The Clinical Link Between Low Back Pain and Sleep Apnea: An Emerging Concern in Chiropractic Care

We understand the unique challenges you face in managing patients who present with overlapping chronic conditions. One such intersection receiving growing attention is the correlation between low back pain (LBP) and obstructive sleep apnea (OSA). Although these conditions may appear unrelated at first glance, recent studies reveal a compelling connection that chiropractic physicians should be aware of when developing care strategies.

1. Bidirectional Influence Between Pain and Sleep Disorders

Multiple studies have documented that sleep disturbances not only amplify the perception of pain but can also hinder recovery from musculoskeletal injuries. Conversely, chronic pain—especially LBP—disrupts sleep architecture, increasing the likelihood of developing OSA or worsening its severity.

• A 2021 study in the Journal of Clinical Medicine found a significantly higher prevalence of sleep apnea symptoms in individuals with chronic low back pain, particularly those with pain lasting more than six months.
  
• Sleep fragmentation, characteristic of OSA, has been shown to alter central pain processing, leading to hyperalgesia (increased sensitivity to pain).
  

2. Common Risk Factors and Pathophysiology

There are shared physiological and lifestyle risk factors that link LBP and OSA:

• Obesity increases mechanical stress on the lumbar spine and also contributes to upper airway obstruction.
  
• Sedentary behavior can result in deconditioning of core musculature and poor sleep patterns.
  
• Inflammation and oxidative stress, both elevated in OSA, may contribute to chronic pain syndromes, including nonspecific LBP.
  

3. Postural and Respiratory Mechanics

Chiropractors understand the importance of postural dynamics. Forward head posture and thoracic spine rigidity—common in those with sleep-disordered breathing—restrict thoracic expansion and diaphragmatic movement, which may indirectly contribute to spinal instability and compensatory lumbar stress.

4. Clinical Implications for Chiropractic Practice

Given this growing body of evidence, chiropractors are uniquely positioned to identify this dual burden:

• Screening Tools such as the STOP-BANG questionnaire can be easily implemented during patient intake for chronic back pain patients.
  
• Collaborative Care with sleep medicine specialists can significantly improve outcomes, especially in patients resistant to conventional chiropractic care.
  
• Emphasis on Respiratory Biomechanics, postural correction, and lifestyle coaching may mitigate both conditions simultaneously.
  

Conclusion

There is strong and emerging evidence that low back pain and obstructive sleep apnea are interrelated in a clinically meaningful way. As chiropractors, we must not treat these as isolated conditions. We can craft more comprehensive, multidisciplinary, and effective care plans by recognizing the overlapping etiology and contributing factors. We urge all providers to consider sleep apnea screening as part of their protocol when managing chronic low back pain.

Neck Pain and Sleep Apnea

Sleep apnea is relevant to this research due to its direct impact on pulmonary and respiratory muscle function, which is a key focus of the study. Here’s how sleep apnea applies to the findings and broader context of this research:

1. Shared Respiratory Dysfunction

Obstructive Sleep Apnea (OSA) is characterized by repetitive airway obstructions during sleep, resulting in decreased oxygen levels, disrupted sleep, and increased respiratory effort. Similar to the findings in neck pain patients, OSA involves dysfunction in respiratory muscles, including accessory muscles like the scalenes and sternocleidomastoid. These muscles play a dual role in both breathing and postural support, indicating a potential overlap in the mechanisms contributing to respiratory and musculoskeletal issues.

2. Overuse of Accessory Breathing Muscles

Individuals with OSA often overuse accessory muscles for respiration due to compromised airway patency. This parallels the study’s observation that persistent neck pain alters cervical muscle activation patterns, reducing efficiency and coordination. The strain placed on these muscles in both conditions could exacerbate musculoskeletal pain, including neck pain, due to fatigue or overcompensation.

3. Biopsychosocial Factors and Inflammation

Both OSA and persistent neck pain are influenced by biopsychosocial factors, such as inflammation and stress. The research highlights how diaphragmatic breathing can reduce inflammatory cytokines (e.g., IL-1β, TNFα) and regulate the autonomic nervous system. These mechanisms are particularly relevant for OSA patients, who often exhibit elevated systemic inflammation and autonomic dysregulation, contributing to cardiovascular and musculoskeletal comorbidities.

4. Implications for Breathing Exercises

The study emphasizes the effectiveness of breathing exercises in reducing pain, improving pulmonary function, and enhancing respiratory efficiency. These exercises could similarly benefit OSA patients by:

• Strengthening the diaphragm and reducing reliance on accessory muscles.
• Improving ventilation efficiency and oxygen exchange, which are impaired in OSA.
• Addressing associated musculoskeletal pain, such as neck or back discomfort, often reported by OSA patients due to poor sleep posture or muscle tension.

5. Overlap in Treatment Strategies

The study underscores the importance of diaphragmatic breathing and respiratory muscle training, which align with therapeutic approaches for OSA, such as positional therapy and CPAP compliance. Incorporating targeted breathing exercises into OSA management may address both the respiratory and musculoskeletal consequences of the condition, offering a holistic approach to treatment.

Conclusion

The link between sleep apnea and neck pain lies in their shared impact on respiratory muscle function, inflammation, and accessory muscle overuse. Addressing these factors through targeted breathing exercises can improve outcomes for both conditions, demonstrating the value of integrated therapeutic strategies. This research supports the inclusion of such exercises in managing sleep apnea, particularly when musculoskeletal pain like neck pain is a concurrent issue.

References from https://www.mdpi.com/2077-0383/14/3/709 and https://spinalmanipulation.org/wp-content/uploads/2025/01/effects-of-breathing-exercises-for-neck-pain-systematic-review-and-meta-analysis-2025.pdf

Confronting Sleep Apnea: Why Timely Treatment Is Critical

Being diagnosed with Obstructive Sleep Apnea (OSA) can feel overwhelming. Navigating the array of treatments and figuring out what works best for you might seem daunting. For many, a pressing concern looms: “Can Sleep Apnea be life-threatening?”

The answer is sobering. Yes, untreated Sleep Apnea can have fatal consequences—not necessarily due to the condition itself but because of the risks associated with chronic fatigue.

Why Treating Sleep Apnea Could Save Your Life

Untreated Sleep Apnea leaves individuals perpetually drowsy, often leading to dangerous situations. Imagine operating at the cognitive level of someone who just pulled an all-nighter—every day and night. Fatigue on this scale increases the likelihood of accidents, some of which can be deadly.

Here are some scenarios where undiagnosed Sleep Apnea could be particularly hazardous:

• Driving a car
• Operating heavy machinery
• Flying a plane
• Engaging in activities like rock climbing or hunting
• Serving in active duty

Studies show that going without sleep for approximately 18 hours impairs your performance as much as having a blood alcohol level of 0.05—just shy of legally drunk. This alarming reality underscores why fatigue-related accidents claimed over 846 lives in 2014 alone.

Drowsiness isn’t just dangerous; it’s also preventable. Seeking and adhering to Sleep Apnea treatment is not just about protecting yourself—it’s about safeguarding everyone around you.

Ensuring Your Sleep Apnea Treatment Works

Treating Sleep Apnea is essential, but it doesn’t always deliver immediate or complete relief. When treatments fall short, it’s often due to incorrect usage rather than the treatment itself. Here’s how to troubleshoot common Sleep Apnea treatment methods:

CPAP (Continuous Positive Airway Pressure)

• Ensure Proper Fit: Improperly secured CPAP masks can leak air, reducing effectiveness. Take time to adjust the mask for a tight seal.
• Facial Hair Concerns: If you have facial hair near the mask area (like a mustache or beard), consider shaving for a better fit and improved results.

Oral Appliances

• Verify the Fit: Occasionally, oral appliances may not fit correctly due to errors during the fitting process. If your device feels uncomfortable or ineffective, consult your sleep dentist to adjust or remake it.
• Comfort Matters: Wearing an appliance that doesn’t help your condition is both uncomfortable and counterproductive. A proper fit is key to successful treatment.

Positional Sleep Therapy

• Address Tossing and Turning: Devices like sleep belts (e.g., slumberBUMP) are effective, but unpredictable movements during sleep can undermine their benefits.
• Stomach Sleepers: If you roll onto your stomach despite using a sleep belt, create a barrier using pillows to support your side-sleeping posture. Over time, this can train your body to maintain the correct sleeping position.

When to Seek Professional Guidance

Sometimes, despite your best efforts, treatment may still not work as expected. In such cases, consulting a professional is the safest course of action. Sleep specialists have the experience to address complex issues and recommend alternative solutions tailored to your needs.

At Premier Sleep Solutions, we’re here to support you every step of the way. Whether you need assistance with an existing treatment or are exploring options for the first time, our team is dedicated to helping you achieve restful, restorative sleep. Remember, treating Sleep Apnea isn’t just a personal victory—it’s a commitment to a healthier, safer future for yourself and those around you.

The sheer amount of technology devoted to sleep speaks to the enormity of the problem. Devices, drugs, home remedies, meditation—all of it designed to gain a few more winks of elusive slumber. 

An article in LiveScience.com makes the case that technology itself has led to a lack of sleep. “All artificial light, including LEDs, fluorescent bulbs and incandescent bulbs, can interrupt normal sleep patterns,” writes Alina Bradford. “The body’s biological clock works in rhythms that are set by the amount of light and dark the body is exposed to. This is called the circadian rhythm.” 

Most polls show that a third of Americans believe they don’t get enough sleep, and some of that is surely due to the ever-present glow of various screens. When it comes to sleep disordered breathing and/or obstructive sleep apnea (OSA), experts predict that 80% to even 90% of sufferers are undiagnosed.  

Continuous positive air pressure (CPAP) therapy has justifiably emerged as the “gold standard” in the fight against OSA. Sleep experts such as Shad Morris, DMD, a sleep medicine specialist in St. George, Utah, agrees with the “gold standard” contention with a few important caveats. 

“CPAP certainly works if patients will consistently use it,” he says. “The problem is that compliance has been historically low for a long time, in spite of manufacturer’s efforts to increase the comfort level of masks. Oftentimes, an oral appliance can be effective, and more comfortable, particularly for those who have mild to moderate OSA.” 

Oral appliances, sometimes referred to as mandibular advancement devices (MADs) are another form of high technology these days, with a growing body of evidence to back up their effectiveness. “There is still a bit of turf war mentality among some sleep clinicians, and we need to get rid of that,” adds Morris. “Whether it’s oral appliances, CPAP, or something else, the most important factor to remember is that we must do what is best for patients.” 

Sleep Apnea doesn’t discriminate. It doesn’t matter your age, race, ethnicity, or sex. The problem is, the stereotype is a middle-aged, overweight, male. When stereotypes like this exist it makes the people who aren’t part of that stereotype think they can’t get Sleep Apnea.

The harm of the stereotype

You’re probably no stranger to the danger of stereotypes, but it’s usually in context of discrimination. In this case, it’s with a very real condition. This preconceived notion of what someone with Sleep Apnea should look like is the exact reason many people with OSA actually get diagnosed with insomnia. Women and children the main sufferers of this since both are far out of the stereotype.

Children really do get it

About 1-4% of children have Sleep Apnea – that’s about as much children that have autism – yet, how many children have you heard of being diagnosed with it? This rate is much lower than the amount of adults that get Sleep Apnea and adult women were 3x as likely to have OSA. However low, it’s still a prevalent enough amount that it’s cause for concern. It’s also just as important to get your children tested as it is you.

Why children are less likely to get it

As dangerous as the stereotype is, there’s a reason this one came to be about. Sleep Apnea can largely be caused by extra fatty tissue. Since Children are statistically less likely to be overweight, they are also statistically less likely to have Sleep Apnea. In fact, this is what makes Sleep Apnea much different in children.

How Sleep Apnea affects children differently

As I just brought up, children usually are less obese than adults. With that in mind, how is it that children can also get Sleep Apnea if they don’t have fatty tissue putting pressure on the airway?

One thing children have that’s different than adults is problematic adenoids/thyroids. As adults, we know whether or not our adenoids/thyroids are going to be a problem and have dealt with the issue. But the fact of the matter is that children still have those organs, and among other issues, they can also give them Obstructive Sleep Apnea.

Surgery as an option

Luckily, this difference gives children a different solution to treatment: surgery. While adults usually shy away from surgery as it doesn’t work so well, it is much more effective on children. Simply removing the inflamed adenoid/thyroid can usually solve the problem. While this is an invasive surgery and not fun, it’s likely something that would have had to be done anyway.

Childhood obesity is the other main cause of childhood Sleep Apnea. If you find that your child still has apnealike symptoms after the surgery such as snoring, tiredness, and lack of energy, you may want to seek further treatment. Sadly, if the surgery doesn’t work then the child will likely have to try an oral appliance, a CPAP, or attempt positional sleep therapy.

Watching out for all the signs of Sleep Apnea is just as important in adults as it is kids. If you’re interested in our treatment protocol you can find it here. Keep in mind, a regular doctor might not be able to always diagnose sleep apnea. If you think your child has it then it’s best to consult a professional, specialized sleep doctor or sleep dentist.

Sleep Apnea and a CPAP go hand in hand. Without a doubt, it is the first thing that will pop up in someone’s mind when you mention one or the other. But that’s beginning to change.

Oral Appliance Therapy is the new favorite, and it’s beginning to change the way the game is played.

How Oral Appliance Therapy works

A dentist will make you a mouthpiece that you place in your mouth every night before bed. The mouthpiece repositions your lower jaw to give more space in your airway. As a positive side effect, the mouthpiece can also help alleviate other breathing problems that may occur during the night.

There are usually regular adjustments that take place with the mouthpiece to ensure it is fit correctly for ease and comfort.

Where a mouthpiece beats out the CPAP

The CPAP is usually the go-to for most sleep doctors, however, they tend to not work. Not because the machine is faulty or it’s an ineffective solution or anything, but because it’s hard to get patients to wear the CPAP.

Not only can CPAPs be difficult to continually wear, but they have tons of side effects that come with them. Among those are

• Air leaking from the CPAP machine
• Dry nose or mouth
• Discomfort while wearing the mask
• Nausea
• Sneezing

With all of these CPAP compliance LESS THAN 50%. Meanwhile, Oral Appliance compliance was found to be 91% in a recent study. How hard is it really to decide which one’s the better option.

Is there any use for a CPAP any more?

While the Oral Appliance is becoming more mainstream and the go to first response, the CPAP isn’t out of it yet. In severe cases of Obstructive Sleep Apnea (OSA), Oral Appliances have been found to be less effective than the CPAP in most cases.

However, the American Academy of Sleep Medicine still recommends oral appliances as a first-line therapy for the treatment of mild to moderate sleep apnea and for those severe sleep apnea sufferers whose CPAP treatment has failed.

Our Protocol at Premier Sleep Solutions

Call us today and we can get you set up with an appointment for a Polysomnography. It’s our go-to test to diagnose most sleep disorders. It’s the gold standard. We will assess your condition and decide whether or not Oral Appliance is the best option for you.

Sleep Apnea is a silent killer. Most people don’t even know they have it when it could be making drastic changes in someone’s life without them even realizing it. Some of these changes could actually be impacting their livelihood. Actually, most of these changes will be hurting them is some way shape or form.

The unknown epidemic

According to the Cleveland Clinic over 80% of Sleep Apnea cases go undiagnosed. If this figure is accurate that would mean 1 in 18 Americans have Sleep Apnea.

This includes grandparents, aunts, women, children, African Americans, and Whites. Sleep Apnea – although more likely in some demographics – can target virtually anybody. Nobody is safe from Obstructive Sleep Apnea.

Why it’s un-diagnosed

There are many reasons, but a few in specific have been ruining the numbers far more than the rest.

Uninformed doctors

With new research popping up everyday about it’s only a matter of time until this isn’t a problem anymore. But sadly, many doctors still just aren’t aware of the symptoms and just basic information surrounding Sleep Apnea.

Many times doctors will diagnose someone with Narcolepsy or some other sleep disorder instead. The many symptoms that fall under Sleep Apnea also fall under many other conditions which can make diagnosing patients difficult for doctors in some cases.

If you go to Premier Sleep Solutions we have a very clearly outlined sleep protocol that can be tailored exactly to each patient’s needs so they won’t have problems with us like they will with other doctors.

Unhealthy stereotypes

Imagine someone with Sleep Apnea. If you’re not thinking of a relative you’re probably thinking of a middle-aged, overweight, white, male. The fact of the matter is that this stereotype – while still holding some truth – is unhealthy.

People are less inclined to get tested for sleep apnea because they think that makes them automatically fat. Sleep Apnea is more likely in overweight people, but it isn’t always the case. Like I said, almost anyone can get it so there isn’t really a reason for the stereotype to continue to exist.

The public just doesn’t know what Sleep Apnea is

With a lack of publicity, many people don’t know what’s happening when they’re presented with the symptoms most commonly associated with Sleep Apnea. People are constantly tired, snoring all the time, and find themselves waking up during the night but they won’t know what to do about it.

The media has given this issue more attention so more people will be informed, hopefully, this problem should disappear with time. But it’s still the responsibility of each individual person to study it for themselves.

What are the long term effects we can see from this

You can currently see and will continue to be able to see a culture that romanticizes sleeplessness. I mean surely you’ve heard people joke about how little sleep they got and probably laugh about it. But the ramifications of this are terrible, it makes people – who otherwise might have seeked treatment – ignore their symptoms and live on their drowsy lives.

Inform yourself and encouraging others who could have Sleep Apnea to get tested and you could potentially save lives.

If you have any questions about OSA or other sleeping conditions don’t be afraid to contact us at any of our four locations.

Once you’re diagnosed with Obstructive Sleep Apnea it can be scary. You’ve got to feel your way around to see what treatment works for you. Even then some people worry and ask, “Can my Sleep Apnea kill me?”

Treatment could save your life

Truth is, Sleep Apnea can be fatal. Not because the symptoms or the complications, but because being drowsy all the time sets up many dangerous situations. Imagine feeling like you just pulled an all nighter every day and every night, because that’s how some people have felt before they started treating their Obstructive Sleep Apnea. Here’s some situations where it could be potentially dangerous for someone with undiagnosed Sleep Apnea.

• Driving a car
• Flying a plane
• Rock climbing
• Hunting
• In active duty

Not sleeping for around 18 hours actually produces an impairment equal to a blood alcohol level of around .05, almost legally drunk. It’s easy to see why it claimed over 846 lives in 2014. I’m sure anybody could think of many more situations where being dead tired could potentially end somebody’s life.

It’s a fact, drowsiness is dangerous. Many people think of being tired as a badge of honor of sorts. But, the truth is, it’s something that is dangerous and selfish to be intentionally doing. That’s why it’s so honorable to get treatment for sleep apnea. You’re not just protecting yourself, you’re protecting everybody you come in contact with.

Make sure your sleep apnea treatment is working correctly

Getting treatment is always the best option, but sometimes it doesn’t work the way we expect. Not only that, but sometimes the treatment doesn’t actually work at all. Most of the time this is because a misuse of the treatment method. There are some quick fixes for most sleep apnea treatments.

CPAP

Make sure the mask is completely sealed. Often times people will incorrectly equip the mask leading to a leakage of air. If the air is leaking, the benefit of the CPAP will often be negated to a point where it’s not even worth wearing.

Many people find that shaving facial hair around the area such as moustaches, goatees, and soul patches makes it much easier to put on correctly. Once the CPAP is correctly applied treatment should work as intended.

Oral Appliances

99% of the time sleep dentists will find the correct fit, however sometimes, mistakes just happen. Something in the process could have gone haywire or the mold could have just been taken incorrectly. Verifying that your mouthpiece is a correct fit is essential to knowing that you’re getting correct treatment. I mean, why wear something uncomfortable if it’s not even treating the Sleep Apnea? Once verified, if problems continue, contact us to see other options.

Positional Sleep Therapy

For anyone who may have a tried a sleep belt such as the slumberBUMP, they’ll know that sometimes sleeping can be more unpredictable than they imagined. Tossing and turning is a part of sleep and is much more prevalent than most people would imagine.

For stomach sleepers, sleep belts can often be problematic. They find they tend to fall forward onto their stomach in their sleep. An easy fix for this is just using pillows to create a wall in front of you. This will train – along with the sleep belt – your body to permanently sleep on its side.

If nothing is working then check with a professional

When it comes down to it patients aren’t doctors. For as many quick and easy fixes there are, just as many more complicated problems can arise. Most of these are best to leave to professionals who have probably seen it before and can find the best solutions to it.

We’re more than happy to help you at Premier Sleep Solutions. We now have four locations in St George, Midvale, Las Vegas, and San Antonio.

The National Football League Players Association (NFLPA) came to Las Vegas, NV for its annual meeting in March. Subjects such as wages and benefits will be discussed, however, the Living Heart Foundation also offered a free health screening for all former players who attend. Pro Player Health Alliance (PPHA) allied with the Project Rose Sleep Program to provide sleep testing for all of these players. They were able to treat players for their own wellbeing. They chose Dr. Shad Morris to head this screening.

Dr. Shad Morris

Last year, over one hundred players took advantage of this during service the annual meeting. Those tested had their body, blood pressure, heart function, and all of their senses tested. American Sleep and Breathing Academy Diplomate Dr. Shad Morris, who is a practicing dentist in Nevada and Utah, was selected as the head dentist for the screening. Shad Morris has an excellent track record and has treated hundreds of patients in the past. He has an amazing reputation for being one of the best sleep dentists in the country. The players were in great shape with him in charge. According to Sleep Scholar, When asked why Dr. Morris was selected to be the point man for the health assessment, David Gergen said,

“Shad has donated time and money to help elderly in his community with holiday church functions for years. He has explained to me that his grandparents forged the way for his future. Although many dentists stay away from Medicare because the reimbursement isn’t good and contains so many regulations, Dr. Morris doesn’t mind because he believes in doing the right thing and helping those who worked hard to give him the opportunities to thrive today; giving back is the right thing to do. When I interviewed him for the position in December of 2017, he told me it’s not about the money it’s about successful outcomes, I knew he was the right guy to bring that same attitude to treating members of the NFLPA.”

Alongside Dr. Morris will be Dr. Ronny Rosenbaum who also has a great reputation for treating athletes sleep problems.

The CEO of the PPHA, David Gergen, said he only chooses ASBA graduates to participate in this screening because they have the highest quality of training. He said that other dentists just don’t know what they’re doing clinically or financially.

The meeting is taking place on April 13-14, 2018, in Las Vegas, NV. This is the best conference for dentists who are engaged in sleep medicine and oral appliances. This is a great opportunity for anybody who is interested in sleep medicine to come and attend to learn more about it.