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“I Know I Don’t Have Sleep Apnea”

A few times every week, when I bring up the possibility of obstructive sleep apnea, a patient will confidently say to me, "I know I don’t have sleep apnea." Nine out of ten times, a sleep study reveals that the person does have sleep apnea. 

A recent study presented at this year’s annual meeting of the Associated Professional Sleep Societies revealed that of all people who were referred for excessive sleepiness, 54% of normal weight people were found to have obstructive sleep apnea. Of these normal weight people with sleep apnea, 54% were found to have moderate to severe levels. 

I’ve been saying for years that young, thin people who don’t snore can have significant obstructive sleep apnea, but it seems like most doctors and lay people still think that only an overweight, snoring man with a big neck can have sleep apnea. Yes, this is the extreme end of the spectrum, but since sleep apnea is an anatomically small jaw problem, you can have this even when you’re young and thin. Later on, you’ll be more likely to gain weight and fit the classic profile, but only after some of the complications of untreated sleep apnea have set in. 

One major reason for this continued myth is that we continue to have studies showing that heavier people are more likely to have sleep apnea. But this doesn’t mean that all thin people don’t. If you’re chronically tired and you don’t have a satisfactory answer for your fatigue, at least think about sleep apnea.

 

CPAP for Upper Airway Resistance Syndrome?

I recently came across a post on a sleep apnea support forum where a member asked about upper airway resistance syndrome (UARS) and how being on CPAP took care of a variety of his medical problems:

"So many things are better on the CPAP: 

My severe peripheral neuropathy of 5 years is almost gone. 
All the aches and pains are pretty much gone. 
My peripheral edema is gone. 
The age spots on my face are going away. 
I’m not huffing and puffing just doing simple things (like walking my son to his classroom.) 
My night sweats are gone. 
No more getting up to go to the bathroom at night. 
My heat intolerance is resolving -no longer sweat when I blow dry and curl my hair. 
I can exercise again and it’s enjoyable.  I no longer come home and go straight to bed. 
I don’t get so sore after exercise. 
My calf muscles are relaxing.  They used to just stay contracted all the time and I couldn’t get them to relax. 
My morning tremors are gone. 
Haven’t lost any weight, but dropped two pant sizes."

Fortunately, this person tolerated and responded very well to CPAP, whereas most people with UARS can’t stand having anything on their faces due to their hypersensitive nervous systems. Unfortunately, he was given CPAP by mistake before it was approved and the insurance company is refusing to pay for it anymore. Since his AHI was below the cut-off line of 5 for diagnosing obstructive sleep apnea (his was 1.9), officially he didn’t have sleep apnea. But he did stop breathing 8 times every hour on average. This is the dilemma with UARS.

My point here is that if the anatomic sleep-breathing problem is fixed definitively, regardless of the method (CPAP, dental devices or surgery), the patient will feel better. I describe a similar, very dramatic story about a young woman with even worse problems in my book, Sleep, Interrupted.

 

The Real Reason for Chronic Fatigue in Mono?

An ENT with ESP?

Three times this week, people have asked me if I have ESP. If they are in front of me, their eyes open wide and with a scary look and they asked me, “Do you have ESP?” I assured them that I do not. In all three situations, I had just asked these people questions from a list of common symptoms that people with airway resistance syndrome have. Some of these symptoms include: sleeping on their side or stomachs, never waking up refreshed, cold hands or feet, occasional dizziness or lightheadedness, frequent headaches, and a parent that snores heavily. More often than not, the parent that snores also has a complication of untreated obstructive sleep apnea such as hypertension or heart disease.

These list of symptoms are so consistent that I stopped asking if either of their parents snore, or which position they sleep in—their back, side or stomach. Instead, I now ask, which parent snores, or do you sleep on your side or stomach? Sure enough, about 99 % of the time, they’ll answer one or the other. 

Do you have any of the symptoms that I described above?

Tune Up Your Body With Craniosacral Therapy

By Gabriel Bobek, Guest Contributor

Slow down!… Stop running!… LISTEN! Is your body 
saying this to you? Living in a world of deadlines and 
cell phones there’s a good chance it is. This 
time-obsessed age pushes our nervous systems and bodies 
beyond healthy limits and the stress can aggravate or cause 
much illness.  
 
In the expanding field of alternative healthcare, 
CranioSacral Therapy is a modality that is foremost about 
listening. By listening and tuning into the ever present 
craniosacral rhythm, a therapist detects misalignment, 
restriction and/or obstruction and gently accesses the 
body’s internal corrective mechanisms.  
 
A “New” Kind of Body Rhythm 
 
CranioSacral Therapy is grounded in the osteopathic 
principle of the body as an integrated unit marvelously 
designed to heal itself and is based on the tiny ebb and 
flow of cerebrospinal fluid that supports the central 
nervous system. The bony cranial and vertebral cavities 
are lined with a tough waterproof membrane containing this 
glistening clear fluid within which the brain and spinal 
cord are suspended and protected. The small movement of 
the system can be compared to a water balloon that is 
squeezed very gently.  
 
Through rigorous scientific experiment Dr. John Upledger 
proved this rhythmic movement happens continuously just 
like our breathing and heartbeat. This rhythm can be 
detected anywhere on the body and listening to it reveals a 
wealth of information directly.  
 
For example, is the craniosacral rhythm of one leg more 
restricted than the other, and if so, where specifically?  
The rhythm is an accurate indicator of past and present 
conditions and can be accessed to promote freedom, release 
and recovery.  
 
CranioSacral Therapy is holistic, exceptionally gentle and 
safe. Unlike drug or other interventions there are no 
negative side effects.

As a CranioSacral Therapist I am keenly attuned to your 
process throughout the session, listening with my hands and 
helping you to tune into your whole system profoundly. By 
involving you in the process we expand awareness of your 
self-healing potential and engage mechanisms that may have 
been untapped.  
 
 
The Many Facets of Cranio Sacral Therapy 
 
It is fascinating that solutions often come in treating 
areas distant to the problem.  
 
One craniosacral therapy session can boost, rebalance and 
revitalize your nervous and immune system but can also 
treat a broad range of conditions including:  
 
• chronic neck & back pain  
• headaches & migraines  
• TMJ dysfunction  
• stress & tension  
• ear/eye/nerve conditions  
• chronic fatigue/sleep disorders 
• post-traumatic stress  
 
It’s recommended for pre & post surgery and has been shown 
to improve surgical recovery.  
 
As an example, I currently have a client with long standing 
Ménières Disease, a serious ear condition that includes 
ringing in the ears, vertigo and painful debilitating 
migraines. There’s been steady improvement with each 
session but it was upon releasing his sacrum at the other 
end of his spine that the most dramatic improvement 
occured. Since then his migraines and vertigo have stopped 
completely and he’s decreased his medication by half. 
 
 
Relax and Revive 
 
A CranioSacral session is received lying comfortably face 
up on a massage table in regular clothing and tends to be a 
very pleasant and deeply calming experience. Depending on 
the severity and type of condition a course of 3 to 5 
sessions produces results which indicate whether continued 
treatment is recommended.  
 
Newcomers to CranioSacral are often surprised by the 
gentleness of the touch but this is the therapy’s secret.  
By working below the body’s recoil response profound change 
is coaxed from the inside out. The results come in gentle 
waves over time and may be noticed immediately, the next 
morning or even days after a session, subtly yet deeply 
supporting healing and building momentum towards well 
being.  
 
CranioSacral Therapy is an excellent complement to 
traditional Western medicine—enhancing and integrating its 
benefits. It is also a great way to reduce stress and 
recharge our batteries.  
 
Let’s slow down and tune in to the sounds within us – the 
answers are there for those who listen.  
 
* * * 
 
Gabriel Bobek has been practicing CranioSacral Therapy 
since 1995 and is a licensed NY State massage therapist 
with national certification. If you would like to 
experience a session in his spacious sunlit midtown studio, 
mention this article and receive a discounted price of $70 
for an hour session. For further information visit  
www.backboneandwingspan.com and click on CranioSacral, his 
biopage or call him directly at (646)-334-1366. 

No Magic Bullets

I’ve stated before that the vast majority of conditions that patients come to see me for (over 90%) are directly a result of the person’s diet, lifestyle, and stress factors. A broken nose, a foreign body or an abscess are acute conditions that can be treated quickly, but many symptoms that I see such as nasal congestion, chronic sinus complaints, ear fullness, chronic fatigue, throat pain and hoarseness, are all conditions that are aggravated by, if not caused by the person’s lifestyle choices. For most people, when I point this out, are grateful that they don’t have to use a medication, and are willing to make the changes so they can start to feel better. Many of these patients do improve.

But there is a small minority that are adamant that there must be pill they can take to get rid of their throat pain or cough or sinus pressure. They are typically younger, and refuse to give up their social lives, and continue to stay up late, eating and drinking, especially on the weekends. If this were you, you may argue: others seem to get by just fine—why am I the only one with this problem?

My answer is that your anatomy is different. They are perfectly happy sleeping on their backs, and are able to breathe properly, even during deep sleep, when their throat muscles relax. In your case, because of smaller jaw anatomy, your tongue falls back easier when on your back, and whenever you go into deep sleep, your tongue relaxes during deep sleep, which causes obstruction and a vacuum effect is created, sucking up stomach juices into your throat, This causes more throat inflammation and swelling, aggravating this vicious cycle.

This is why it’s important that if you’re susceptible to this condition, you shouldn’t eat late or drink alcohol close to bedtime. This is one mechanism that explains why you can gain weight if you eat late. Inefficient sleep promotes weight gain. In addition, alcohol relaxes your muscles and only aggravates this problem.

How many of you are willing to make the necessary sacrifices to improve your health?

58% of Diabetics Have Obstructive Sleep Apnea

I came across this blog that mentioned that the International Diabetes Federation did a study which showed that 58% of type 2 diabetics have obstructive sleep apnea. Not too surprising, since we’ve known for years that the stress response created by sleep-breathing problems can cause glucose intolerance. This number may be much higher if you take into consideration all diabetics that obstruct 5 to 25 times every hour who wake up after 1-9 seconds each. Since they didn’t reach to 10 second threshold to count as an apnea, their apnea score (AHI) is officially 0. Rest assured, there will be many more of these “links” between obstructive sleep apnea an a myriad of other conditions such as hypertension (many studies already published), stroke (many studies), depression (many published), anxiety (many published), heart disease (many published), headaches (many published), obesity (many published), ADHD (too many to mention), and many other various conditions such as chronic fatigue, IBS, migraines, TMJ, chronic sinusitis, etc. So many associations between all these conditions and obstructive sleep apnea…hmmmmmm….is there a common link?

Knowing about the results of this study, do you think it will sway doctors to at least start screening for obstructive sleep apnea in their diabetic patients?
photo credit: Yogma

Tired of Being Tired?

Upper airway resistance syndrome (UARS) is very common condition that could explain chronic fatigue in many people. In most cases, it goes undiagnosed. It’s been associated with chronic fatigue syndrome, depression, attention deficit disorders, fibromyalgia, cold hands or feet, irritable bowel syndrome, migraines, TMJ, and acid reflux. Hear Dr. Park talk about this newly described syndrome, and how you can possibly begin to wake up more refreshed every morning. http://www.doctorstevenpark.com Media files Click Here to listen! (MP3 Format Sound, 10.9 MB)

Tired of Being Tired — The Upper Airway Resistance Syndrome

Note: This is an edited transcription of a podcast recording 

Today, we are going to spend the next 30 minutes talking about upper airway resistance syndrome, or UARS. It’s a relatively new description of a condition that’s related to obstructive sleep apnea but as you’ll hear in this podcast, has enormous ramifications in regards to so many health conditions that we see, not only in our field, but in almost every other field in general. I have to say, however, that this is a condition that is not yet accepted by the medical community as it is a relatively new diagnosis and much of what I will talk about is based on my own experiences in my practice. If you think you may have this condition, please see your doctor first and get a complete medical evaluation before considering this diagnosis. In my practice, I am amazed at how consistently I see the same pattern over and over again and I am excited to share this new information with you. 

Upper airway resistance syndrome was first described by researchers at Stanford University in 1993. They described a group of young women and men who complained of chronic fatigue and excessive daytime sleepiness. They all also underwent a formal sleep study and all were found not to meet the official criteria for obstructive sleep apnea. However, by treating them as if they had obstructive sleep apnea, most improved significantly. To understand how upper airway resistance syndrome is unique or different from sleep apnea, you have to first understand what obstructive sleep apnea is.   

Obstructive sleep apnea is a well-known sleep related breathing disorder characterized by repetitive breathing cessations during sleep, due to total collapses of the tissues of the throat.  This can happen anywhere from a few times every hour to over 100 times every hour. By definition then, apnea is defined as a total cessation of breathing for 10 seconds or more. And hypopnea is restricted breathing with greater than 30% chest wall movement decrease and blood oxygen drop of more than 4% for 10 seconds or more. A pretty complicated definition! The total combinations of apneas and hypopneas for the entire night divided by the total number of hours one sleeps gives us the apnea/hypopnea index or the AHI. This is the most commonly used measure to diagnose sleep apnea. Untreated, sleep apnea can lead to hypertension, diabetes, obesity, depression, lack of sexual desire, heart disease, heart attack or even stroke.   

Unlike sleep apnea where you have obstruction, apnea, then arousal, UARS patients typically have mostly obstructions and then arousals. As mentioned previously, all UARS patients have some form of fatigue, almost all state that they are “light sleepers,” and almost invariably, they don’t like to sleep on their backs. In some cases, they actually can’t. Some people attribute their poor quality sleep to insomnia, stress or working too much. Due to repetitive arousals at night, especially during the deeper levels of sleep, one is unable to get the required deep, restorative sleep that one needs to feel refreshed in the morning. In most cases, the anatomic reason for this collapse is the tongue. There are many reasons for the tongue to cause obstruction including being too large or being overweight. But once it occurs, the only thing you can do is to wake up.   

In deeper levels of sleep, especially during REM sleep, the normal protective layers of muscle tone that keeps your airway open during inspiration diminishes. So, if your airway is normal to begin with and you take a deep breath in, a vacuum-like pressure is set up and the back of your tongue can fall back completely. In many cases, whenever I examined this narrowed airway with the patient lying flat on his or her back, all I see is a 1-2mm slit between the back of the tongue and the throat.   

When awake, you’re fine, but once you start to fall asleep, the tongue falls back and you wake up, either fully or subconsciously. This is why so many people can’t fall asleep on their backs and therefore, have unconsciously trained themselves to roll over to their side or their stomach where the tongue collapse is less likely, although it can still happen. This can happen 10, 20 or 30 times every hour preventing you from sustaining deep sleep. You may realize that you are waking up sometimes, but the vast majority of arousals are subconscious. If this happens for a few nights in a row and you return to your normal sleep habits, you’re fine. But if it occurs continuously for months or years, then certain events can happen. 

Due to repetitive arousals, your body goes into almost a chronic state of low-grade stress. Think of what would happen if somebody poked you with their finger every few minutes while you tried to sleep for 6 months straight. Think about how you would feel the next morning. Think about how you would feel after months or years of inefficient sleep. You would feel tired, groggy with no motivation to do anything, have focus or concentration problems, or, you could feel depressed.   

Physiologically, these multiple arousals also affect what is called the autonomic nervous system, or the AMS. The AMS is the internal nervous system that regulates your internal body functions such as digestion, breathing, heart rate, blood pressure, etc. It’s divided into two parts: the sympathetic and the parasympathetic parts. When you’re frightened or running away from a bull, your heart rate and blood pressure goes up, your vision and hearing are very sensitive, and all your blood flow and energy are mobilized around a fight. These functions are activated by the sympathetic nervous system. In contrast, after a good meal, your digestive organs kick in and begin to break down your food and you feel sleepy. This is your parasympathetic nervous system working.   

Your autonomic nervous system is in a constant state of relative balance between the two, depending on what you’re doing. Imagine if you’re stressed because you keep waking up at night for years. Your sympathetic nervous system becomes overly activated and stays active even when awake. A number of events can occur. Your hands or feet can become cold or numb, in general, activated by cold temperatures or stress. Some people have to wear mittens or socks all year round. This condition is called Raynaud’s phenomenon. There are many theories as to why people why so many people have this condition but there is no definitive cure. Since you’re under stress, your body thinks that it is under attack and it shunts blood from your peripheries to the more central muscles and to the heart, so that you can run or fight more effectively.  This might actually validate the saying “cold hands, warm heart.”   

Similarly, since you don’t need to digest food when you’re fighting, blood gets shunted away from your entire gastrointestinal system to the heart muscles, leading to chronic diarrhea, constipation, indigestion, acid reflux or bloating. Remember the last time you were stressed?  How well were you able to eat, or digest food if you had just eaten? We already know that stress can aggravate acid production in the stomach. In addition to chronic gastrointestinal problems, many people with UARS also have LPRD, or laryngopharyngeal (throat and voice box) reflux.  It’s somewhat different than GERD, or gastroesophageal reflux disease. In most cases, you won’t feel any heartburn or the classic symptoms associated with GERD.   

The common complaints of LPRD include one or many of the following:  chronic throat clearing, postnasal drip, hoarseness, cough, throat or ear pain, lump in the throat, difficulty swallowing, tightness or pain with swallowing. You don’t have to feel any heartburn, either. Studies have shown that once acid reaches the throat, it can also go into the lungs, causing or aggravating asthma or bronchitis and even into the nose and ears causing more aggravating nasal congestion, sinus or ear infections.   

Pepsin, one of the stomach’s digestive enzymes and even H. pylori, a bacteria that can cause stomach infections have been found in the lungs, ears and the nasal cavity in people with infections. Any degree of swelling or irritation blocking the very narrow ear or sinus openings can cause pressure build-up or infections.   

Another study showed that in about 23% of people with UARS have low-blood pressure, sometimes dangerously low. In addition, these people frequently are dizzy or lightheaded, aggravated by standing up too soon. This is called orthostatic intolerance.  Even if the blood pressure is normal, one may still be prone to episodes of dizziness or lightheadedness.   

Recurring periods of stress may confuse your autonomic nervous system, so it doesn’t respond to the changes in blood flow and head position appropriately or quickly enough. People can also have chronic or recurrent sinus pain or pressure or infections, which can be debilitating.  Frequently, patients are  seen multiple times for recurrent sinus infections, given antibiotics (which only help temporarily), and in many cases, migraines can also masquerade as a sinus headache without the classic symptoms. 

Your nose is also regulated by the two opposing parts of the autonomic nervous system.  Studies have shown that there is an imbalance between the two parts of the ANS in the nose in people with acid reflux or sleep apnea. Thus, many people with either sleep apnea or UARS have chronic runny or stuffy noses with postnasal drip and are prone to sinus headaches or infections.  This process, in addition to the acid exposure described earlier is a very good reason for chronic nasal or sinus problems.   

Classic migraine and tension headaches are also frequent in UARS along with TMJ (temporo-mandibular joint) problems, due to grinding and clenching of the teeth. Sometimes these sinus headaches and pressure problems responded to decongestants and sometimes, anti-migraine medications. One doesn’t have to have the classic, typical migraine headache to have one. A recent study showed that in most cases of self-diagnosed sinus headaches, they were actually migraines.  Regardless of what comes first, the chicken or the egg, one probably aggravates the other, leading to a vicious circle.  TMJ can also give you ear pain, headaches along the side of your head, and it can also wear down your teeth.   

UARS is also associated with depression, anxiety or attention deficit problems. For obvious reasons, sleep deprivation, especially deep sleep deprivation with multiple arousals, can lead to many of these conditions. In addition, if you don’t sleep deeply, it’s been shown that your body produces increased levels of cortisol. And as we all know, cortisol is what makes you gain weight and eat more. It also lowers your immune system’s ability to fight infections and aggravate insulin resistance, leading to diabetes.   

Almost invariably, people with UARS prefer not to sleep on their backs. Many people state that if they try, they choke or wake up as they fall asleep. Over the years, they have trained themselves to sleep on their side or their stomach. Even then, they obstruct and wake up to a certain degree.  Many people also state that they have crazy or vivid dreams or sometimes no dreams at all. This is because when you wake up while you’re dreaming in REM sleep; you’ve remembered your dreams vividly. By definition, all dreams are wild and vivid. Only because you tend to wake up more frequently when you are dreaming, do you remember your dreams more vividly. Some people wake up as they begin to enter the dreaming stage, so they never dream at all.   

Family history is also very important. This is one way that I gauge what the patient might look like in 20-40 years. And in many cases, patients with UARS or sleep apnea have one or more parents that snore severely with one or many of the cardiovascular consequences such as obesity, diabetes, high blood pressure or heart disease. If one parent is noted to have had a heart attack or stroke in their 40’s or 50’s, I take the patient’s condition more seriously.   

The natural course of UARS is highly variable with some patients remaining unchanged for years or decades, where others are slowly progressing into sleep apnea. Some older, overweight women in their 50’s or 60’s with sleep apnea tell me that when they were in their 20’s, they were very thin and had cold hands, low blood pressure, chronic diarrhea, and dizziness, and now they don’t have any of these conditions except that now they have high blood pressure, snoring and severe fatigue.   

What seems to aggravated UARS symptoms most however, is a relative change in their lives.  So a relative weight gain, even 5 or 10 pounds, can aggravate the symptoms which go away once the weight has stabilized and as the body adjust and accommodates to the new weight. A bad cold or infection can also aggravate these symptoms, since it causes swelling, which narrows the upper airway. Pregnancy is another situation where this occurs. 

UARS people who are already living on the edge tend to have more prolonged or severe colds as airway swelling causes more narrowing and anatomic collapse, which further aggravates throat acid reflux, which causes more swelling, perpetuating the vicious cycle. At a certain point, the body can’t adjust and the vicious cycle is self-perpetuating. Poor sleep can also aggravate weight gain for reasons described before, previously. Weight gain narrows the throat even more, causing more obstruction and arousals.  Stress is also a big factor, whether it is emotional, psychological or physical. Whether the stress is internal or external, the body behaves the same way. 

On a personal note, my wife has many features of UARS. She has cold hands and low blood pressure. But after each of her two pregnancies, her UARS symptoms were greatly exaggerated.  After our first son, she had severe postpartum depression for almost a year. Only after she lost her entire pregnancy weight did she feel back to normal. After our second son was born, for four months she was severely lightheaded and dizzy, to the point of not being able to function properly. She saw a number of doctors and even had to go to the Emergency Room because one doctor thought she was having a stroke. The only objective finding was that her low blood pressure, which was low to begin with, was even lower. Only after she lost her entire pregnancy weight, did this condition go away. Sure enough, when I looked at her airway lying down, she had the typical narrowed airway behind the tongue.  Furthermore, her father has known moderate sleep apnea with diabetes. 

So how does one diagnose UARS?  The first step is to undergo a complete ear, nose and throat evaluation. In most cases, the exam is normal. Sometimes what we’ll see is a deviated septum or nasal congestion due to allergies but more commonly what you’ll see is when we look in the mouth, the back of the throat is very narrow and you’ll have a very large tongue that sits very high up, covering up the uvula, the little thing that hangs down in the middle of your throat.   

The next step is to undergo an endoscopic evaluation, meaning that a small, tiny camera is placed through your nose and your airway is visualized. Normally, when you look at the airway, you can see the vocal cords behind your voice box but in people with UARS, the tongue fits further back, so most of the voice box is covered up. Especially if the person lies down, the tongue falls back even more, leaving a 1-2mm slit. When you are awake, you can breathe through this slit.  But as you fall asleep, the muscles relax as you get deeper into sleep. Then, when you reach deeper levels of sleep, or REM sleep (when you’re dreaming), the muscles have to relax completely and that’s when you start to obstruct. Then, once you obstruct, you stop breathing and you get aroused, going to light sleep and the cycle happens over and over again.   

One of the ways that this is treated is using a dental device that pulls the lower jaw forward, which is similar to what you use for snorers and mild sleep apnea patients. So I have the patients thrust their jaw forward and by putting the jaw forward, it also pulls the tongue forward and you can see a vast improvement in the caliber of the airway.   

Based on an extensive series of questionnaires, your physical examination, your past family history and the endoscopic evaluation, you can determine whether or not you need a sleep study. So if you undergo a sleep study and you are found to have sleep apnea, then it is treated like normal sleep apnea. That is a topic for another podcast in itself. But if you don’t officially meet the criteria for sleep apnea—meaning that your apnea/hypopnea index is less than 5 but you do have evidence of multiple arousals, then we can say that you may have UARS.   

You may be wondering, I just gave you a good explanation for UARS, but what can you DO about it?  In general, UARS is treated like sleep apnea. In general, the options are nasal breathing optimization, dental appliances, CPAP, or surgery, as a last resort.  Nasal optimization means if you have any degree of nasal congestion or obstruction, that’s dealt with, whether medically or surgically.  So, for most people, allergies are a very common reason that can be treated properly with medications or avoidance measures or even allergy shots. If you have a deviated septum, then that can be dealt with surgically if the medical options don’t work.  Dental appliances are also useful in people with sleep apnea and snoring in the same way it can be used for UARS patients, as well.  The mechanism is essentially the same: as the tongue starts to fall back—if it only falls back partially, then you create a vacuum effect upstream and the palate starts to collapse and then you get snoring. But in UARS patients, the tongue falls back completely, causing obstruction and more arousals. Some of the problems with a dental device include jaw pain, ear pain, and bite problems due to the nature of this device. 

CPAP, or Continuous Positive Airway Pressure, is actually the gold standard treatment for sleep apnea. In the original article that described UARS, CPAP was used successfully in many of these patients. The way CPAP works is that a small mask is placed tightly over your nose and a small amount of positive air pressure is gently blown in through your nose, stenting your airway open while you are sleeping at night. If you have tried and failed these conservative options, then there are surgical options as well.   

Before we finish this evening’s discussion, let me just bring up an interesting case example which will illustrate my point. I had a patient, a young woman in her 30s, who came to see me with recurrent throat infections and was also found to be extremely tired and had depression, on anti-depressants. She also had severe cold hands and feet, low blood pressure with frequent lightheadedness and dizziness, recurrent sinus infections, migraines and chronic diarrhea. She was severely distraught because her overall health had deteriorated to the point where she couldn’t function normally at her job. A sleep study showed that she had mild sleep apnea, at 14 events every hour. She tried CPAP but couldn’t tolerate the mask. Then, she also refused a dental device because she had TMJ. Finally, after a long discussion we decided to perform sleep apnea surgery with her palate and tongue. 

We did a conservative procedure on her palate, called a uvulopalatal flap, as well as a tongue-based procedure. Six months later on a follow-up sleep study; her apnea/hypopnea index had dropped to .2, which is basically cured. But, more surprisingly, she noted that her cold hands and feet were gone, her diarrhea was much better and even her sinus headaches and migraines were better. On her last doctor’s exam, she noted also that her blood pressure had normalized and she wasn’t lightheaded or dizzy anymore. She was completely off her anti-depressants and reported a “life-changing experience.”   

This woman had classic UARS but because she also met the criteria for sleep apnea, was able to undergo definitive treatment. My guess is that, untreated for many years, she would have gained more weight eventually. Many of her UARS symptoms would have disappeared as the onset of sleep apnea signs and symptoms began to appear.   

One interesting study many years ago looked at UARS and its possible association with the somatic syndromes and these include a wide-ranging list of medical conditions like chronic fatigue syndrome, fibromyalgia, hypothyroidism, irritable bowel syndrome and more. Obviously, not all patients with the above conditions have UARS but based on this paradigm, I think it’s safe to say that a significant number of people with these conditions actually have UARS instead. People with these somatic syndromes all have in common some form of chronic fatigue, as well as an inability to sleep well. Obviously, more study is needed in this area.   

As you can see, UARS can potentially explain many symptoms. Typically, these patients see multiple doctors for various complaints without ever finding complete relief. In the end, some even lose faith in Western or allopathic medicine and look elsewhere in alternative or complimentary forms of treatment. UARS is a treatable condition. The first step is a thorough evaluation by someone who knows what to look for. 

If you want more information about UARS, as well as a more complete picture of why we have so much of these problems and what we can do about it, go to sleepinterrupted.com to take a look at my newly released book, which describes everything in much more detail. 

That’s it for tonight’s podcast.  For more information, please visit doctorstevenpark.com. You can sign up for my email updates and newsletters as well at this address. 

Until next time, good night! 

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