Troubled sleep? Constantly waking up or cannot fall back into sleep?

Signs and Symptoms: Difficulty falling back into sleep.

Type of Trauma: Cannot recall any.

Adjustments: C1 correction using the adjusting instrument based on the findings from the Cone Beam CT (3D X-ray).

Outcome: Insomnia was resolved and did not return until the last visit (Last visit was Sep 2022). ALL of patient’s presenting signs and symptoms resolved. Insomnia disappeared in Aug 2021.

A female health professional in her late 30s visited the Headache and Neck Clinic seeking relief from chronic neck pain, which induced nausea, and persistent insomnia. She also experienced a sensation of stiffness and tightness in her neck. The patient strongly believed that her insomnia was stemming from her neck issues.

Her sleep was severely disrupted, as she would fall asleep only to wake up after an hour or two, unable to fall back asleep. This left her with only a few hours of sleep each night.

To investigate further, a Cone Beam CT (CBCT) scan was ordered, which revealed four separate complete arcuate foramen on her atlas (C1).

Arcuate foramen, also known as the retroarticular vertebral artery ring, is an anatomical phenomenon that can affect the cervical spine. It is relatively common to find two arcuate foramen at the back of the C1 vertebra (Atlas), but it is highly unusual to have four, especially with some located laterally on the sides of the C1. The lateral arcuate foramen is a very rare occurrence, with only a few documented cases.

In this patient’s case, the Cone Beam CT (CBCT) scan revealed four separate arcuate foramen on the C1, which is considered quite exceptional.

Symptoms linked to the presence of arcuate foramen can vary significantly. In general, the following conditions have been observed in patients with this anatomical variation:

• Back pain: 36%

• Headaches: 2.9%

• Vertigo (dizziness): 2.9%

• Neck pain: 23.7%

• Brachial symptoms (pins and needles sensations in the hands or arms): 23.7%

• Hip or leg pain: 8.2%

• Tension, hyperactivity, insomnia, high blood pressure: 4.3%

• Respiratory illnesses: 1.7%

The vertebral artery passes through the transverse foramen of the cervical spine, and before entering the skull, it forms a distinctive loop. This loop allows for some flexibility to sustain any mechanical stress or stretch on the vertebral artery during motion. If there are any arcuate foramen, either complete or incomplete, at any site of the C1, it can disrupt the vertebral artery mechanically.

CBCT revealed a mild displacement/misalignment at the atlanto-occipital joint level. The angles and location of this displacement/misalignment were measured, and an adjustment was delivered using an adjusting instrument. The patient immediately reported a reduction in neck stiffness/tightness. This was the first C1 correction, and since then, the insomnia has not returned.