Fatigue is Too Costly to Ignore: Significance of Clinical Nutrition in Managing Insomnia. The Chiropractic Perspective Mark Kaye, DC

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1 Fatigue is Too Costly to Ignore: Significance of Clinical Nutrition in Managing Insomnia The Chiropractic Perspective Mark Kaye, DC

Overview of fatigue and insomnia Up to an estimated 70 million US adults have sleep or wakefulness disorders Lack of sufficient sleep (insomnia) is associated to $100 billion dollars annually in

2 Overview of fatigue and insomnia Up to an estimated 70 million US adults have sleep or wakefulness disorders Lack of sufficient sleep (insomnia) is associated to $100 billion dollars annually in societal costs US$13 billion per annum in physician visits, prescriptions and procedures Patients with insomnia in particular have been found to be two and a half times more likely to report car crashes vs their well-rested counterparts Drowsy driving is associated to 328,000 motor vehicle crashes annually, including 109,000 that result in injuries and 6,400 fatalities One-third of soldiers get 5-hours or less of sleep per night resulting in Increased risk for musculoskeletal injuries Greater susceptibility to illness Development of anxiety, depression, and PTSD Institute of Medicine. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: The National Academies Press; Fullerton et al. The economic impact of insomnia in managed care: a clearer picture emerges. Am J Manag Care May;12(8 Suppl):S The economic impact of insomnia in managed care: a clearer picture emerges.. Pigeon WR. Diagnosis, prevalence, pathways, consequences & treatment of insomnia. Indian J Med Res Feb;131: Brian C. Tefft. AAA Foundation for Traffic Safety. armymedicine.mil/health_of_the_force_report_nov_2015.pdf Prevalence of Motor Vehicle Crashes Involving Drowsy Drivers, United States,

The concept of ideal sleep is to be able to sleep like a baby Sleep is hypothesized to be a restorative process that is important for the proper functioning of the immune system Experimentally

3 The concept of ideal sleep is to be able to sleep like a baby Sleep is hypothesized to be a restorative process that is important for the proper functioning of the immune system Experimentally induced partial night sleep deprivation induces a pattern of immune alterations similar to that found in depressed- and alcoholic patients Irwin M. Effects of sleep and sleep loss on immunity and cytokines; Brain Behav Immun Oct;16(5):

4 Inadequate sleep leads to poor health outcomes Clinical evidence shows insufficient sleep is associated with: Increased inflammatory cytokines such as IL-1β, TNF-α, and IL-6 Inflammatory immune response (increased cellular stress) Increased free-radical activity and damage (decreased antioxidant response) Increased risk to: Cardiovascular disease and stroke Obesity Metabolic syndrome Type II diabetes (T2DM) Breast, colorectal, and prostate cancer risk Worsened neurobehavioral function with impairments in cognitive and motor performance are comparable to those induced by alcohol consumption at or above the legal limit Luyster et al. Sleep: a health imperative. Sleep Jun 1;35(6):

Data suggest insufficient intake of nutrients may contribute to pain commonly associated with insomnia Musculoskeletal pain affects nearly half of all adults, most of whom are vitamin D deficient,

5 Data suggest insufficient intake of nutrients may contribute to pain commonly associated with insomnia Musculoskeletal pain affects nearly half of all adults, most of whom are vitamin D deficient, [which can result] in presumptive nociceptor hyperinnervation of skeletal muscle, which in turn is likely to contribute to muscular hypersensitivity and pain Tague et al, Vitamin D deficiency promotes skeletal muscle hypersensitivity and sensory hyperinnervation J Neurosci Sep 28;31(39):

Natural ingredients scientifically shown to support restfulness, relaxation, and improve sleep quality Melatonin Hormone naturally produced in the brain that helps regulate sleep, waking, and the

maintaining a healthy sleep/wake cycle and calms stress-induced limbic-hpa axis hyperactivity Calcium & Magnesium May help relieve minor pain associated with muscle tension, which can be caused by

6 Natural ingredients scientifically shown to support restfulness, relaxation, and improve sleep quality Melatonin Hormone naturally produced in the brain that helps regulate sleep, waking, and the body s circadian rhythm (or time clock) Neuroimmune balancing properties Chinese Skullcap Protects against oxidative stress and supports central nervous system health, which is important for maintaining a healthy sleep/wake cycle and calms stress-induced limbic-hpa axis hyperactivity Calcium & Magnesium May help relieve minor pain associated with muscle tension, which can be caused by stress or physical overexertion Passion Flower, Lemon Balm, Hops & Valerian Traditional mixture of European herbs for added support for relaxation and a sense of calm In vivo and in vitro studies: GABA A and melatonin receptor stimulation Wyatt et al.. Role of melatonin in the regulation of human circadian rhythms and sleep. J Neuroendocrinol Apr;15(4):432-7 Cajochen et al. Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadian-phase dependent Sleep May;29(5): Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadianphase dependent. de Carvalho et al. Involvement of GABAergic non-benzodiazepine sites in the anxiolytic-like and sedative effects of the flavonoid baicalein in mice Behav Brain Res Aug 1;221(1): doi: /j.bbr Epub 2011 Mar 4..

7 Management guide to aid in insomnia assessment Do your intake forms provide for assessment of patient s sleep status? If not, incorporate appropriate intake and screening (monitoring) forms to evaluate sleep quality Assess co-morbidities: shift-work; eating patterns (late-dinners, social drinking, excessive coffee, energy drinks or similar); technophile or TV (exposure to bright lights late into the evening); health conditions or medications associated with insomnia (depression, SSRI) Note patterns associated with sleep deficit: minor trauma (falls, minor injuries), motor vehicle accidents, and/or overall health patterns (recurring colds/flu, hypothyroid, chronic muscle tension headache) Evaluate labs: melatonin, adrenal stress profile, thyroid (hypo- and hyperthyroid concern), vitamin panel, CBC (iron-deficiency anemia), or assessment of mental status (early dementia or age-related cognitive decline) Consider appropriate nutritional support: melatonin, valerian, passiflora, magnesium, vitamins A & D, neuroprotective herbs and adaptogenic herbs such as ginseng If appropriate and necessary refer: patient for appropriate care including mental health specialists Provide educational materials: to support proper home-life patterns that promote regularity of sleep (Cognitive Behavioral Therapy)

8 Relevance to Chiropractic clinician It is reported Chiropractic patients express higher levels of perceived stress compared to conventional practitioner counterparts (greater than national average) 60% chiropractic patients reported at least one of the following complaints: stress, fatigue, anxiety, depression, and/or sleep disorders Lack of proper rest predisposes patients to trauma-related injury including motor vehicle or workplace accidents The body s physiological response to stress including fatigue due to lack of rest can markedly impact the DC s ability to improve patient outcomes The side-effects of modern life (shift work, night-life, computers/tablets/tv) fatigue is becoming a national epidemic DC s need tools to actively address fatigue and causes to fatigue to effectively support their patients return to wellness

9 Check out the following additional information on this topic at MHICN: Type into the search field at MHICN any of the following: How many hours of sleep should one get every night? Sleep Apnea in Perimenopausal Women Health Issues for Menopausal Women: The Top 11 Conditions Have Common Solutions The Fantastic Four? Sure! But go beyond...to the Heavenly Seven Morning Wellness: The benefits of fitness in the morning and a healthy breakfast

Karen s Ultimate Guide to a Solid Nights Sleep

Karen s Ultimate Guide to a Solid Nights Sleep Insomnia has reached epidemic proportions. It s estimated to be the #1 health-related problem in America. More than 1/3 of Americans have trouble sleeping