UARS

The #1 Reason You're So Tired (It's Not What You Think)  

By Melanie Haiken, Caring.com senior editor

Does this sound familiar? You finally manage to get everything done and fall into bed, where it's easy to fall asleep because you're bone-tired. You sleep a reasonable number of hours -- at least it seems as if you do -- but when you wake up, you feel like you hardly slept. Then you drag around all day, feeling fuzzy-headed, grumpy, and longing for a nap.


If this sounds like you or someone close to you, you'll want to know about a little-known breathing problem called Upper Airway Resistance Syndrome (UARS). Unlike sleep apnea, which has been well known for a long time, UARS has only recently been getting attention. The term "resistance" refers to the fact that something is slowing or blocking air in the nasal passages. The most common causes are mild nasal congestion or tongue position during sleep that blocks breathing. Because resistance in the upper airways makes it harder work simply to breathe, your sleep is disrupted throughout the night. According to otolaryngologist Steven Park, UARS is extremely common in older women – one French study found that nearly half of all women with chronic insomnia and daytime fatigue turned out to have this type of sleep-disordered breathing.

Park says he sees many patients with UARS who think they're sleeping poorly due to stress or insomnia, but it’s more complicated than that. He wrote a book about the phenomenon called Sleep Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired. What’s really happening, Park says, is that your body is half-waking up over and over again during the night. Since you’re unable to fall into a deep restorative sleep, you don’t feel refreshed in the morning.

While sleep apnea is much more common in men (only 5 percent of those with apnea are women) UARS affects men and women about equally. Other characteristics common to many people with UARS: having a narrow face, having a small or narrow jaw, and having a thin neck. In fact, if you had to have orthodontia as a child for overcrowded teeth, Park says it’s very likely you could develop UARS. Some people with UARS also have low blood pressure and cold hands and feet. And, says Park, if you have found over the years that you simply cannot sleep on your back (you invariably wake up) it's very likely the reason is UARS.

UARS is so new, not all doctors are familiar with it, and many sleep clinics don’t use techniques capable of identifying these subtle changes in breathing patterns. (UARS may not show up in traditional tests for disordered breathing, which measure oxygen levels.) So if you suspect you have UARS, choose a sleep study lab that's familiar with the disorder and has the equipment to test for pressure changes in your nose or alternations in breathing or pulse wave signals.

Over-the-counter products can be effective at treating UARS, says Park, so this is a great first step. Many people benefit from breathing strips, such as “Breathe Right.”

To see if breathing strips might work for you, try this simple test: Looking in a mirror, press the side of one nostril firmly to close it off. Then close your mouth and try to breathe. If you feel resistance as you inhale through the open nostril, try holding it wider open with your pinky finger or the flat side of a toothpick. Try this on both sides. If you notice that you breathe more easily with your nostril propped open, you're a good candidate for breathing strips.

Some people also find great benefit from the nasal dilator Nozovent, available online. Other steps to try include irrigating the nasal passages with a saline nasal spray and taking a non-sedating allergy medication such as Claritin if you suspect congestion from allergies. You can also ask your doctor for a prescription nasal spray containing itraconazole (Sporanox), xylitol, mupirocin (Bactroban), and dexamethasone.

If these don’t work, the next step is to ask your doctor for a referral to an ear, nose, and throat (ENT) specialist. With the help of an ENT, you’ll have access to a number of treatments, including dental devices and Continuous Positive Airway Pressure (CPAP), a specially designed nasal mask that prevents your nasal passages from collapsing and delivers air directly into your airway.

If the otolaryngologist determines that tongue position during sleep is causing your UARS, she might recommend a dental device that pushes the jaw forward, which also pushes the tongue forward and prevents it from blocking the opening to the throat. If the obstruction is in the nasal passages, then CPAP is likely to work best. There are also minimally invasive surgical techniques available in cases where the obstruction is located in the area of the soft palate.
Getting a good night's sleep is absolutely essential in order to be at your best during the day, so if any of this sounds like it might apply to you, take action. Once you experience what if feels like to sleep deeply again, you'll look back and be thankful you got help.