Insomnia Specialist

Craig S. Rubenstein, DC, DACBN, CCN

Chiropractor located in Long Island, Medford, NY & Midtown, New York City, NY

Insomnia Q & A

“I just can’t take it... Another night of tossing and turning.  I’m exhausted and can’t keep this up. I have to get a good nights sleep or I’m going to lose my mind”

If this sounds like you even a little bit.... keep reading. Dr. Rubenstein see’s sleep problems from a multitude of angles. There is no one size fits all solution when it comes to getting a good nights sleep!

The Treatment of insomnia is quite varied from profession to profession and from doctor to doctor. In this blog post we will cover the main areas I focus on to help those suffering from insomnia.

After discussing my treatment of those with insomnia with Dr. Raja Jaber of Stony Brook University Hospital, she asked me a question that went something like this, How well does your treatment work? I love people who want the bottom line!

The people who respond best are those with mild to moderate insomnia. Those who “literally” sleep only 1 or 2 hours a night have historically not responded well to my treatment, except if this extreme type of insomnia has just begun, then we have a chance.

Lets discuss a few categories of poor sleepers. Each type of sleep disturbance necessitates a different type of treatment. There is no “one size fits all” treatment.

The Applied Kinesiology and Clinical Nutrition Approach:

If the main problem is an inability to fall asleep easily then there is typically either a need for calcium in specific forms or the need to augment pineal gland function. The pineal gland is the gland in your brain that produces the right amounts of melatonin at the right times through the night for proper sleep.

Whether falling asleep is OK or not, but staying asleep is difficult, it is typically related to a need for B vitamins. This is particularly true if you wake up at a few random times a night and it takes longer than you think it should to fall back to sleep. It is also possible that pineal gland is again partly the issue.

The two other possibilities of having trouble staying asleep that I assess are low blood sugar and the twenty-four hour acupuncture energy cycle or horary cycle.

In the case of low blood sugar you typically find it difficult to fall back to sleep unless you eat something. This can take a very well rounded approach to moderate your blood sugar issues..

What is the “Horary Cycle”: The energy in the acupuncture meridians or acupunture circuits cycle throughout the day being highest in each circuit/meridian for a specific two hour period of each day and lowest in energy twelve hours later. When a person presents with a symptom at the same time of the day or night it is common that it relates to the meridian that is at its highest energy level at that specific time. As an example it is very common that after the loss of a loved one that people chronically awaken between 3-5am. This is “lung time” and the lung relates to grief and loss. Treatment would need to be geared towards fixing the horary cycle and in many cases it is the emotional relationship to the acupunture circuit involved that most be dealt with. In this example, the loss or grief. Sometimes a few simple acupressure sessions can make enough of a change to “fix” the problem.

Pineal gland: I have found that pineal gland extracts have been very useful for those with insomnia. As you may know the pineal gland releases melatonin which is intricately associated with sleep. Other nutrients known to enhance melatonin production are niacinamide, B6, calcium and magnesium.

Melatonin: The whole issue of using melatonin should be taken fairly seriously. Even though it is sold over the counter it is still a form of hormone replacement therapy and we are now learning that excess melatonin can potentially have ill effects on the body such as inhibiting ovulation. SO BE CAREFUL. A better bet might be to investigate why your pineal gland is dysfunctional. You will probably also benefit from early morning bright light stimulation and consuming foods high in melatonin such as: oats, sweet corn, rice, Japanese radish, ginger, tomatoes, bananas and barley or those high in tryptophan (a precursor to melatonin) such as spirulina, seaweed, soybean, cottage cheese, chicken liver, pumpkin seeds, turkey, chicken, watermelon seeds, almonds, peanuts, brewers yeast, milk and yogurt.

The one major part of what is called sleep hygiene (things related to creating a good environment for sleep (lighting, quiet, comfortable bed)) that I find important is...

Screen Time: The discussion here will relate mainly to being on your phone, computer, tablet or watching television just before going to bed. The more light that is sensed the more your pineal gland is inhibited and thereby decreasing melatonin secretion. Sometimes, using night time settings or other ways of decreasing blue light can mitigate these effects.

Cranial work: For many years practitioners of Applied Kinesiology (a diagnostic and treatment technique developed by Dr. George Goodheart starting in 1964) have clinically found that a particular set of cranial structures may need “adjustment” in order to improve pineal gland function. A simple in office manual muscle test was developed to help test for the need for pineal gland treatment in the form of cranial work and to help determine what nutritional support is needed for each individual patient.

The Functional Neurological Approach:

Respiratory irregularities: The respiratory irregularities we will discuss relate to poor diaphragmatic function and poor rib cage (chest) movement. Both cause decreased respiratory efficiency and lower oxygen levels in our blood (hypoxia).

Decreased brain function: Hypoxia causes decreased functioning of the cerebral cortex (the newest part of our brain). The newest part of our brain normally inhibits the more primitive parts of our brain. When the cortex is decreased in function the older parts are no longer inhibited and are allowed to exert their effects with less suppression. When this occurs the fight or flight part of our nervous system the sympathetic nervous system (one of the primitive portions of the brain) is less inhibited which among other things causes a general stimulation of the whole body especially through the adrenal glands. This is definitely a potential cause or an augmenting factor in insomnia. A fairly common scenario is as we age it is not uncommon that our blood pressure increases (an effect of increased sympathetic nervous system activity), and we have more difficulty or are unable to sleep as much as we have in the past. This is the effect of a general decrease in activity of our cortex allowing the sympathetic system to become more active than it should. This can occur from chronic hypoxia or from a lack of physical activity, which happens to be the largest stimulus to our brain.

Diaphragm function and rib movement: When there is poor diaphragm function or fixation of rib movements there is a decreased ability of the lungs to fully expand. This causes the aforementioned low blood oxygen (hypoxia) leading to increased sympathetic (fight or flight) activity.  In this scenario we may also see an inability to blow off enough carbon dioxide (CO2) called hypercapnea. A particular part of the brain called the mesencephalon is very sensitive to increase CO2 levels. As CO2 levels increase in the blood due to poor rib and diaphragm function the mesencephalon stimulates another part of the nervous system called the ascending reticular activating system (ARAS). The ARAS is partly responsible for maintaining a wakeful state. The over stimulation of the ARAS therefore leads to difficulty sleeping.

Improving diaphragm function can be done by using forms of reflexology, balancing other muscles such as the abdominal muscles and the psoas muscles that attaches into the diaphragm, as well as by direct manipulation into the area of the diaphragm and breathing exercises. Spinal and rib manipulations are other crucial factors. Doing specific manipulation to the rib joints both in the front of the rib cage near the breastbone and in the back where the ribs attach to the spine is of utmost importance to improve the excursion of the ribs. This increased excursion will allow for fuller expansion of the lungs and better removal of CO2 and acquisition of O2.

Right brain dysfunction: So far we have discussed decreased function of the whole brain. We will now discuss something I consider even more interesting. There can be a decrease in brain function on only one side or hemisphere of the brain. When it is the right side in particular that is decreased in function there are very specific effects that are quite different than when it is the left side or hemisphere that is decreased in function. Right hemisphere decrease causes a general hyperactive state. Many people with right-sided decreases will be hyperactive, nervous, anxious, impulsive or irritable which as you could imagine may make it difficult to sleep. There are many other effects of right brain dysfunction but they are beyond the scope of this brief lecture. It has become fairly easy to recognize right vs. left side decreases during a clinical examination of a person. Improving right brain function can be accomplished through many different techniques such as: light and sound stimulation, eye exercises, specific types of visualization, doing spatially oriented tasks, spinal manipulation and much more. In relation to spinal manipulation for right-sided decreases it is very important to manipulate mainly the left side of the body and especially only the left side of the neck. Manipulating both sides of the neck will allow for intense stimulation of the left side of the brain as well as the right and will either negate the effect on the right side of the brain or even create more of an imbalance. As you can see it is important to understand how your brain function is impacted by the therapy you receive.

Now you can also see that insomnia has different causes in each person and treatment must be individualized.

PS: Please make sure all your medications/supplements that you may be taking later in the day, are not stimulatory.