Another Possible Explanation for Chronic Fatigue Syndrome
July 23, 2012
Almost every week, I see young patients that come in who complain of severe fatigue, poor concentration and various aches and pains, despite 10 to 12 hours of sleep. In many cases they’ve undergone extensive testing, and even with sleep studies showing that they don’t have obstructive sleep apnea. However, in many of these patients, I see that their airway is extremely narrowed, leading to frequent obstructions and arousals during deep sleep that prevents them from being able to stay in deep sleep. I suspect that many people with this condition may have upper airway resistance syndrome.
Here’a news piece from the BBC that reports on a study that estimated that about 1 in 100 high school students in England may have chronic fatigue syndrome (CFS), or myalgic encephalomyelitis (ME). What caught my eye was the picture of the teenage girl in the video lower down in the article. Notice that she’s mildly overweight and she has a very recessed jaw. I’m willing to bet that she can’t ever sleep on her back, and she has severe dental crowding and upper airway narrowing from her nose to behind her tongue base. Sleeping on the back causes the tongue to fall back even further, and will often obstruct breathing completely when in deep sleep, due to muscle relaxation. Most people compensate by sleep in on their sides or stomach, but this is usually not good enough.
The vast majority of younger people with this condition will have one or two parents that snore heavily. However, these patients may or may not snore. The reason for this is that when they obstruct, they’ll wake up from deep to light sleep immediately. They won’t go into the intermediate state of snoring, with partial obstruction and vibration of the soft palate. Sleep apnea patients will pause for long periods after having an obstruction, leading to low oxygen levels. Patients with upper airway resistance syndrome will wake up too quickly, never reaching the threshold for an apnea or a hypopnea. This is why on sleep studies, despite not having very many apneas, they’ll have lots of arousals, movements, and sleep fragmentation. This leads to a chronic state of sympathetic nervous system overload, causing you to be overly sensitive to essentially everything.
In my experience, some patients with this condition will have large lingual tonsils (lymphoid tissues behind the tongue base). After surgery, these patients usually will feel much better. However, even surgery won’t cure them completely, since there’s usually some complement of brain dysfunction. This brings up an obvious question: Does sleep-disordered breathing lead to brain dysfunction, or does brain dysfunction lead to sleep-diordered breathing? I answered this partially in my last post about dementia.