1
www.postersession.com References . Introduction Acknowledgment Discussion Results Chronic pain occurs in patterns and recurs when nociceptive pain generators overwhelm an individuals tolerance and interfere with function. Management and treatment usually target at symptoms, not base causation. Research targets are interrupting, confusing or blockading pain signals; they are not identification and removal of the base generators of those signals. A basic scientist seeks identification of patterns, pattern analysis. He seeks calculation of the simplest, lowest common denominator. Usually this involves multiple fancy, expensive gadgets or drugs with success measured by a pvalue of <0.05. This is an epidemiologic study with the same scientific goals. The tools are more basic. The P value sought is < .00001. Headache syndromes are well documented as the greatest cause of lost and diminished work capacity in the United State. This holds true across the world for both absenteeism from work and presenteeism(at work with diminished performance capability). (1) Headache syndromes are often categorized as migraine or tension. This study addressed these together as a mixed pattern headache syndrome (HAp). Most headache sufferers with function loss have mixed headaches. Impairment from function is what counts. This is regardless of category: tension, migranoid, or mixedwith or without neuro-vascular-sympathomimetic, visceral… components. The focus here is on a pattern: recurrence; related functional impairment; persistence over a year; an identifiable trigger on one main side; strict adherence to an anatomical area ;and, a consistent timing. Pattern headache affect work-place ability to function/concentrate. Those with chronic headache conditions are also noted to have associated tempromandibular joint dysfunction, tinnitus, neck muscle spasms, sleep problems, anxiety and depression. The authors noted an unsuspected close pattern of correlation between patterned headache syndromes and face sleep postures = head and neck twisting, specific muscle triggers, and laterality. This data set focuses on the head and neck. The head and neck may be untwisted, face neutral (Fn) ; or, it may be torqued right or left, in order to breathe face twisted (Ft) . Ft posture hyper-stretches muscles, pinches nerves and pulls at joints. It also twists the fleshy airway. 1- Burton W, Landy S, Downs K, et al. The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clinic Proc. 2009; 84 (5): 436 445. 2- Malik, Z. Pain, Endorphins, and rTMS. PowerPoint. UCSD 3- Mount F, Whitmore M, and Stealey S. Evaluation of neutral body posture on shuttle mission STS-57 (spacehab-1). 2003. 1-30. 4- Panettiere, A. Treating Sleep Problems in PTSD and TBI. PowerPoint. Monthly Webinar. 23 Feb 2012. 5- Romanello S, Spiri D, Marcuzzi E, et al. Association between childhood migraine and history of infantile colic. JAMA. 2013; 309 (15): 1607-1612 Humans typically engage in prolonged periods of sleep with very little movement. During these relaxedperiods, the twisted, curled and or torqued body slowly kink, distorts or compresses sensitive and vital structures. Such traumas form the basis of injury and chronic pain. These may or may not heal in the more active daytime. The data demonstrates the strong relationship between twisted head and neck postures and headache syndrome (pattern headaches with lost work efficiency and time), cervical pain, and obstructive sleep dysfunctions. Also demonstrated is a very high correlation of laterality with the head direction, specific muscle spasms, and headache trigger sides. In this unselected group of subjects, most of these findings were not active complaints. They were in the background, yet found when looked for. It gives an insight into causation that rarely identified, yet necessary understand pain syndromes. Sleep posture can be readily controlled if the individual understands the posture and the effects of the postures. They can then can picture them and provide a nest into which to employ them. The safest, restorative sleep positions are the neutral body postures. In contradistinction, twisted (and curled) postures predispose to a spectrum of injury and pain. Image 1: NASA Astronaut Neutral Body Posture 1 Face neutral (Fn)= Untwisted -- Neutral Body Position for Sleep Graphs for Group A 109 Illustration 3 : 107 of the 109 were evaluated for Positive findings of spasticity and tenderness of ±3/5. --Negative, no pain or spasm= 3 ; --Positive R + R>L = 52 ; --Positive, about equal, R= 2 5; and, --Positive L + L>R = 27. Illustration 4 : 258 subjects. The individual breakdown for each side is, Face Neutral (Fn): 41, Face twist right (rrlFt) =R+R>L = 148, Face twist equal (eFt), Equal: 13 Face twist left (llrFt) = L+L>R = 56. *41 are Face neutral, 2 with pHA *217 are face twisted, 190 with ppHA. Headaches are 36/1 Ft/Fn Numbers are similar for SCM and TMJ. Laterality is matched with HA side, SCM spasm side, and Face turn direction. Graphs for Group B 258 Illustration 1 : Of 109, 106 were evaluated for headache.. Pattern headache affect on work-place ability to function/concentrate. --Gp-0, G-2-Mild headache, loss of 6-10 hours per month of effective function G-2, presenteeismpain is there, & job duties are impaired 10-30 hours per month total; they l may lose, 8 h/mo. G-3, loss of 20 to 60 hours+ per month, mostly absenteeism Illustration 2 : Laterality in 105 subjects --No Headache: 4; --Right side and Right>Left: 59; --Equal,( right and left seem equal): 21; --Left side and Left>Right: 23. Illustration 5 : A total of 258 subjects. This graph is similar to the one above, it summarizes the face neutral individuals from face twisted This is dedicated to the hundreds of active duty service members whose eager, honest and frank responses to along and detailed active-exam-survey made it possible to catalogue patterns of pain, injury and behaviors. There is a particular thanks to the scores of those who begged and demanded that the above and the multitude of directly related chronic-pain-patterns be brought to the attention of their command structure and their health providers. Illustration 8: Examples of neutral sleep postures: Illustration 9: The data present in the 109 and 258 groups illustrates an epidemiologic relationship between just one specific element in sleep posture and headaches, neck muscle pain and sleep dysfunctions. This is a small hip of the iceberg. Sleep time should be about recovery and rest, but for some, twisted sleep postures evoke injury to a number of areas. Fn Fn X X According to fifty years of NASA research, at zero gravity, a Neutral Body Posture, during static poses or sleep protects human nerves and muscles from injury. The current data from two detailed exam-surveys strongly confirms the NASA research. It also documents a strong reproducible pattern of specific neuro-musculo-skeletal pain and other maladies directly associated with specific dominant (static) twisted or hyper-flexed static sleep postures. Protection of nerves, vasculature, muscle, viscera, and bone from static cumulative compressive injury is maintenance of a neutral posture during sleep (Image 1). Methodology The gathered data was recorded into a fully de-identified databases separate from files or records. None of the data was correlated, nor sleep positions calculated, until six months after the final subject exam-study collection. Specific sleep postures of the head and neck are closely related to pattern headaches, headache syndromes with function loss, and specific lateralized muscle muscle trigger areas. The observations recorded demonstrate that the triggers are mechanical associated with neuro- vascular structures. The data patterns multiple positive findings of physical disabilities that correlate with related sleep postures. Such patterns (causes?) are unknown and have not been previously catalogued. First, Group-A (109:) over a six month period, five applicants per week were selected who complained of or were found with TMJ, bruxism, and jaw tenderness. 109- Subjects; Average age 36; 94-males;15 female.s Second, Group-B (258), for prevalence: all randomly assigned applicants for screening general physical exam over 6 months. None were specifically being evaluated for headache, sleep dysfunction, or the other myofascial-pain disorders that were documented for absence or presence and intensity. Average age 42; 22-male; 30-female. Group-B had less detail gathered, but the data was parallel with Group-A. There were 367 randomly-assigned evaluees for general medical screening in two sequential groups. Face (Ft): Head and neck = Twisted to breathe during dominant sleep posture Examples of Head & Neck/ Face Positions Demonstrated Fn Fn Neuroscience, Anesthesiology and Medicine University of California San Diego Al-Timimi, NA & Gillick, JS Illustration 6: Cervical pain was muscle-related to the combined SCM and other cervical muscles 258 subjects, the breakdown for each *No spasm53; *Spasm/pain-Right= R+R>L= 117 *Spasm/ pain about equal= RL =35: *Spasm/pain-Left=L+L>R= 53 *** 205 subjects are positive for cervical pain and 53 with none. ***9/41 Fns had cervical pain/spasm ***196/217 Fts had cervical pain/spasm This is a 6.3/1 ratio with Ft/Fn The SCM muscle is usually the local trigger for tension headache with the Suboccipital area for migranoid. If neck sleep position is twisted, the SCM and posterior cervical muscle on the most faced side twisted toward is tender, spastic and the trigger. Illustration 7 : In the258 subjects. ; 28/30 females slept twisted, 189/228 males slept twisted. Ft-right Ft-left Ft-left Ft-right Positions & Onset Headaches and Neck Muscles Combined Conditions Sleep Problems Group-A Group-A Headaches Group-A- HApf affecting work function - loss Group-B Headache Correlates Group-B Prevalence Group-B Prevalence Group-B Prevalence Group-A Group-B Prevalence Group-A Do Specific Common Sleep Postures Independently Evoke Headaches and Breathing Obstruction?

Sleep Postures Headache and Breathing Obstruction · 2018. 11. 1. · tempromandibular joint dysfunction, tinnitus, neck muscle spasms, sleep problems, anxiety and depression. The

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Page 1: Sleep Postures Headache and Breathing Obstruction · 2018. 11. 1. · tempromandibular joint dysfunction, tinnitus, neck muscle spasms, sleep problems, anxiety and depression. The

www.postersession.com

References

.

Introduction

Acknowledgment

Discussion

Results

Chronic pain occurs in patterns and recurs when nociceptive pain generators

overwhelm an individual’s tolerance and interfere with function. Management

and treatment usually target at symptoms, not base causation. Research targets

are interrupting, confusing or blockading pain signals; they are not

identification and removal of the base generators of those signals.

A basic scientist seeks identification of patterns, pattern analysis. He seeks

calculation of the simplest, lowest common denominator. Usually this involves

multiple fancy, expensive gadgets or drugs with success measured by a “p”

value of <0.05. This is an epidemiologic study with the same scientific goals.

The tools are more basic. The P value sought is < .00001.

Headache syndromes are well documented as the greatest cause of lost and

diminished work capacity in the United State. This holds true across the world

for both absenteeism from work and “presenteeism” (at work with diminished

performance capability). (1)

Headache syndromes are often categorized as migraine or tension. This study

addressed these together as a mixed pattern headache syndrome (HAp). Most

headache sufferers with function loss have mixed headaches. Impairment from

function is what counts. This is regardless of category: tension, migranoid, or

mixed– with or without neuro-vascular-sympathomimetic, visceral…

components. The focus here is on a pattern: recurrence; related functional

impairment; persistence over a year; an identifiable trigger on one main side;

strict adherence to an anatomical area ;and, a consistent timing.

Pattern headache affect work-place ability to function/concentrate. Those with chronic headache conditions are also noted to have associated tempromandibular joint dysfunction, tinnitus, neck muscle spasms, sleep problems, anxiety and depression. The authors noted an unsuspected close pattern of correlation between patterned headache syndromes and face sleep postures = head and neck twisting, specific muscle triggers, and laterality.

This data set focuses on the head and neck. The head and neck may be untwisted, face neutral (Fn); or, it may be torqued right or left, in order to breathe face twisted (Ft). Ft posture hyper-stretches muscles, pinchesnerves and pulls at joints. It also twists the fleshy airway.

1- Burton W, Landy S, Downs K, et al. The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clinic Proc. 2009; 84 (5): 436 445.

2- Malik, Z. Pain, Endorphins, and rTMS. PowerPoint. UCSD3- Mount F, Whitmore M, and Stealey S. Evaluation of neutral body posture on shuttle mission STS-57

(spacehab-1). 2003. 1-30.

4- Panettiere, A. Treating Sleep Problems in PTSD and TBI. PowerPoint. Monthly Webinar. 23 Feb 2012.5- Romanello S, Spiri D, Marcuzzi E, et al. Association between childhood migraine and history of infantile

colic. JAMA. 2013; 309 (15): 1607-1612

Humans typically engage in prolonged periods of sleep with very little movement. During these “relaxed” periods, the twisted, curled and or torqued body slowly kink, distorts or compresses sensitive and vital structures. Such traumas form the basis of injury and chronic pain. These may or may not heal in the more active daytime.

The data demonstrates the strong relationship between twisted head and neck postures and headache syndrome (pattern headaches with lost work efficiency and time), cervical pain, and obstructive sleep dysfunctions. Also demonstrated is a very high correlation of laterality with the head direction, specific muscle spasms, and headache trigger sides.

In this unselected group of subjects, most of these findings were not active complaints. They were in the background, yet found when looked for. It gives an insight into causation that rarely identified, yet necessary understand pain syndromes.

Sleep posture can be readily controlled if the individual understands the posture and the effects of the postures. They can then can picture them and provide a nest into which to employ them. The safest, restorative sleep positions are the neutral body postures. In contradistinction, twisted (and curled) postures predispose to a spectrum of injury and pain.

Image 1: NASA Astronaut Neutral Body Posture

1

Face neutral (Fn)=Untwisted -- Neutral Body Position for Sleep

Graphs for Group A – 109

Illustration 3: 107 of the 109 were evaluated for

Positive findings of spasticity and tenderness of ±3/5.

--Negative, no pain or spasm= 3 ;

--Positive R + R>L = 52 ;

--Positive, about equal, R≅ = 2 5; and,

--Positive L + L>R = 27.

Illustration 4: 258 subjects. The

individual breakdown for each side is,

Face Neutral (Fn): 41,

Face twist right (rrlFt) =R+R>L = 148,

Face twist equal (eFt), Equal: 13

Face twist left (llrFt) = L+L>R = 56.

*41 are Face neutral, 2 with pHA

*217 are face twisted, 190 with ppHA.

Headaches are 36/1 Ft/Fn

Numbers are similar for SCM and TMJ.

Laterality is matched with HA side,

SCM spasm side, and Face turn

direction.

Graphs for Group B – 258

Illustration 1: Of 109, 106 were evaluated

for headache..

Pattern headache affect on work-place

ability to function/concentrate.

--Gp-0,

G-2-Mild headache, loss of 6-10 hours per

month of effective function

G-2, “presenteeism” pain is there, & job

duties are impaired 10-30 hours per month

total; they l may lose, 8 h/mo.

G-3, loss of 20 to 60 hours+ per month,

mostly absenteeism

Illustration 2: Laterality in 105 subjects

--No Headache: 4;

--Right side and Right>Left: 59;

--Equal,( right and left seem equal): 21;

--Left side and Left>Right: 23.

Illustration 5:

A total of 258 subjects. This graph is

similar to the one above, it

summarizes the face neutral

individuals from face twisted

This is dedicated to the hundreds of active duty service members whose eager, honest and frank responses to along and detailed active-exam-survey made it possible to catalogue patterns of pain, injury and behaviors.

There is a particular thanks to the scores of those who begged and demanded that the above and the multitude of directly related chronic-pain-patterns be brought to the attention of their command structure and their health providers.

Illustration 8:

Examples of neutral sleep postures:

Illustration 9:

The data present in the 109 and 258 groups illustrates an epidemiologic relationship between just one specific element in sleep posture and headaches, neck muscle pain and sleep dysfunctions. This is a small hip of the iceberg. Sleep time should be about recovery and rest, but for some, twisted sleep postures evoke injury to a number of areas.

Fn

Fn

X

X

According to fifty years of NASA research, at zero gravity, a Neutral Body Posture, during static poses or sleep protects human nerves and muscles from injury.

The current data from two detailed exam-surveys strongly confirms the NASA research. It also documents a strong reproducible pattern of specific neuro-musculo-skeletal pain and other maladies directly associated with specific dominant (static) twisted or hyper-flexed static sleep postures.

Protection of nerves, vasculature, muscle, viscera, and bone from static cumulative compressive injury is maintenance of a neutral posture during sleep (Image 1).

Methodology

The gathered data was recorded into a fully de-identified databases separate from files or records. None of the data was correlated, nor sleep positions calculated, until six months after the final subject exam-study collection. Specific sleep postures of the head and neck are closely related to pattern headaches, headache syndromes with function loss, and specific lateralized muscle muscle trigger areas. The observations recorded demonstrate that the triggers are mechanical associated with neuro-vascular structures. The data patterns multiple positive findings of physical disabilities that correlate with related sleep postures. Such patterns (causes?) are unknown and have not been previously catalogued.

First, Group-A (109:) over a six month period, five applicants per week were selected who complained of or were found with TMJ, bruxism, and jaw tenderness. 109-Subjects; Average age 36; 94-males;15 female.s

Second, Group-B (258), for prevalence: all randomly assigned applicants for screening general physical exam over 6 months. None were specifically being evaluated for headache, sleep dysfunction, or the other myofascial-pain disorders that were documented for absence or presence and intensity. Average age 42; 22-male; 30-female.

Group-B had less detail gathered, but the data was parallel with Group-A.

There were 367 randomly-assigned evaluees for general medical screening in two sequential

groups.

Face (Ft): Head and neck =Twisted to breathe during dominant sleep posture

Examples of Head & Neck/ Face Positions Demonstrated

Fn

Fn

Neuroscience, Anesthesiology and Medicine

University of California San Diego

Al-Timimi, NA & Gillick, JS

Illustration 6:

Cervical pain was muscle-related to the

combined SCM and other cervical muscles

258 subjects, the breakdown for each –

*No spasm–53;

*Spasm/pain-Right= R+R>L= 117

*Spasm/ pain about equal= R≅L =35:

*Spasm/pain-Left=L+L>R= 53

*** 205 subjects are positive for cervical

pain and 53 with none.

***9/41 Fn’s had cervical pain/spasm

***196/217 Ft’s had cervical pain/spasm

This is a 6.3/1 ratio with Ft/Fn

The SCM muscle is usually the local

trigger for tension headache with the

Suboccipital area for migranoid.

If neck sleep position is twisted, the

SCM and posterior cervical muscle

on the most faced side twisted

toward is tender, spastic and the

trigger.

Illustration 7:

In the258 subjects. ;

28/30 females slept twisted,

189/228 males slept

twisted.

Ft-rightFt-left

Ft-left

Ft-right

Positions & Onset

Headaches and Neck Muscles

Combined Conditions

Sleep Problems

Group-A

Group-A

Headaches

Group-A- HApf

affecting work

function - loss

Group-B

Headache

Correlates

Group-B

Prevalence

Group-B

Prevalence

Group-B

Prevalence

Group-A

Group-B

Prevalence

Group-A

Do Specific Common Sleep Postures Independently Evoke

Headaches and Breathing Obstruction?