Monday, March 7, 2022

Sleep and Performance - Assessing Sleep

In an earlier article I discussed the importance of sleep and performance.

Many people aren't getting the adequate amount of sleep required for their bodies to function properly. While some individuals just need more sleep because of family, social, or work obligations impacting their sleep, others may have an untreated sleep disorder that keeps them from getting good quality sleep each night.

This week I investigate a method for testing sleep; a Polysomnogram

A Polysomnogram or PSG is a diagnostic tool to perform a sleep study and to determine if you have a sleep disorder.

This test monitors your sleep cycles and stages to identify any disturbances. You are connected to a variety of equipment to help monitor things like:

  • Brain activity
  • Breathing activity
  • Muscle activity

A polysomnogram is used to diagnose a wide range of sleep disorders such as:

  • Central sleep apnea, OSA, sleep-related hypoventilation disorders, and other sleep-related breathing disorders.
  • REM behavior disorder, or other parasomnias (abnormal actions or behaviors while sleeping).
  • Idiopathic hypersomnia, narcolepsy, and other hypersomnolence disorders.
  • Non-24-hour sleep-wake syndrome, delayed sleep phase syndrome (DSPS), or advanced sleep phase syndrome and other circadian rhythm sleep-wake disorders.
  • Bruxism, periodic limb movement disorder (PLMD), restless legs syndrome (RLS), and other sleep-related movement disorders.
So what do the results mean? I decided to undergo a sleep study to ascertain the cause of my constant fatigue first thing in the morning.

I was connected to a polysomnogram (portable diagnostic study in my home) overnight. Due to the position of the device on my chest, I was forced to sleep on my back. The tracing was measured at 30 second intervals, with the following parameters:-
  • Frontal, central and occipital Electroencephalogram (EEG) - detects abnormalities in your brain waves or the electrical activity of your brain
  • Electrooculogram (EOG) - records the movements of the eyes during sleep 
  • Submentalis Electromyography (EMG) - measures Atonia or Bruxism 
  • Nasal and oral airflow
  • Electrocardiogram (ECG) - to measure disorders of the heart during sleep
  • Body position
  • Inductance plethysmography - to detect thoracic and abdominal movement
  • Pulse oximeter - to measure oxygen saturation Sp02
The results of the Sleep study were quite interesting:
  1. Sleep efficiency was normal at 87.1%
  2. Sleep architecture was normal
  3. All stages of sleep were achieved
  4. Only a few minutes of slow wave sleep were achieved
  5. Supine REM sleep was seen
  6. Sleep latency and REM sleep latency were normal
  7. Occasional bursts of repetitive obstructive apneas and hypopneas
  8. Sleep fragmentation (AI 7.8)
  9. Oxyhaemoglobin desaturation 81%
  10. Respiratory Disturbance Index (RDI) 14.1 events per hour
  11. REM Respiratory Disturbance Index 37 events per hour
  12. Average awake oxygen saturation 94%
  13. Oxygen Desaturation Index (ODI) 11.2 events per hour
  14. Time spent oxyhaemoglobin saturation below 88% was 1.4% of sleep time and below 80% was 0.0% of sleep time
  15. ECG was normal 
  16. No periodic limb movements
  17. Snoring was recorded
  18. Reported sleep quality was the same as usual, with discomfort of apparatus while sleeping supine
In summary, I was diagnosed with mild Sleep Disordered Breathing (SDB). This was due to the RDI of 14.1 events per hour predominantly in REM sleep, associated with sleep fragmentation (AI 7.8) and oxyhaemoglobin desaturation to 81%.

Sleep-disordered breathing (SDB) consists of episodes of periodic obstructive or central sleep apnea and partial upper airway obstruction. 

It is to be noted that lying on your back (supine) can itself cause sleep apnea, as gravity increases the tendency for the jaw, tongue and soft palate to drop back toward the throat, which narrows your airways and can lead to breathing difficulties. Therefore, had the sleep study been performed while side-lying, the result may have been different.

In the next article I will investigate treatment options for Sleep-Disordered Breathing.

Monday, January 31, 2022

Back Injury in the Nursing Home

When you consider back injury, the first thought that comes to mind is heavy lifting. While heavy or improper lifting is responsible for many back injuries, it may not apply in all cases. 

If your loved one is in a nursing home and has suffered a back injury, it is very unlikely that he or she was lifting something heavy – after all, patients are supposed to be monitored to prevent them from doing things that might injure them.

Causes of back injury

As we age, back pain and injury become more frequent. In elderly patients, arthritis, degenerative disc disease, herniated discs and spinal stenosis are all relatively common causes of back pain. 

If your loved one is suffering from back pain in a nursing home, the first step should be to determine if any of these issues could be causing the pain. If so, the senior will be able to receive the treatment needed to help alleviate the pain.

Slips and falls are also major contributors to back injuries and pain in nursing home patients. Twisting, landing on the back, or hitting something during the fall can all cause injury – especially in those suffering from osteoporosis or other diseases that make the bones brittle and weak. 

These causes may be more common in the elderly, however if you have ruled out other potential causes of your loved one's back injury, you may need to take a closer look at the care he or she is receiving.

Images taken before treatment             

Care of the injured elderly patient 

Sadly, as the patient ages within a nursing home setting, he or she becomes more sedentary and this increases the risk of back injury.

As a Carer, what can you do to reduce the risk of injury to your loved one?

Have you considered Geriatric Chiropractic treatment? Back pain and reduced or limited mobility have a negative impact on daily life. Simply getting through the day can be challenging, with every day tasks including self care and errands, much more difficult to accomplish.

If your loved one is 65 years or older and dealing with back pain, a Chiropractor can help. Chiropractic treatment can reduce their pain and help improve your mobility so they can have a better quality of life.

Improving Spinal Mobility

By gentle manual movement of the spinal vertebrae through various techniques, normal range of movement can be restored, relieving pain and nerve compression, and helping return the patient to a normal state of function. 

Spinal Manual Techniques for the Geriatric patient include:-

  • Instrument assisted manipulation (Activator, Arthro-Stim)
  • Specialised tables (Drop Table, Flexion-Distraction)
  • Soft Tissue Mobilisation 
  • Myofascial Release

                                       Image of Flexion-Distraction Treatment

Spinal Manipulation is a non-drug treatment and therefore it's role in the care of the Senior patient is especially important. 

Pain medications and Opioids affect Seniors differently than younger people. For example, Opiods can increase the risk of falls in the Senior patient. 

Images taken after treatment 

Fall Prevention

Approximately one third of Seniors over 65 fall each year. Falls are the leading cause of injury and death for this at risk group. Seniors who have been hospitalised after a fall, have increased chance of losing their independence. In fact, 40-50% of Seniors hospitalised after a fall, will enter a nursing home. 

Aside from annual eye checks and removing or avoiding environmental hazards, it is important to address balance problems, weak muscles, pain in the back, legs and other parts of the body and difficulty walking. 

Chronic conditions such as arthritis can cause pain for Senior patients and will also affect their walking and balance. It is therefore important to seek treatment that relieves stiffness, joint pain and improves mobility. 

Physical Activity and Exercise Therapy

Physical activity is crucial to keep the body healthy, however due to pain, muscle loss and stiffness, physical activity for the Senior is extremely difficult. Receiving Geriatric Chiropractic care in combination with Exercise Therapy, such as Neurac™ can help alleviate these problems and keep the Senior more active in their daily life. By improving balance, muscle tone and increasing strength, This reduces the risk of further pain and injury and is crucial to preventing falls. 


                                      Image of Neurac

Unsure of which treatment, physical activities and exercises are best for your loved one? 

One of our expert team can recommend a treatment, exercise or physical therapy regimen that works best for you. 

Contact our office today to schedule an appointment.


Monday, January 24, 2022

Sleep and Performance

Sleep is essential to achieve the best state of physical and mental health. Research suggests that sleep plays an essential role in learning, memory, mood and judgement. Sleep affects how you perform when you are awake; both your daily work and your athletic performance.

The amount of time you sleep as well as the quality of your sleep is important. If you are an athlete, it is even more important to regularly get a good night's sleep to allow your body to rest and recover between periods of exercise, as well as to decrease the risk of injury.

How much sleep is enough?

Adequate sleep is vital for your health, but can be hard to achieve when life is busy. Sleeping problems are common with up to 4 in 10 Australian adults not getting enough good quality sleep. Fortunately there are many things you can do to improve your sleep.

Most adults need about 8 hours of sleep per night. Children and Teenagers need more sleep than adults, while older people tend to sleep more lightly and for shorter time span.

What if you don't get enough sleep?

Not getting enough sleep can detrimentally affect your health. As well as impacting concentration and mood, lack of sleep has been linked to serious illnesses such as heart disease, high blood pressure, diabetes and even death.

In the short term, people who don't get adequate sleep, are more likely than others to have motor vehicle accidents and can lead to problems with productivity and safety in the workplace.

Common sleep disorders include insomnia, snoring and sleep apnoea; a breathing abnormality.

Sleep problems can affect your health, performance and safety, so if you are feeling sleep deprived or waking after adequate hours of sleep with fatigue, poor concentration and mood, see one of our expert team for a review of your current state of health and arrange a Sleep Assessment. or 0414570621

Saturday, January 15, 2022

Do our muscles have memory?

If you live in Sydney, cycling is difficult to avoid. But as anyone new to the city can attest, hopping back on a saddle for the first time in years to weave through the narrow busy streets can be a daunting prospect.

Luckily, the old saying holds true: it really is like learning to ride a bike. Many people will have experienced the amazing and long-lasting memory for skills that is often known as "muscle memory".

Muscle memory exists in all kinds of different skills, from sewing, to dancing, to gaming. What is muscle memory? Does it involve changes in structure? What is happening in the brain?

What is Muscle Memory?

Even the simplest of everyday tasks involves a complex sequence of tensing and relaxing many different muscles. 

For most of these actions we have had repeated practice over our lifetime, therefore they can be performed faster, more smoothly and more accurately. 

Over time, with continual practice, actions as complicated as riding a bike, sewing, or even playing a musical instrument, can be performed almost automatically without thought.

We often talk about these skills as being held in muscle memory, but this term is really misleading. Although certain skills, like cycling or perfecting a golf swing, might require the strengthening of certain muscles, the processes that are important for learning and memory of new skills occur mainly in the brain, not in the muscles. 

Changes that occur in the brain during skill learning and memory alter the information that the brain sends out to the muscles, thereby changing the movements that are produced.

Skill learning and memory are clearly quite different from other forms of memory. It is thought that human memory is made up of multiple different systems that can all operate almost independently of each other (Squire, L. R. & Zola, S. M. Structure and function of declarative and non-declarative memory systems. Proc. Natl. Acad. Sci. 93, 13515–13522 (1996).

We can have memories for facts, for example London is the capital of England, but we may not be able to remember when or where we originally learned this fact. Likewise, you might remember having a conversation with a friend, but not remember what the conversation was about. 

This is because "declarative memory"; the memory for facts, is though to be a different system, controlled by different brain mechanisms, than the one used for memory of life events or "episodic memory"

Memory for skills can be thought of as another distinct system. You may be able to ride a bike perfectly, but that doesn’t mean you could explain to someone the exact sequence of movements needed in order to cycle. You may not even remember when or where you learned this skill. 

Studies of patients with amnesia and other memory disorders have demonstrated how these different memory systems can operate separately. 

The findings demonstrate an important aspect of skill memory; that it can be stored without any conscious awareness, and the skilled actions can be performed almost automatically. (Milner, B. Les troubles de la mémoire accompagnant des lésions hippocampiques bilatérales. Physiol. Hippocampe Cent. Natl. Rech. Sci. pp. 257–272 (1962).

It therefore becomes apparent, returning to the Velodrome Track to ride after a 16 year hiatus, that the brain never forgets the skills required to ride a bike and do so smoothly and with precision around the corners and on the banks of the track.

Why is correct spinal motion so vital to this process?

Correct spinal motion, involving the movement of the spinal bones and associated tissues and proper posture, have an influence on the brain and its function, thus affecting overall health.

This is because many brain functions have been linked to movement feedback and the maintenance of our upright posture against gravity.

Increased "body stress signals" such as a strain in the spine while riding, or an injury from falling off the bike, can lead to a range of deleterious effects in the brain, the nervous system and the body, more generally.

Body awareness messages or "Proprioception" can be thought of as an essential nutrient for the brain. It is essential for perceptual awareness and interaction with our environment.

It follows then, that correct, healthy function of the body and joints, will lead to normal nerve system communication, which really means reduced "body stress signals" and increased levels of "body awareness" messages. (Seaman D. R. JMPT 1998; 21(4).

It is for this reason that Chiropractic and Neuromuscular Rehabilitation are so vital to healthy brain function and memory.

Dr Vivienne Brimelow

If you would like further information and learn how Chiropractic and Neuromuscular Rehabilitation can assist you on your health journey, please contast us: or 0414 570 621

Monday, January 10, 2022

Support your back as you jump into 2022

Now that the traditional indulgence over Christmas and New Year has come to an end, many of you may be considering jumping into a new fitness regime to get back in shape. 

But before taking up a new gym membership or getting on the running track just yet, it is important to remember the basics of good spinal health.

Otherwise, you may be putting yourself at risk of injury.

And that’s not how you want to start 2022!

To help our clients start the year on the right foot, we’ve released a new Healthy Spine Checklist that allows you to assess the health of your spine and joints, and identify any possible problems areas.  

For example, if any of the following points sound like you, your spine may need a helping hand to guide it back into shape.

Are you . . .  

  1. Having difficulty turning your head so that your chin makes it to your shoulder
  2. Struggling to bend down so your hands drop below your knees when your legs are straight
  3. Experiencing stiffness in your body and joints when waking up in the morning
  4. Feeling sore or stiff during walking
  5. Having difficulty putting socks and/or shoes on whilst standing

Remember: Your overall level of fitness can be affected by the health of your spine. Getting the basics right first - such as employing a correct posture, walking upright, having good nutrition – will give you the best chance of improving your health in 2022.

If you are suffering from any of the symptoms above, make sure to arrange an appointment with a member of our team.

You can also pop in to the practice anytime to pick up your own copy of the new Healthy Spine Checklist.

Dr Vivienne Brimelow

Thursday, December 16, 2021


CHIROPAEDIC – was formed due to an inherent need for Chiropractors who specialise in Orthopaedics; the specialty that focuses on injuries and diseases of your body’s musculoskeletal system. This complex system, which includes your bones, joints, ligaments, tendons, muscles, and nerves, allows you to move, work, and be active.

At Chiropaedic, we utilize only evidence based treatment and are fully equipped to meet your needs and maximize your neurological and muscular function. Our Chiropractors will work with you to develop a customized treatment plan to manage the physical, emotional, and behavioral changes that you may experience.

We treat patients with a wide variety of conditions and diagnoses including:

  • Brain injury
  • Spinal Cord Injury
  • Parkinson’s Disease
  • Multiple Sclerosis
  • Muscular Dystrophy
  • Neuropathy
  • Other neurological injuries

Neuromuscular rehabilitation consists of evaluation and treatment of conditions related to the neurological system; brain, nerves, and spinal cord. Neuromuscular rehabilitation has been scientifically proven to assist in the faster recovery of neuromuscular injuries than Chiropractic alone.

Commonly used techniques during rehabilitation include stretching, mobility training, gait training, neuromuscular retraining, functional training and pain management. Technology plays an important role in advancement of neurological rehabilitation and we offer the following:

  • Redcord® Neurac; a treatment method that aims to restore functional and pain-free movement patterns through high levels of neuromuscular stimulation
  • Neuromuscular Electrical Stimulation (NMES); is a technique used to elicit a muscle contraction using electrical impulses.

Electrical stimulation has been shown to be an effective therapeutic option for individuals suffering from pain and weakness. Below are some of the benefits clients may experience:

  • Decreased pain
  • Muscle re-education and Strengthening
  • Increased range of motion
  • Increased circulation
  • Decreased spasticity
  • Reduced edema
  • Decreased inflammation
  • Improved overall function

At Chiropaedic your care plans are goal focused. Utilising visual outcome measures we can set a benchmark of your functional ability. We can track your performance during your care so that you can see noticeable improvement in not just how you feel but how you function. We focus on improving your activities of daily living, reducing the risk of injury and therefore improving your long-term quality of life.

To learn more about Chiropaedic, visit our website here:


  • Phone: (02) 9438 2868
  • Shop 3/38-46 Albany St
    St Leonards NSW

Saturday, October 23, 2021


Corporate “Wellness” clinics and franchise arrangements may soon dominate the marketplace for Chiropractic treatments. Aggressive marketing while diminishing the real risks of treatment hallmarks, are the voracious drive to get the punters in the door. 
Once you are in the door, upselling is the name of the game. 

Unhappy with the outcome? Well too bad-you didn’t read the fine print when you signed on? It should be appreciated that these clinics operate to a “set play”, delivered by practitioners trained to a formula. The delivery is fast track with the predictable simplicity of a “one size fits all” formula. 

The clinics are almost exclusively motivated by profit and characterised by an “off the shelf” approach. It may be worth asking who owns the clinic. The answer is more than likely to be a Chiropractic entrepreneur, struck-off from international regulatory boards, replicating the same formula in Australia. 

Targeting the inexperienced, excited apprentice, motivated by the promise of success and financial reward, the formula then replicates and becomes scalable. Like “Fast Food Chains” they may well succeed but the stomach is far more forgiving than the Spine. 

Discerning patients are not seduced by the lure of cheap end entrepreneurs with highly indigestible outcomes.

by Dr Vivienne Brimelow (Chiropractor & Health Writer)