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Category: Sleep Hygiene

ChiroMedBlogSleep Hygiene

Sleep Hygiene ChiroMed. Healthy sleep is important for physical and mental health, improving productivity and overall quality of life. Dr. Alex Jimenez describes sleep hygiene as a variety of habits that are often necessary to achieve a proper quality of sleep to rise with full daytime alertness. Everyone, from children to older adults, can benefit from better sleep, and sleep hygiene is key to achieving that goal. Sleep is essential for physical health and well-being because it is important in the body’s natural healing and repairing functions. Therefore, the most important sleeping measure is to maintain regular sleeping patterns. Research has demonstrated that forming good habits is a central part of health. The ideal sleep environment is cool, quiet, and dark. Research has also shown that uncomfortable room temperature, light, and noises can interrupt continuous sleep. Sleep hygiene specialists recommend selecting a comfortable mattress, pillows, and bedding and moving or hiding a visible clock. This prevents the sleeper from focusing on time passing while trying to fall asleep. Heavy meals before bed, caffeine or alcohol before bed, and even improper sleeping postures accompanied by pain and discomfort can be frequent poor sleep hygiene practices that can interfere with the sleep quality of many individuals. Crafting sustainable and beneficial routines makes healthy behaviors feel almost automatic, creating an ongoing process of positive reinforcement that can lead to higher-quality sleep and better overall health.

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care, Sleep Hygiene , , , , , , , , , , , , , , , , ,

Pseudoarthrosis After Spinal Fusion Surgery Explained

What is pseudoarthrosis of the cervical and lumbar spine?

Pseudoarthrosis of the cervical and lumbar spine

Individuals may need a spinal fusion to treat a fractured vertebra, scoliosis, or conditions like spinal stenosis, degenerative disc disease, and spondylolisthesis/slipped vertebrae. A spinal fusion reduces pain and stabilizes the spine by limiting movement between vertebrae. Pseudoarthrosis happens when the bones don’t heal after a fracture or bone surgery. When pseudoarthrosis affects the cervical or lumbar spine, it means that two vertebrae did not heal and grow together after spinal surgery to fuse them (spinal fusion). Reasons for a failed spinal fusion include:

  • Issues with the instruments used to stabilize the bone
  • Lack of bone growth
  • The number of vertebrae being fused.

The patient’s health and lifestyle play a role in failed fusions, which can include

  • Diabetes
  • Inflammatory health conditions increase the risk
  • Smoking
  • Long-term steroid use

In many cases, revision surgery is needed.

Surgery-Related

During a spinal fusion, surgeons insert a bone graft between two vertebrae and then apply spinal fixation hardware (instrumented spinal fusion) that includes:

  • Plates
  • Rods
  • Screws
  1. The bone graft promotes growth between the two bones.
  2. The hardware stabilizes the vertebrae and prevents movement while they fuse and grow together.
  3. The hardware goes inside, or internal fixation.
  4. Although rare, a severe spinal fracture or deformity may need external fixation.
  5. A rigid frame secured outside the body helps to stabilize the bones.

If the fusion fails, it could be caused by one or more of the following surgical issues:

Number of Vertebrae Being Fused

Hardware

  • The surgeon must carefully plan and use the right hardware.
  • The type of hardware used during a spinal fusion may influence bone healing.
  • The instruments can come loose or break, interfering with the fusion process.
  • Spinal osteoporosis, having thin, weak bones, can affect fixation.
  • Even with the optimal surgical preparedness, weak bones significantly increase the chance of the instruments loosening and pseudoarthrosis developing.

Bone Graft

  • The type of bone graft used may affect the fusion.
  • For example, in cervical/neck spinal fusions, an autograft, which uses a small piece of bone from the patient’s body, has a higher success rate. (Verla T. et al., 2021)
  • Other graft options include specialized steel cages that fit between vertebrae and contain bone growth factors.
  • The surgeon recommends the optimal bone graft for the type of surgery, the number of vertebrae involved, and risk factors.

Risk Factors

  • The patient’s overall health and lifestyle impact the results of spinal fusion. Smoking increases the risk. (Berman D. et al., 2017)
  • Nicotine restricts blood circulation, decreases bone density, reduces new bone formation, and delays bone healing. (Hernigou J., & Schuind F., 2019)

The risk of pseudoarthrosis increases if the individual has any of the following: (Scoliosis Research Society, 2023)

  • Previous pseudoarthrosis
  • Obesity
  • Chronic steroid use
  • Malnutrition
  • Inflammatory diseases

Inflammatory conditions that can lead to bone loss and non-optimal bone healing include: (Torres H. M. et al., 2023)

  • Diabetes (Jiao H, Xiao E, & Graves DT, 2015)
  • Inflammatory bowel disease
  • Psoriasis
  • Rheumatoid arthritis
  • Chronic obstructive pulmonary disease/COPD
  • Periodontitis
  • Systemic lupus erythematosus/SLE

Symptoms

  • The primary sign of pseudoarthrosis is pain in the same area as before the fusion surgery.
  • If the bones pinch a spinal nerve, one arm may experience pain, tingling, burning, or numbness.
  • Rarely does a pinched nerve affect both arms.
  • The pain may return shortly after the procedure.
  • The pain may develop gradually or not appear for many months.
  • However, it’s more likely to appear after several months when the individual returns to their usual activities.

Diagnosis

  • The healthcare provider will learn about symptoms and perform a physical exam to evaluate the back.
  • They’ll assess mobility and the type of movement that causes pain.
  • Then, they order diagnostic imaging to see the spine and identify the cause of pain.
  • Individuals may need a CT scan, MRI, and/or X-rays to evaluate the spinal structures and instrumentation fully.

Treatment

Treatment for pseudoarthrosis will likely start with:

  • Physical therapy
  • Pain management – especially in cases where it is important to rule out other sources of back or neck pain.
  • Medication
  • Injections
  • If symptoms don’t improve with conservative care or if there is severe pain, the healthcare provider may recommend revision surgery.
  • Revision surgery is another procedure to treat complications or correct issues that arise after the initial pseudoarthrosis surgery.

Injury Medical Chiropractic and Functional Medicine Clinic

As a Family Practice Nurse Practitioner, Dr. Jimenez combines advanced medical expertise with chiropractic care to address various conditions. Our clinic integrates Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine to create customized care plans that promote natural healing, mobility, and long-term wellness. By focusing on flexibility, agility, and strength, we empower patients to thrive, regardless of age or health challenges. At El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately focus on treating patients after injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility, and agility programs tailored for all age groups and disabilities. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes.

Enhancing Health Together

References

Boonsirikamchai, W., Wilartratsami, S., Ruangchainikom, M., Korwutthikulrangsri, E., Tongsai, S., & Luksanapruksa, P. (2024). Pseudarthrosis risk factors in lumbar fusion: a systematic review and meta-analysis. BMC musculoskeletal disorders, 25(1), 433. https://doi.org/10.1186/s12891-024-07531-w

Verla, T., Xu, D. S., Davis, M. J., Reece, E. M., Kelly, M., Nunez, M., Winocour, S. J., & Ropper, A. E. (2021). Failure in Cervical Spinal Fusion and Current Management Modalities. Seminars in plastic surgery, 35(1), 10–13. https://doi.org/10.1055/s-0041-1722853

Berman, D., Oren, J. H., Bendo, J., & Spivak, J. (2017). The Effect of Smoking on Spinal Fusion. International journal of spine surgery, 11(4), 29. https://doi.org/10.14444/4029

Hernigou, J., & Schuind, F. (2019). Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone & joint research, 8(6), 255–265. https://doi.org/10.1302/2046-3758.86.BJR-2018-0344.R1

Scoliosis Research Society. (2023). Pseudoarthrosis. https://www.srs.org/Patients/Conditions/Pseudoarthrosis

Torres, H. M., Arnold, K. M., Oviedo, M., Westendorf, J. J., & Weaver, S. R. (2023). Inflammatory Processes Affecting Bone Health and Repair. Current osteoporosis reports, 21(6), 842–853. https://doi.org/10.1007/s11914-023-00824-4

Jiao, H., Xiao, E., & Graves, D. T. (2015). Diabetes and Its Effect on Bone and Fracture Healing. Current osteoporosis reports, 13(5), 327–335. https://doi.org/10.1007/s11914-015-0286-8

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Physio, Sleep Hygiene, Therapy , , , , , , , , , , , , , , , , , , ,

Sleep Cervical Neck Roll for Better Rest

Could making their own cervical neck roll help relieve pain and improve sleep for individuals who have neck pain after sleeping or during sleep?

Sleep Cervical Neck Roll

Neck pain can lead to sleep loss, leading to various health problems. Neck pain and everything that comes with it can limit the ability to work, drive, or sleep normally. A cervical roll may be one way to keep your neck in the optimal position while sleeping. Many with neck pain require extra support from their pillow. A cervical pillow can provide that support.

For individuals who develop neck pain, a visit to a chiropractic physical therapist can help manage symptoms. Treatments and modalities like traction may be necessary to relieve pressure on cervical nerves. (Gudavalli M. R. et al., 2015) Steps to self-manage neck pain may include performing specific neck exercises and maintaining proper posture (Hesby B. B. et al., 2019). Using the right pillow with the right support can help keep the neck in correct alignment, decrease or eliminate neck pain, and get you back to normal activities.

Neck Support During Sleep

The neck comprises seven vertebrae bones, normally forming a slight curve called lordosis. Maintaining a forward curve in the neck is important when treating neck pain, as it can help relieve pressure on spinal discs and nerves. A cervical roll, also known as a neck roll or cervical pillow, is a small pillow placed in the pillowcase that supports the neck while sleeping. The cervical roll provides the right amount of support for the neck and maintains alignment while lying down. (Gross A. R. et al., 2013)

  • Individuals can purchase a cervical roll online or at a store or pharmacy.
  • Individuals can also contact a physical therapist to help them obtain a cervical roll.

Making Your Own

Making a cervical roll is simple to do. Here’s how:

  • Using a hand towel.
  • Fold it in half.
  • Slide the towel into the pillowcase along the lower edge.
  • Be sure the towel is tucked in so it doesn’t slip out.
  • Individuals can place tape around it so it stays in the rolled shape.

The towel roll will also help support the neck when lying on one side or the other, filling in the space between the head and shoulder. Sleeping on the stomach is usually not recommended for neck pain. Exercise and postural correction training are essential components of treatment for neck pain, and finding the right sleeping posture can help quickly eliminate pain. (Harvard Publishing, 2022)

If neck pain persists, worsens, or is accompanied by arm weakness or numbness and tingling, a visit to a healthcare provider may be necessary to assess the cause. A visit to a local chiropractic physical therapist can also help. They can immediately show you how to treat neck pain.

Injury Medical Chiropractic & Functional Medicine Clinic

A cervical roll can give your neck the right support while sleeping. This can help you quickly and safely manage neck pain and return to your previous level of function. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

The Road To Recovery: Chiropractic Care

References

Gudavalli, M. R., Salsbury, S. A., Vining, R. D., Long, C. R., Corber, L., Patwardhan, A. G., & Goertz, C. M. (2015). Development of an attention-touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain. Trials, 16, 259. https://doi.org/10.1186/s13063-015-0770-6

Hesby, B. B., Hartvigsen, J., Rasmussen, H., & Kjaer, P. (2019). Electronic measures of movement impairment, repositioning, and posture in people with and without neck pain-a systematic review. Systematic reviews, 8(1), 220. https://doi.org/10.1186/s13643-019-1125-2

Gross, A. R., Kaplan, F., Huang, S., Khan, M., Santaguida, P. L., Carlesso, L. C., Macdermid, J. C., Walton, D. M., Kenardy, J., Söderlund, A., Verhagen, A., & Hartvigsen, J. (2013). Psychological Care, Patient Education, Orthotics, Ergonomics, and Prevention Strategies for Neck Pain: A Systematic Overview Update as Part of the ICON Project. The open orthopaedics journal, 7, 530–561. https://doi.org/10.2174/1874325001307010530

Harvard Health Publishing. (2022). Say “good night” to neck pain. https://www.health.harvard.edu/pain/say-good-night-to-neck-pain

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Exercises, Sleep Hygiene , , , , , , , , , , , , , , , , , ,

Exercising Before Bed: Impact on Your Sleep Cycle

What type of exercise is recommended for individuals who want to exercise before bed?

Exercising Before Bed

Exercising sounds like a good way to tire the mind and body before bed. However, research shows that moderate to vigorous exercise later in the day can negatively impact sleep quality. (Alkhaldi E. H. et al., 2023)

  • To improve sleep, it is recommended that you exercise in the morning or earlier in the day, at least four hours before bed.
  • Individuals who exercise later should aim for lighter activities, such as non-strenuous walking or gentle, restorative yoga.
  • Light physical activity, like a slow walk after dinner, is OK.

Advantages

Daily exercise improves sleep quality. (Johns Hopkins Medicine, 2025) Mild exercise before bed and engaging in light activities like walking or stretching can positively affect health (Hijikata Y, Yamada S. 2011). These include:

  • Decrease muscle tension
  • Improve digestion
  • Improve blood sugar regulation
  • Relax the mind and body

Disadvantages

The nervous system naturally switches between active and calm. It is ready to work and engage in physical activities when it is active. When it is resting, sleep occurs. Activating the nervous system before bed can affect sleep, and exercising can affect body temperature, producing sleep challenges. Typically, body temperature decreases as the body prepares for sleep. Exercising before bed can increase core temperature and disrupt the process. (Szymusiak R. 2018) Moderate or vigorous physical activity close to going to sleep can: (Alkhaldi E. H. et al., 2023)

  • Make it more difficult to fall asleep
  • This leads to more waking up during the night.
  • Decrease sleep quality

Recommended Types of Exercise

Pre-bedtime activities should not be vigorous or engaging enough to make the body and mind more alert. Some exercises to calm the body and mind before bed include: (Sleep Foundation, 2023)

Restorative Yoga

  • Yoga Nidra and other low-intensity yoga can help promote sleep.
  • More intense forms of yoga, such as vinyasa/flow, should be done earlier.

Tai Chi

  • A Chinese practice that incorporates slow, gentle movements and focuses on breathing to promote peace and relaxation.

Slow Walking

  • Walking at a leisurely pace can help the body unwind and relax.

A slow heart rate and breathing indicate that the activity is calming and not stimulating.

Exercises to Avoid

Moderate to high-intensity workouts before bed that increase breathing and heart rate can disrupt sleep. Individuals who struggle to fall asleep or get restful sleep should try reducing the intensity of certain exercises or avoiding them one to two hours before bed. Examples of moderate to vigorous exercises include: (American Heart Association, 2024)

  • Gardening or heavy yard work
  • Running
  • Brisk walking
  • Cycling
  • Dancing
  • Sports activities

Working Out In The Evening

Sometimes, exercising later in the day or close to bedtime is the only time to get physical activity. If this is the case, late exercise is better than no exercise at all, but there are ways to lessen its impact on sleep, including:

  • Light physical activity, like walking, can be done up to an hour before bed.
  • Do more intense exercises at the beginning of the workout.
  • End the workout with a cooldown, like walking or stretching, to relax the mind and body.
  • Know how your workout schedule impacts your sleep, and adjust as necessary.

How Long After Working Out to Go To Sleep?

For individuals who want restful and uninterrupted sleep, experts recommend waiting one to two hours after a moderate or vigorous workout to go to bed. (Harvard Health Publishing, 2024) (Johns Hopkins Medicine, 2025)

Injury Medical Chiropractic & Functional Medicine Clinic

Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Optimizing Your Wellness

References

Alkhaldi, E. H., Battar, S., Alsuwailem, S. I., Almutairi, K. S., Alshamari, W. K., & Alkhaldi, A. H. (2023). Effect of Nighttime Exercise on Sleep Quality Among the General Population in Riyadh, Saudi Arabia: A Cross-Sectional Study. Cureus, 15(7), e41638. https://doi.org/10.7759/cureus.41638

Johns Hopkins Medicine. (2025). Exercising for better sleep. https://www.hopkinsmedicine.org/health/wellness-and-prevention/exercising-for-better-sleep

Hijikata, Y., & Yamada, S. (2011). Walking just after a meal seems to be more effective for weight loss than waiting for one hour to walk after a meal. International journal of general medicine, 4, 447–450. https://doi.org/10.2147/IJGM.S18837

Szymusiak R. (2018). Body temperature and sleep. Handbook of clinical neurology, 156, 341–351. https://doi.org/10.1016/B978-0-444-63912-7.00020-5

Sleep Foundation. (2023). Bedtime routines for adults. https://www.sleepfoundation.org/sleep-hygiene/bedtime-routine-for-adults

American Heart Association. (2024). American Heart Association recommendations for physical activity in adults and kids. https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

Harvard Health Publishing. (2024). Does exercising at night affect sleep? https://www.health.harvard.edu/staying-healthy/does-exercising-at-night-affect-sleep

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Exercises, Sleep Hygiene , , , , , , , , , , , , , , , , ,

Weight Resistance Training and Its Impact on Sleep Quality

For individuals looking to improve sleep, could weight training be the answer to increase healthy sleep?

Weight Resistance Training

Researchers found that resistance weight training improves sleep quality, among other methods like diet and sleep hygiene practices. Resistance training may improve sleep by reducing anxiety and stress, benefiting heart health, and promoting muscle recovery. Researchers examined non-medication methods of improving sleep in younger and middle-aged adults, comparing exercise, diet, and sleep hygiene practices. The findings showed that for adults under 65, resistance training is the best non-pharmacological way to improve sleep quality. (Hirohama, K. et al., 2024) These findings reinforce that sleep and exercise lead to improved restful sleep. Resistance training is highly effective compared to aerobic exercise (running or cycling) in improving sleep quality. The research shows that resistance exercise has more profound benefits than aerobic training alone.

Resistance Training and Improved Sleep

Resistance training, also called strength training or weight training, is intended to build muscle and strength using resistance. This can include:

  • Your body weight
  • Resistance bands
  • Free weights
  • Weight-lifting machines

The mechanisms by which exercise alters sleep are unknown. However, the researchers point out that weight training may improve sleep by improving mental health issues such as anxiety and depression. (Cunningham J. E. A., & Shapiro C. M. 2018) (Carbone E. A. et al., 2023) Other research on resistance training and sleep found that resistance training helped decrease anxiety and stress. (Alley J. R. et al., 2015) Resistance training can benefit heart health as it increases blood circulation. This means the heart’s vessels don’t have to work as hard during sleep when blood pressure should naturally drop, which is known as nocturnal dipping, which is great for individuals with high blood pressure.

Another reason this training may help with sleep is its impact on the body. Previous research on resistance training and sleep suggests that since weight training stresses muscle tissue, it could signal the brain that sleep is needed to repair the damage (Iowa State University, 2022). The hormone adenosine, which helps promote sleep, is a key factor in why exercise increases adenosine levels and helps the body doze off. (Roig M. et al., 2022)

How Much Resistance Training Is Needed?

Sleep doctors advise patients to perform some form of daily movement or exercise to improve sleep. The amount of resistance training an individual needs depends on their circumstances, such as underlying conditions, injuries, fitness level, physical ability, and time.

  • General guidelines from the American Heart Association recommend strength training at least twice a week.
  • The guidelines for physical activity from the Department of Health and Human Services recommend adults do a muscle-strengthening activity at least two days each week in addition to at least 150 to 300 minutes of moderate-intensity aerobic activity.
  • The meta-analysis research found that a 55-minute resistance training session consisting of three sets of 10 to 12 exercises done three times a week positively affected sleep quality.
  • They added that higher intensity and frequency of training could have a greater effect on sleep.

In other research on exercise and sleep, study participants were grouped into resistance training, aerobic, and combination workouts – both resistance and aerobic exercise. Each group engaged in 60-minute training sessions three times a week, with the combination group doing 30 minutes of resistance training and 30 minutes of aerobic exercise each session. (Iowa State University, 2022) Resistance training increased sleep by an average of 40 minutes compared to about 23 minutes for those who did an hour of aerobic exercise. A combination of aerobic and resistance increased sleep by about 17 minutes. (American Heart Association, 2022)

Previous research on resistance training and sleep found that exercise at any time can improve sleep quality compared with no strength training. However, evening sessions tend to help individuals sleep a little better. (Alley J. R. et al., 2015) Resistance exercise may offer benefits regarding the ability to fall asleep and stay asleep for those with osteoporosis, sarcopenia, anxiety, or depression.

Strength Workouts

Resistance training that targets all the major muscle groups is the goal. The Iowa State University research had participants use 12 resistance machines to perform exercises, including: 

  • Leg presses
  • Chest presses
  • Lat pulldowns
  • Bicep curls
  • Abdominal crunches 
  • Participants performed three sets of eight to 12 reps at 50% to 80% of their one-rep max. (Iowa State University, 2022)
  • One of the studies had participants work out for 30 minutes using nine different resistance machines, completing three sets of 10 reps. (Alley J. R. et al., 2015)

However, individuals can also use dumbbells such as bicep curls or chest presses, barbells for deadlifts or back squats, resistance bands for lateral shoulder raises or leg extensions, or their body weight for movements such as chin-ups or push-ups.

Other Ways to Improve Sleep Without Meds

Other non-drug methods to improve sleep include a healthy diet, proper hydration, dietary changes, and stress management like meditation. Aerobic exercise is known to improve both sleep quantity and quality. (Kovacevic A. et al., 2018) Lifestyle behaviors outside exercise are also important for sleep. Sleep hygiene refers to having healthy sleep habits and behaviors at night. This includes optimizing pre-bedtime routines to prepare the mind and body for sleep and improving bedroom environments to ensure sleep support, meaning it is cool, dark, quiet, and free from distractions like phones. Another important method of improving sleep is listening to your body and not forcing yourself to stay up late when exhausted. Pushing the brain and body to stay up later leads to chronic sleep debt. Eating sugary and high-fat foods before bed can hinder sleep patterns. Drinking caffeine after dinner or close to bedtime can disrupt the sleep cycle, as well as alcohol consumption before bed can hurt sleep quality.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals need rest time to adjust to working out, so consult a doctor on the balance of rest and training. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.

Weight Loss Techniques

References

Hirohama, K., Imura, T., Hori, T., Deguchi, N., Mitsutake, T., & Tanaka, R. (2024). The effects of nonpharmacological sleep hygiene on sleep quality in nonelderly individuals: A systematic review and network meta-analysis of randomized controlled trials. PloS one, 19(6), e0301616. https://doi.org/10.1371/journal.pone.0301616

Cunningham, J. E. A., & Shapiro, C. M. (2018). Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review. Journal of psychosomatic research, 106, 1–12. https://doi.org/10.1016/j.jpsychores.2017.12.012

Carbone, E. A., Menculini, G., de Filippis, R., D’Angelo, M., De Fazio, P., Tortorella, A., & Steardo, L., Jr (2023). Sleep Disturbances in Generalized Anxiety Disorder: The Role of Calcium Homeostasis Imbalance. International journal of environmental research and public health, 20(5), 4431. https://doi.org/10.3390/ijerph20054431

Alley, J. R., Mazzochi, J. W., Smith, C. J., Morris, D. M., & Collier, S. R. (2015). Effects of resistance exercise timing on sleep architecture and nocturnal blood pressure. Journal of strength and conditioning research, 29(5), 1378–1385. https://doi.org/10.1519/JSC.0000000000000750

Iowa State University. (2022). Pumping iron may improve sleep more than cardio workouts. https://www.news.iastate.edu/news/2022/03/03/resistance-exercise-sleep

Roig, M., Cristini, J., Parwanta, Z., Ayotte, B., Rodrigues, L., de Las Heras, B., Nepveu, J. F., Huber, R., Carrier, J., Steib, S., Youngstedt, S. D., & Wright, D. L. (2022). Exercising the Sleepy-ing Brain: Exercise, Sleep, and Sleep Loss on Memory. Exercise and Sport Sciences Reviews, 50(1), 38–48. https://doi.org/10.1249/JES.0000000000000273

American Heart Association. (2022). Resistance exercise may improve sleep more than aerobic exercise. https://www.heart.org/en/news/2022/03/03/resistance-exercise-may-improve-sleep-more-than-aerobic-exercise#:~:text=The%20results%20are%20considered%20preliminary,at%20night%2C%22%20Brellenthin%20said.

Kovacevic, A., Mavros, Y., Heisz, J. J., & Fiatarone Singh, M. A. (2018). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep medicine reviews, 39, 52–68. https://doi.org/10.1016/j.smrv.2017.07.002

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Sleep Hygiene, Therapy , , , , , , , , , , , ,

Managing Periodic Limb Movements of Sleep for Better Rest

For individuals experiencing periodic limb movements of sleep, can understanding how movements at night may relate to other sleep disorders help bring healthy sleep?

Periodic Limb Movements of Sleep

Periodic limb movements of sleep (PLMS) are involuntary, repetitive leg and sometimes arm movements during sleep. PLMS is one of the sleep disorders that may cause disruptive movement of the legs, like restless legs syndrome (RLS). It can lead to sleep disruption, insomnia, and daytime sleepiness.

Causes

The exact cause of PLMS is unknown, but it is thought to be related to:

  • Underlying medical conditions (e.g., restless legs syndrome, sleep apnea)
  • Nerve dysfunction
  • Neurochemical imbalances (e.g., dopamine, iron)

Symptoms

  • Repetitive leg and/or arm movements during sleep, typically lasting 0.5-5 seconds.
  • It may be accompanied by sensations of tingling, crawling, or pulling in the legs.
  • It can cause sleep disturbances, leading to daytime fatigue.

Type of Movements

Periodic limb movements during sleep (PLMS) consist of sudden jerking movements of the legs that occur involuntarily during sleep, which the affected individual may not realize is happening. It can be kicking, twitching, or extension of the legs.

  • Restless legs syndrome (RLS) symptoms are noted when awake.
  • PLMS occurs during sleep. (Walters A. S., & Rye D. B. 2009)
  • The movements associated often consist of flexion or extension at the ankle.
  • In some cases, this can also occur at the knee.
  • It may occur on one side or alternate back and forth between the left and right sides. (Cleveland Clinic, 2023)
  • It tends to increase with age and often but is not always accompanied by restless leg symptoms.

If PLMS causes daytime impairment, such as significant sleep disruption, excessive daytime sleepiness, and insomnia, it may be diagnosed as periodic limb movement disorder (PLMD). (Sleep Foundation, 2024)

Diagnosis

PLMS is diagnosed through a sleep study (polysomnography), which records brain waves, eye movements, muscle activity, and breathing patterns during sleep. As part of the study, superficial electrodes are placed on the legs and sometimes the arms to detect muscle contractions or movements.

  • In individuals with PLMS, repetitive movements at least four in a row may last from 1/2 second to 5 seconds. 
  • The movements may be more significant if they are associated with arousal or awakenings from sleep.
  • They also may be deemed important if they become disruptive to a bed partner.
  • No further treatment may be necessary when noted in isolation on a sleep study without associated symptoms or impacts.
  • If another disorder cannot explain the movements, PLMS may be the likely diagnosis.
  • Again, if the movements lead to sleep disruption, insomnia, and excessive daytime sleepiness, it is called PLMD.
  • Isolated PLMS noted on a sleep study, without consequence, are insignificant and do not require treatment with medication.

Restless leg syndrome is diagnosed based on clinical criteria of having an uncomfortable feeling in the legs associated with an urge to move that occurs in the evening when lying down and is relieved by movement. (Stefani, A., & Högl, B. 2019)

Treatment

Treatment for PLMS depends on the underlying cause and severity of symptoms. Options include:

  • Medications (e.g., dopamine agonists, iron supplements)
  • Lifestyle changes (e.g., exercise, avoiding caffeine before bed)
  • Treating the underlying medical condition

In general, it is unnecessary to treat PLMS if the individual affected has no complaints of sleep disruption. Treatment can be considered if it causes:

  • Partial or total arousal from sleep
  • Contributes to insomnia
  • Undermines sleep quality
  • Also, if the movements are disruptive to a bed partner, getting them under control may be desirable.

Prescription medications can be effective in treating PLMS. (Cleveland Clinic, 2023) Many of the meds used to treat RLS can be helpful. These may include benzodiazepines (clonazepam), Mirapex (generic name pramipexole), and ropinirole. Movements may also occur with obstructive sleep apnea events, and then the treatment would target the breathing disorder.

Injury Medical Chiropractic and Functional Medicine Clinic

Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment to restore health. Individuals can recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Revitalize and Rebuild with Chiropractic Care

References

Walters, A. S., & Rye, D. B. (2009). Review of the relationship of restless legs syndrome and periodic limb movements in sleep to hypertension, heart disease, and stroke. Sleep, 32(5), 589–597. https://doi.org/10.1093/sleep/32.5.589

Cleveland Clinic. (2023). Periodic limb movement disorder (PLMD). https://my.clevelandclinic.org/health/diseases/14177-periodic-limb-movements-of-sleep-plms

Sleep Foundation. (2024). Periodic Limb Movement Disorder What it is, what it feels like, its possible causes, and how it’s addressed. https://www.sleepfoundation.org/periodic-limb-movement-disorder

Stefani, A., & Högl, B. (2019). Diagnostic Criteria, Differential Diagnosis, and Treatment of Minor Motor Activity and Less Well-Known Movement Disorders of Sleep. Current treatment options in neurology, 21(1), 1. https://doi.org/10.1007/s11940-019-0543-8

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Sleep Hygiene , , , , , , , , , ,

The Best Natural Botanicals for Better Sleep: a Detailed Overview

Can many individuals with sleep issues incorporate natural botanicals to get a good night’s sleep and reduce stress?

Why Sleep Is Important?

Often, many people are constantly on the move and trying to find ways to rest and relax; however, in today’s world, many individuals are still experiencing various sleep issues that are not fulfilling them to achieve the full 8 hours of restful sleep. How often have you experienced fatigue throughout the day due to staying up late working on a project? Do you doom scroll on your phone while lying in bed at night that you accidentally stayed up late? Or do chronic health issues keep you up at night, which makes sleep difficult? When it comes to understanding why sleep is important, many people do not realize that sleep plays a huge role in cognitive functioning, mental health, and creativity. (Charest & Grandner, 2020) When environmental factors start to impact the body over time, it can lead to the development of sleep disorders. Environmental factors like stress can affect the circadian rhythm, causing dysregulation and sleep disorders. (Agorastos & Olff, 2021) However, there is some good news: there are various natural ways to help relax the body, get the full recommended amount of sleep without medications, and even help many people stay asleep longer. We associate with certified medical providers who inform our patients of the benefits of getting the full recommended amounts of sleep to reduce the stress affecting the body. While asking important questions to our associated medical providers, we advise patients to integrate natural ways to reduce stress and sleep disorders to ensure proper sleeping habits. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.

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Natural Botanicals & Remedies To Promote Sleep

When it comes to incorporating healthy sleeping habits, many individuals have found natural remedies to not only stay asleep but also reduce any stressors associated with environmental factors. Many people trying to make small changes in their sleeping habits can do some of the following:

  • Find the right mattress and pillows
  • Turning off electronics an hour before bedtime
  • Have the room be in a comfortable, cool temperature

Additionally, herbal botanicals can help relax the body and ensure proper sleep. Almost all natural botanicals are found in teas and supplements at the local grocery store. Below are some botanicals that can help many individuals get quality sleep.

Valerian

As a native to Europe and Asia, valerian is a perennial flowering plant with a unique and long history in traditional medicine, as it is used as a sedative and an anxiolytic. However, it has many sleep-promoting effects. (Yeom & Cho, 2024) The unique characteristic of valerian is that it interacts with the neurotransmitter GABA, as it is used to reduce sleep onset latency and increase sleep quality. (Bruni et al., 2021) The valerian plant can be utilized in a tea or a supplement as it is given to individuals for about 2 weeks at a time for its beneficial effects to start to work.

Ashwagandha

Known as winter cherry and located in India, ashwagandha has numerous health properties that can help many people with multiple ailments. The entire plant has been marketed in many forms and is common in pills and capsules as it possesses anti-inflammatory and antioxidant properties. (Cheah et al., 2021) Additionally, ashwagandha in small dosages can help improve cognitive function and immunity and reduce cortisol levels to help relax the body. (Park et al., 2023) Sleep can come easily to the individual when the body is relaxed after taking ashwagandha.

Chamomile

A common herb that can be used in teas, oils, or extracts, chamomile has been used as a sedative, mild analgesic, and sleep medication as it induces relaxation. (“Chamomile,” 2012) In tea form, this herb can become the most relaxing drink to sip at night and make a person sleepy. At the same time, when people drink chamomile, its soothing, beneficial properties can relieve and target the receptors in their central nervous system, causing them to be stressed and anxious, thus calming them down.

Lavender

As one of the most popular herbs everyone uses, from teas to aromatherapy, lavender is a multipurpose plant with many beneficial properties that can help anyone. Lavender has two main components, linalool, and linalyl, with sedative, antinociceptive, and anti-spasmolytic effects to stimulate the parasympathetic system. (Hamzeh et al., 2020) This, in turn, can help relax the body with its calming aroma and provide beneficial results for individuals dealing with insomnia. In its essential oil form, lavender can help increase the total amount of NREM (non-rapid eye movement) and reinforce a person’s sleep ability. (Ren et al., 2025) By making small changes and incorporating these natural botanicals to provide better sleep quality, many people will notice their bodies becoming more relaxed, their minds less anxious, and finally get that full 8 hours of sleep they deserve because sleep is for everyone, not the weak.

References

Agorastos, A., & Olff, M. (2021). Sleep, circadian system and traumatic stress. Eur J Psychotraumatol, 12(1), 1956746. https://doi.org/10.1080/20008198.2021.1956746

Bruni, O., Ferini-Strambi, L., Giacomoni, E., & Pellegrino, P. (2021). Herbal Remedies and Their Possible Effect on the GABAergic System and Sleep. Nutrients, 13(2). https://doi.org/10.3390/nu13020530

Chamomile. (2012). In LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. https://www.ncbi.nlm.nih.gov/pubmed/31643492

Charest, J., & Grandner, M. A. (2020). Sleep and Athletic Performance: Impacts on Physical Performance, Mental Performance, Injury Risk and Recovery, and Mental Health. Sleep Med Clin, 15(1), 41-57. https://doi.org/10.1016/j.jsmc.2019.11.005

Cheah, K. L., Norhayati, M. N., Husniati Yaacob, L., & Abdul Rahman, R. (2021). Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLOS ONE, 16(9), e0257843. https://doi.org/10.1371/journal.pone.0257843

Hamzeh, S., Safari-Faramani, R., & Khatony, A. (2020). Effects of Aromatherapy with Lavender and Peppermint Essential Oils on the Sleep Quality of Cancer Patients: A Randomized Controlled Trial. Evid Based Complement Alternat Med, 2020, 7480204. https://doi.org/10.1155/2020/7480204

Park, C. W., Hong, K. B., Suh, H. J., & Ahn, Y. (2023). Sleep-promoting activity of amylase-treated Ashwagandha (Withania somnifera L. Dunal) root extract via GABA receptors. J Food Drug Anal, 31(2), 278-288. https://doi.org/10.38212/2224-6614.3456

Ren, Y. L., Chu, W. W., Yang, X. W., Xin, L., Gao, J. X., Yan, G. Z., Wang, C., Chen, Y. N., Xie, J. F., Spruyt, K., Lin, J. S., Hou, Y. P., & Shao, Y. F. (2025). Lavender improves sleep through olfactory perception and GABAergic neurons of the central amygdala. J Ethnopharmacol, 337(Pt 3), 118942. https://doi.org/10.1016/j.jep.2024.118942

Yeom, J. W., & Cho, C. H. (2024). Herbal and Natural Supplements for Improving Sleep: A Literature Review. Psychiatry Investig, 21(8), 810-821. https://doi.org/10.30773/pi.2024.0121

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Sleep Hygiene , , , , , , , ,

Restless Leg Syndrome: The Key To Improving Sleep

Can individuals find therapeutic ways to reduce restless leg syndrome and improve their sleep quality in their beds?

What Is Restless Leg Syndrome?

Do you feel general aches or leg pain, causing you to feel restless? Do you experience fatigue throughout the day, making it difficult to fall asleep? Or do you feel uncomfortable sensations in your legs, making falling and staying asleep difficult? Many people worldwide have experienced these issues known as restless leg syndrome. Also known as Willis-Ekbom disease, restless leg syndrome is often characterized by an uncomfortable urge to move legs when a person rests for the night and can be accompanied by unpleasant sensations that cause irresistible restlessness. (Gossard et al., 2021) Restless leg syndrome (RLS) can also be primary or secondary depending on the severity of the issue affecting the individual’s legs. Since the legs allow the individual to be mobile through walking, running, and jumping, the various muscles and tendons that make up the legs can succumb to RLS. As it is a chronic movement disorder, it is common to many individuals. It is associated with abnormal, non-painful sensations that are active when a person rests and relieved when they are in motion. (Mansur et al., 2025) We associate with certified medical providers who inform our patients of how restless leg syndrome affects their legs. While asking important questions to our associated medical providers, we advise patients to incorporate ways to reduce restless leg syndrome and restore their sleep quality. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.

Causes

What causes individuals to develop RLS can often be correlated with environmental factors. Additionally, since RLS can be primary or secondary, the overlapping risk profiles also play a factor. Environmental factors like stress and anxiety can cause the central nervous system to go haywire, causing the sensations to set off and become worse. When RLS is primary, the central nervous system can cause the legs to develop RLS by not getting enough dopamine, which is a neurotransmitter that regulates body movement. The RLS symptoms can worsen when there isn’t enough dopamine in the body. When RLS is secondary, it could be due to iron deficiency that the brain areas have low levels of iron being transported to the blood-brain barrier and not being imported to the neuronal cells. (Vlasie et al., 2022) This can cause numerous symptoms and affect the legs when a person is trying to get a good night’s rest.

Symptoms

Some of the symptoms associated with RLS can affect the circadian rhythm, which can cause the central nervous system to sensitize and hyperarousal, leading to sensory disturbances and frequent awakening periods. (Tang et al., 2023) Other symptoms include:

  • Crawling/ Itching sensations
  • Fatigue
  • Mood changes
  • Difficulty concentrating
  • Sleep disruptions

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Ways To Reduce Restless Leg Syndrome

When it comes to reducing restless leg syndrome, many people can find ways to minimize the comorbidities associated with RLS. Many people can sleep with the right mattress and pillows that can help provide them with a restful night. Others may try exercising or meditation to reduce the everyday stress that is affecting them. These small changes can help many people develop healthy sleeping habits that improve sleep quality and incorporate a proper sleeping routine. (Taximaimaiti et al., 2021)

Vitamins & Supplements

Incorporating iron supplements to reduce the effects of restless leg syndrome by replenishing the neurons and cells in the central nervous system. (Elstrott et al., 2020) Combined with magnesium, this can help lower the intensity of the RLS symptoms and even improve sleep quality. (Jadidi et al., 2022) Ask the doctor which iron supplement the body is low on before buying.

Massage

Incorporating massages as part of a routine to reduce restless leg syndrome can benefit the body. Massage therapists can work on the muscles in the lower extremities to manipulate the soft tissues while strengthening the immune system. Massages like reflexology, Swedish, and deep tissue can help reduce stress and anxiety, relieve leg fatigue, improve blood circulation, and reduce sleep disturbances. (Ghanbari et al., 2022)

Conclusion

Incorporating these various techniques and remedies to reduce restless leg syndrome can improve the body and increase sleep quality. Making small changes to these everyday stressors can reduce the chances of restless leg syndrome returning.

References

Elstrott, B., Khan, L., Olson, S., Raghunathan, V., DeLoughery, T., & Shatzel, J. J. (2020). The role of iron repletion in adult iron deficiency anemia and other diseases. Eur J Haematol, 104(3), 153-161. https://doi.org/10.1111/ejh.13345

Ghanbari, A., Shahrbabaki, P. M., Dehghan, M., Mardanparvar, H., Abadi, E. K. D., Emami, A., & Sarikhani-Khorrami, E. (2022). Comparison of the Effect of Reflexology and Swedish Massage on Restless Legs Syndrome and Sleep Quality in Patients Undergoing Hemodialysis: a Randomized Clinical Trial. Int J Ther Massage Bodywork, 15(2), 1-13. https://doi.org/10.3822/ijtmb.v15i2.705

Gossard, T. R., Trotti, L. M., Videnovic, A., & St Louis, E. K. (2021). Restless Legs Syndrome: Contemporary Diagnosis and Treatment. Neurotherapeutics, 18(1), 140-155. https://doi.org/10.1007/s13311-021-01019-4

Jadidi, A., Rezaei Ashtiani, A., Khanmohamadi Hezaveh, A., & Aghaepour, S. M. (2022). Therapeutic effects of magnesium and vitamin B6 in alleviating the symptoms of restless legs syndrome: a randomized controlled clinical trial. BMC Complement Med Ther, 23(1), 1. https://doi.org/10.1186/s12906-022-03814-8

Mansur, A., Castillo, P. R., Rocha Cabrero, F., & Bokhari, S. R. A. (2025). Restless Legs Syndrome. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/28613628

Tang, M., Sun, Q., Zhang, Y., Li, H., Wang, D., Wang, Y., & Wang, Z. (2023). Circadian rhythm in restless legs syndrome. Front Neurol, 14, 1105463. https://doi.org/10.3389/fneur.2023.1105463

Taximaimaiti, R., Luo, X., & Wang, X. P. (2021). Pharmacological and Non-pharmacological Treatments of Sleep Disorders in Parkinson’s Disease. Curr Neuropharmacol, 19(12), 2233-2249. https://doi.org/10.2174/1570159X19666210517115706

Vlasie, A., Trifu, S. C., Lupuleac, C., Kohn, B., & Cristea, M. B. (2022). Restless legs syndrome: An overview of pathophysiology, comorbidities and therapeutic approaches (Review). Exp Ther Med, 23(2), 185. https://doi.org/10.3892/etm.2021.11108

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Sleep Hygiene , , , , , , , , ,

The Role of Melatonin in Enhancing Sleep

Can melatonin help many individuals dealing with sleep issues and help them stay asleep longer and feel refreshed in the morning?

What Is Melatonin?

How often do you have trouble sleeping at night? Do you constantly toss and turn at night, which makes you stay awake even longer? Or do you feel continually stressed, and you feel more tired than before, and that is affecting your routine? Many people can fall asleep instantly when it comes to getting a good night’s sleep. However, when environmental factors like stress and insomnia start to affect the body, while causing many people to deal with restless sleep and symptoms of fatigue that affect their routine. Hence, why are many people taking a supplement known as melatonin to get a full night’s sleep? But what is melatonin, and how can it help improve sleep quality? Located and secreted in the pineal gland, melatonin is a hormone primarily synthesized to regulate the body’s sleep and wake cycle. (Savage et al., 2024) This hormone helps many people fall asleep, stay asleep, and wake up refreshed. At the same time, it is an antioxidant that dampens chronic inflammation and helps with the immune system. We associate with certified medical providers who inform our patients of the effects of melatonin as a supplement to reduce overlapping risk profiles affecting sleep quality. While asking important questions to our associated medical providers, we advise patients to incorporate various techniques to stay asleep longer and utilize melatonin when needed. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.

Its Benefits

Melatonin is a hormone that is produced from the body’s pineal gland, and it can naturally command the circannual rhythm as its synthesis and exert its effect on the body’s biological rhythm and sleep initiation. (Boutin et al., 2023) There are many benefits that melatonin provides as it can:

  • Lengthen total sleep time
  • Reduce seasonal depression
  • Increase human growth hormone levels
  • Help with eye health
  • Treat GERD

However, many people have noticed that melatonin has hypnotic “effects” that are exerted through thermoregulatory mechanisms. Melatonin helps the body lower its core temperature, reduce arousal, and increase sleep propensity (Dawson & Encel, 1993). This allows many people dealing with sleep disorders to have a good night’s rest and feel better when waking up.  

Eating Right To Feel Better- Video

How Melatonin Improves Sleep

When it comes to melatonin and improving sleep quality, many people with sleep disorders like insomnia, CRSD (Circadian Rhythm Sleep Disorder, and DSPD (Delayed Sleep Phase Disorder) use melatonin in pill and gummy form to administer the beneficial properties of improving sleep initiation and maintenance. (Cruz-Sanabria et al., 2023) At the same time, melatonin, especially exogenous melatonin, can be prescribed by a doctor or taken as a supplement in pill, tablet, or gummy form and has been the most frequently requested as a non-prescription sleep pain to promote total sleep time. (Costello et al., 2014) However, even though melatonin is used as a dietary supplement, it has to be regulated to what dosage the individual takes to reduce adverse effects. (Tuft et al., 2023) This is because taking too much melatonin can lead to the development of chronic conditions. If a person is taking medication, it can cause overlapping risk profiles for the individuals. Luckily, when it comes to reducing sleep disorders, taking melatonin for at least 30 minutes to an hour before bed can allow the body to relax and help kickstart the sleep-wake cycle for individuals to get that full night’s rest they deserve.

References

Boutin, J. A., Kennaway, D. J., & Jockers, R. (2023). Melatonin: Facts, Extrapolations and Clinical Trials. Biomolecules, 13(6). https://doi.org/10.3390/biom13060943

Costello, R. B., Lentino, C. V., Boyd, C. C., O’Connell, M. L., Crawford, C. C., Sprengel, M. L., & Deuster, P. A. (2014). The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature. Nutr J, 13, 106. https://doi.org/10.1186/1475-2891-13-106

Cruz-Sanabria, F., Carmassi, C., Bruno, S., Bazzani, A., Carli, M., Scarselli, M., & Faraguna, U. (2023). Melatonin as a Chronobiotic with Sleep-promoting Properties. Curr Neuropharmacol, 21(4), 951-987. https://doi.org/10.2174/1570159X20666220217152617

Dawson, D., & Encel, N. (1993). Melatonin and sleep in humans. Journal of Pineal Research, 15(1), 1-12. https://doi.org/10.1111/j.1600-079x.1993.tb00503.x

Savage, R. A., Zafar, N., Yohannan, S., & Miller, J. M. M. (2024). Melatonin. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30521244

Tuft, C., Matar, E., Menczel Schrire, Z., Grunstein, R. R., Yee, B. J., & Hoyos, C. M. (2023). Current Insights into the Risks of Using Melatonin as a Treatment for Sleep Disorders in Older Adults. Clin Interv Aging, 18, 49-59. https://doi.org/10.2147/CIA.S361519

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Sleep Hygiene , , , , , , , , , , ,

Sleep Easy: Choosing The Right Pillow For Neck Pain

Can choosing the right pillow help many individuals with neck pain get a full night’s sleep and reduce pain-like symptoms?

The Effects Of Neck Pain

How often do you feel stiffness in your neck and shoulders after being hunched for an extended period? Does it hurt when turning your neck from side to side? Or have you been suffering from constant headaches or migraines that are making you have a hard time falling asleep? As the second most common musculoskeletal condition, neck pain is a multifactorial disease developed through various risk factors that can impact a person. (Kazeminasab et al., 2022) The multiple muscles surrounding the neck are constantly overstretched and tight, which can cause pain and discomfort to the upper extremities due to environmental factors. Some environmental factors can range from improper posture to injuries that can affect the neck. When many people are experiencing neck pain associated with environmental factors, it can cause considerable personal pain and discomfort, disability, impaired quality of life, and, for adults, loss of time from work. (Ben Ayed et al., 2019) At the same time, when people experience neck pain, they can develop disruptive sleeping habits. We associate with certified medical providers who inform our patients of the effects of neck pain and how it can disrupt their sleeping habits. While asking important questions to our associated medical providers, we advise patients to incorporate various techniques to reduce neck pain and find ways to stay asleep longer. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.

How Neck Pain Disrupts Sleep

Now, many people wonder how neck pain is associated with sleep. Environmental stressors like chronic stress from the workplace or natural disasters can cause a person to have tense neck muscles and can increase sleep disturbances. (Yabe et al., 2022) When environmental stressors impact the body, the musculoskeletal system becomes tight and tense in different body areas. In the neck, the muscles that surround the cervical can become tense and develop trigger points in muscle tissue, causing referred pain and discomfort. When neck pain causes disruptive sleep problems, it can cause impairment to the multifunctional protective role of sleep via physiological homeostasis and restoration. (Van Looveren et al., 2021) At the same time, some of the pain-like symptoms that can be increased with neck pain associated with disruptive sleep include: (Chin et al., 2021)

  • Soreness
  • Pain
  • Numbness
  • Difficulty in movement

However, there are ways to reduce the effects of neck pain and get a full night’s sleep, starting with the bedroom.

Low Back & Neck Pain Rehabilitation-Video

Choosing The Right Pillow For Neck Pain

 Now, when it comes to getting a full night’s sleep, it is important to find the right mattress to stay asleep as well as feel refreshed. However, as important as it is to sleep in the right mattress when dealing with neck pain, finding the right pillow can do wonders for the neck and help people get enough sleep. When it comes to finding the right pillow, the individual needs to find a pillow with an appropriate height that can provide adequate support for the head and neck to reduce cervical spinal stress and relax the surrounding neck and shoulder muscles. (Lei et al., 2021) This is because when it comes to quality sleep, many people prefer sleeping positions, pillows, and mattresses aimed at comfort. Many pillows have a variety of materials that can help aid in comfort and help reduce neck pain. Some of the types of pillows include:

  • Memory foam
  • Polyfilled pillows
  • Down Pillow
  • Latex
  • Combo style

Finding the right pillow for neck pain allows the individual to have their neck fully supported while having the pillow in a lateral position to reduce neck fatigue and improve sleep quality (Son et al., 2020). By doing so, many people can finally get a good night’s sleep and wake up feeling better. By choosing the right pillow, many people will begin to be more mindful of their bodies and make small changes to their routine while getting the sleep they deserve.

References

Ben Ayed, H., Yaich, S., Trigui, M., Ben Hmida, M., Ben Jemaa, M., Ammar, A., Jedidi, J., Karray, R., Feki, H., Mejdoub, Y., Kassis, M., & Damak, J. (2019). Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children. J Res Health Sci, 19(1), e00440. https://www.ncbi.nlm.nih.gov/pubmed/31133629

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941626/pdf/jrhs-19-e00440.pdf

Chin, W. S., Chen, Y. C., Lin, T. T., Guo, Y. L., & Shiao, J. S. C. (2021). Short sleep and chronic neck and shoulder discomfort in nurses. J Occup Health, 63(1), e12236. https://doi.org/10.1002/1348-9585.12236

Kazeminasab, S., Nejadghaderi, S. A., Amiri, P., Pourfathi, H., Araj-Khodaei, M., Sullman, M. J. M., Kolahi, A. A., & Safiri, S. (2022). Neck pain: global epidemiology, trends and risk factors. BMC Musculoskelet Disord, 23(1), 26. https://doi.org/10.1186/s12891-021-04957-4

Lei, J. X., Yang, P. F., Yang, A. L., Gong, Y. F., Shang, P., & Yuan, X. C. (2021). Ergonomic Consideration in Pillow Height Determinants and Evaluation. Healthcare (Basel), 9(10). https://doi.org/10.3390/healthcare9101333

Son, J., Jung, S., Song, H., Kim, J., Bang, S., & Bahn, S. (2020). A Survey of Koreans on Sleep Habits and Sleeping Symptoms Relating to Pillow Comfort and Support. Int J Environ Res Public Health, 17(1). https://doi.org/10.3390/ijerph17010302

Van Looveren, E., Bilterys, T., Munneke, W., Cagnie, B., Ickmans, K., Mairesse, O., Malfliet, A., De Baets, L., Nijs, J., Goubert, D., Danneels, L., Moens, M., & Meeus, M. (2021). The Association between Sleep and Chronic Spinal Pain: A Systematic Review from the Last Decade. J Clin Med, 10(17). https://doi.org/10.3390/jcm10173836

Yabe, Y., Hagiwara, Y., Sekiguchi, T., Sugawara, Y., Tsuchiya, M., Yoshida, S., & Tsuji, I. (2022). Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake. BMC Musculoskelet Disord, 23(1), 459. https://doi.org/10.1186/s12891-022-05410-w

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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Chiropractic Care, Sleep Hygiene , , , , , , , , , , , , , , , , , ,

Say Goodbye to Back Pain: Selecting the Perfect Mattress

What is the recommended way to choose a mattress for individuals with back pain?

Back Pain Mattress

When choosing a back pain mattress, one size does not fit all in selecting one for those with spine pain. Several other factors play a role, as well. However, whether a firm or soft mattress is the best option for individuals whose back pain keeps them up at night, most health experts say the choice is yours and that the mattress that makes you feel most comfortable is likely the best option. The research says that medium firmness seems to provide the most painless sleep. A review gathered information from 24 controlled trials where participants used soft, medium-firm, firm, or custom-inflated mattresses. The results showed that medium-firm and self-adjusted mattresses were best for sleep comfort, quality, and spinal alignment. (Radwan A. et al., 2015)

Medical Status

Selecting the back pain mattress best suited to your spinal condition is more than just how hard or soft the mattress is. Individuals and their healthcare providers should thoroughly review their medical history to tailor the mattress to their needs. Before purchasing a mattress, check the following:

  • Age
  • Medical history
  • Injuries current and past
  • Current diagnosis or diagnoses
  • Disease and/or Conditions
  • Sleeping preferences

For example, symptoms of spinal stenosis tend to present themselves when one is standing and walking but not when lying down. For this reason, mattress firmness is not a big issue only for people with spinal stenosis. However, it must be taken into consideration for those who have degeneration along with spinal stenosis.

Individuals with spinal arthritis without stenosis, disc problems, or non-specific back pain need to consider the relative firmness or softness of the back pain mattress. People with these conditions do better with more support, i.e., a firmer mattress. While everyone needs some back support when they sleep, those who have undergone multiple back surgeries often need less. The tissues have been altered and may be stiffer after several surgeries. In this case, a softer mattress may be more suitable and comfortable.

Mattress Age

Mattress springs break down over time, which makes the bed softer. This can aggravate the spine and back muscles. Based on this, investing in a new mattress makes sense, or pain and stiffness can worsen with the current one. While this will vary among individuals, medical research may help shed some light: A study measured the comfort and quality of sleep for 27 participants with low back pain and stiffness. The participants recorded their sleep comfort and quality in their beds for 21 days and then with a new prescribed mattress and bedding system, which they used for 12 weeks. The study found that the participants showed significant and progressive improvement in back pain and stiffness on the new mattresses and improved sleep quality significantly. (Jacobson B. H. et al., 2010)

Sleeping Position

The position usually slept in makes a difference in the support needed for the back pain mattress. Some recommendations for back sleepers, side and fetal position sleepers, and stomach sleepers:

Side Sleepers

  • Most people are side sleepers.
  • They sleep in the fetal position with their knees drawn up toward their chest.
  • This position tends to place pressure on the hips and shoulders.
  • For side and fetal sleepers, a slightly softer mattress is recommended.
  • The foam the mattress is made of conforms to the body, especially in the thoracic and lumbar regions of the spine.

Stomach Sleepers

  • For the stomach sleeper, soft mattresses can irritate the back.
  • A soft mattress encourages the abdomen to sink into the bed.
  • The resulting position is known to increase the arch in the lower back and cause pain.
  • A medium-firm surface is good for stomach sleepers.
  • The idea is to derive support from the chosen mattress without the abdominal sinking.
  • The sinking effect is amplified if you have a large abdomen.
  • For thin individuals, sinking may not be as much of an issue.

Back Sleepers

  • For support, place a thin, rolled towel or pillow under the knees and lower back of those who sleep on their backs.
  • A pillow/s under these areas will help support them and provide more comfort.

Researchers divided the participants according to their usual sleep position. They were assigned to a medium-firm mattress with foam and latex layering based on their preferred sleep position. The participants rated their sleep comfort and quality daily for three months. The researchers found that the new mattresses improved back pain and stiffness. For this reason, they concluded that sleep surfaces relate to sleep discomfort and that replacing a mattress with one uniquely suitable to your spinal condition can reduce and relieve pain. (Jacobson B. H. et al., 2010)

Injury Medical Chiropractic and Functional Medicine Clinic

Choosing the right back pain mattress ultimately comes down to personal preference. Individuals should try various mattresses and see which one they like best. Individuals who struggle with sleep or other sleep disorders that impact their ability to get restful sleep should consult with their healthcare provider about getting an assessment and treatment. Injury Medical Chiropractic and Functional Medicine Clinic can help individuals recover and regain the benefits of quality rest through healthy sleep practices and lifestyle accommodations. We build optimal health and wellness solutions with primary healthcare providers and specialists. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Chiropractic Care Can Transform Pain Into Relief

References

Radwan, A., Fess, P., James, D., Murphy, J., Myers, J., Rooney, M., Taylor, J., & Torii, A. (2015). Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; systematic review of controlled trials. Sleep health, 1(4), 257–267. https://doi.org/10.1016/j.sleh.2015.08.001

Jacobson, B. H., Boolani, A., Dunklee, G., Shepardson, A., & Acharya, H. (2010). Effect of prescribed sleep surfaces on back pain and sleep quality in patients diagnosed with low back and shoulder pain. Applied ergonomics, 42(1), 91–97. https://doi.org/10.1016/j.apergo.2010.05.004