, which will position chiropractors on the front row of education and management of sleep disorders.
Resources
On Jan. 24 1978, the New Zealand governor-general referred to a Commission of Inquiry an investigation to determine the desirability of providing for reimbursement of chiropractic benefits under the New Zealand Social Security Act and the New Zealand Accident Compensation Act. The commision's findings would impact chiropractic worldwide for decades to come.
As chiropractors, we observe signs and symptoms as colors on an artist’s palette, melding them together to determine how they affect the speed, fluency, quality, and ease of activities of daily living. We communicate this vision to our patients in a report of findings. However, converting that vision into the International Classification of Diseases Clinical Modification (ICD-CM) coding language presents challenges.
After more than 12 years of effort, the Pro Baseball Chiropractic Society (PBCS) has member DCs serving every team in MLB. Working as part of the health care teams with athletic trainers and medical physicians, these highly skilled chiropractors help keep their players on the field and in optimal health.
