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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.


Late 30s female health professionals visited Headache and Neck Clinic for her neck pain (which induces nausea) and insomnia. She also suffers from a stiffness/tightness sensation on her neck and strongly believed her insomnia was originating from her neck.

After falling into sleep, she wakes up in an hour or two then cannot go back into sleep therefore only sleeps few hours everyday.


Cone Beam CT was requested and revealed 4 separate complete arcuate foramen on her atlas (C1).


Arcuate foramen, also known as a retroarticular vertebral artery ring is a fairly common phenomenon however it is never common to have 4. Usually 2 at the back of the C1 but not on the side of the C1. Lateral arcuate foramen is a very rare phenomenon and only few cases are reported.


Complaints which exhibits in arcuate foramen are, back pain in 36%, headache, vertigo, diplopia in 2.9%, neck pain, brachial symptoms (pins and needle sensation to hand(s) or arm(s) in 23.7%, hip, leg pain 8.2%, tension, hyperactivity, insomnia ,high blood pressure in 4.3%,respiratory illness in 1.7%



Vertebral artery passes through the transverse foramen of the cervical spine and before enters the skull, it forms a distinctive loop (very important). This loop is to give some allowance to sustain any mechanical stretch or stress onto the vertebral artery during motion. Therefore 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 she has a subluxation at the level of an atlanto-occipital joint. Angles and location of the subluxation was measured and adjustment was delivered using an adjusting instrument and patient felt the neck stiffness/tightness disappeared immediately. This was the first C1 correction day and since then the insomnia did not return.




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