Facts About Carpal Tunnel Syndrome and Sleep

            Have you ever woken up at night with numbness and tingling in your fingers and had to climb out of bed and shake your hands, flick your fingers, and/or rub your arms to “…wake them up?” Well, you’re not alone! In fact, this is one of the more common and often one of the FIRST symptoms of Carpal Tunnel Syndrome (CTS). So, WHY does this happen?

            The “carpal tunnel” is literally just a tunnel that MANY components of the body travel through on the way to the hand. The walls are made from eight small “carpal” bones and the “floor” of the tunnel is made by the transverse carpal ligament. These structures vary in size and shape and differ between males and females, which may be one reason CTS is more common among women than men. The contents of the tunnel include eight tendons that connect the muscles in the forearm to the index, third, ring, and pinky fingers. A ninth tendon that connects to the muscle that flexes the thumb also travels through the tunnel along with blood vessels. Perhaps most importantly, the median nerve that supplies sensation and strength to the palm side fingers (index, third and ring fingers) and the palm of the hand also travels through the carpal tunnel. The tendons to the fingers and thumb are “sheathed” and can swell due to the friction created by the tendon rapidly moving in the tight sheath. This is one reason why people who work in an occupation that requires fast, repetitive hand movements (such as assembly line work, carpentry, food preparation, for example) will often have problems with carpal tunnel syndrome.

            The pressure inside the wrist normally doubles when it is fully bent either forwards or backwards. However, because there is already greater pressure in the affected carpal tunnel of individuals with CTS (due to swollen tendons, for example), the pressure inside the carpal tunnel can increase much more when the wrist is bent. This added pressure can exacerbate the symptoms normally associated with CTS -- including numbness and tingling in the hands and fingers -- especially when the wrist is bent for a prolonged period of time, such as during sleep.

            Treatment associated with carpal tunnel syndrome includes the use of a night wrist cock-up splint, which keeps the wrist from flexing or extending during sleep and helps the swelling inside the carpal tunnel abate. Cock-up splints are not typically worn during the day, as they tend to interfere too much with normal activity and may actually worsen the condition depending on the length of time and the type of work the person is performing. Driving will often increase symptoms, and use of the cock-up splint can be effective during this time.

            Chiropractic management offers a unique form of treatment called manipulation and mobilization that is applied to the fingers, hand, wrist, forearm, and any other area where nerve compression might be present, which frequently includes the cervical spine/neck region. The shoulder and elbow may also require care.

            Anti-inflammatory measures including ice massage over the wrist and anti-inflammatory herbal preparations such as ginger, turmeric, and/or digestive enzymes taken between meals can help. Modifying the ergonomics of a CTS patient's workstation is a good idea in order to reduce the repetitive strain commonly associated with chronic carpal tunnel syndrome.