Most doctors don't know about this - Upper airway resistance syndrome (UARS)

Do you snore and feel tired, but you were told that your sleep study is normal (i.e you don't have sleep apnoea)? Then you might have upper airway resistance syndrome (UARS).

Learn about this condition which normally isn't found on simple sleep study tests which are looking for sleep apnoea. The typical patient is young, thin snorer who is tired during the day but has a normal AHI.

Chapters
0:00 Introduction
0:28 What is Upper Airway Resistance Syndrome?
1:47 What are the symptoms of UARS?
2:22 How do you diagnose UARS?
2:34 RERAs Respiratory Effort Related Arousals
3:30 Oesophageal manometry
3:52 Flow Limitation
5:03 Pulse Transit Time
5:20 Respiratory Rate
5:33 Movement during sleep, Helicoptering
6:10 Pulse Variability
6:44 How to treat UARS
7:12 Lingual Tonsils
7:30 CPAP / BiPAP
7:48 Treating positional sleep apnoea / positional UARS
8:15 Slumberbump positional device
9:01 Conclusion

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** Disclaimer - The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional. **

[Daurentius]

Imagine my frustration when I've been experiencing all the hallmark symptoms of UARS for almost 13 years, yes including psychological issues such as anxiety and being overwhelmed by pretty much everything, having done 2 sleep studies at the local hospital that didn't detect anything and yet my symptoms persisted.

A month ago I had enough and decided to contact a private clinic here in the Netherlands for a sleep study through them and guess what? They concluded that I have 27.8 sleep interruptions per HOUR and even before the study the specialist checked my mouth and said that I have abnormalities that pretty much would cause me to start choking in my sleep and that the test would probably not indicate OSA but UARS and she was totally right.

And here I am, after more than 10 years of being told that I am a hypochondriac that is probably having some personal problems that are causing this I finally have found the root cause for ALL my issues and now I am being forwarded back to the hospital to discuss the findings and get a CPAP machine for my respiratory problems.

Whoever is reading this, if you suffer from teeth grinding in your sleep, waking up tired despite sleeping for >8 hours, having Irritable Bowel Syndrome, night time reflux, being anxious for no reason despite having a stable environment, going to the gym every day and being very lean and eating a healthy diet and STILL feeling like utter @#$& then my suggestion to you is to find a clinic in your area that can provide an independent sleep study, sure it will cost you but at least you'll know what is up and you can take the results and go back to the ENT and have them treat you.

[georgewagner]

Ive been going to doctors for 30 years telling them about unrefreshing sleep. Finally a sleep study found uars.

[dollyandsandy]

This is fascinating. I'm freshly diagnosed. It was clear as day by my current sleep doctor. I don't know what the sleep clinic I went to 10 years ago missed it. They knew I had restless leg but it didn't account for all of my wakeups. I woke up an average of once every two minutes during the night back then and they didn't know why. This new sleep doctor had me hooked up with a nose thing, 24 wires, and two lung/abdomen straps, just like you described. I just saw the graph and it was crazy how hard it is for me to breathe.

I've been so tired in my life. I have sometimes gone about my day and literally forgotten the names of coworkers I'd worked with for years. I'm on a wait list for a CPAP machine now because I had another study while using one and it helped tremendously. The difference was night and day. I can hardly wait for my first ever good night's sleep. Just like you described, as a child, I sometimes woke up on my floor, or with my feet where my head used to be, or at a 90 degree angle to where I started. My blankets would be on the floor or wrapped around new like a burrito. I would wake all night, on this side, on that side, on my stomach, on my back, always changing position. Who knew.

[thomasputko]

Oh my gosh... everything, all the pieces just fall into places as you speak... thank you so much doctor.

[nicholastsaclas]

The nose is a very complex organ that is finally getting the attention it deserves. Excellent explanation of this syndrome. Another condition to consider is acid reflux aka LPR or Respiratory Reflux. When the digestive enzyme pepsin makes its way into the laryngopharynx and binds to tissue the nose goes into physiologic defense mode by producing a higher pH mucous secretion as pepsin is completely denatured at a pH of 8. Unfortunately when this is happening the nasal airflow becomes blocked due to mucosal hypertrophy which clearly contributes to resistance.

[RyanWilliams]

Lots of good points here. I particularly like your take on positional therapy and the potential for a confusing mixture of obstructive sleep apnea and UARS at 7:50.

[serglezo]

Concise and precise.

Great explanations!

[proveit]

Seems like UARS is picking up recognition recently. People are waking up to the fact that this serious condition is responsible for an epidemic of mental illness in young people

[MrGeoff]

Thanks for this very interesting information! I really enjoyed listening to this having just had a UARS diagnosis .

[wahabbaig]

You are so intelligent and helpful as always nice mimic of all sounds

[jakec]

btw, as many other commenters have said, these videos are very helpful. thanks a lot . it helps many of us understand what is going on and treatment options and to be a better educated patient and take some control over our health.

[stevemagnuson]

Your concise explanation may have saved my life as my Sleep Dr. hasn’t a clue why I am still experiencing problems 6 years into an OSA diagnosis with excellent CPAP usage for the first 4 years then started having problems with CPAP compliance. I will ask them to address UARS specifically.
Update: just had polysomnography last week. 8.4 AHI, 12.5 RDI, 0 Apnea’s, 45 Hyponias, 20 Reras

[louisequirk]

I was diagnosed with UARS about 7 years ago with mild sleep apnea...been slightly better using cpap but recently feel like im struggling to breathe again through the night and often wake up completely bunged up, I'm also constantly changing sleep position again

[jackslater]

Dr. Veer, Are there any institutions or practitioners in the USA that you would recommend or that have similar methodologies to yourself? I've had poor experiences trying to diagnose my sleep issues and I'm not sure where to go.

[LottieBlix]

I have been struggling for 10+ years with this. I have had 3 Polysomnographies and been diagnosed with OSA but CPAP did nothing for me, plus UPPP, tonsillectomy etc. with no results. Currently trying to fundraise for my MMA surgery because the govt and some doctors still dont recognize UARS

[shaikhtanveerhossain]

Hi, Dr.Veer, Thanks a lot for your comprehensive video on this. You have helped me to answer an important question about my question UARS: Why my RDI/AHI is mild even though I have severe symptoms of sleep apnea. I am a patient with sleep apnea since 2016. Tried all the non-invasive solutions over and over again; no outcome. Gone through 6 surgeries: septoplasty, sinus surgery, UPPP, Giniglossus adv, Tongue radio freq, and Hyoid suspension. First, three helped to reduce 75% of the problem severity but the rest of them made no improvements at all. Still suffering from morning headache, lack of concentration, sleepiness, and all other sleep apnea symptoms (except I do not snore). I wish I could meet you but unfortunately, I am not in the UK. I am currently in Oregon, USA. There are a lot of experienced doctors here too but it is really hard to get a doctor who would believe a patient saying that he/she has sleep apnea because he/she feels choking while sleeping every single night but the PSG can not pick it for an unknown reason. You mentioned the limitations of PSG and DISE in your videos. By the way, I have been through DISEs 3 times also and all of them showed enough blockage to proceed for surgery. Moreover, as things were confusing doctors have tried hundreds of other tests to find "if there is anything else for these symptoms ". But everything came out absolutely perfect. Due to all the issues, I can not do any rigorous thinking work. I completed my master's to start my career as an engineer but everything got paused. I would highly appreciate it If you could give me any suggestions. I wanted to do the esophagus manometry test but it seems it is no more done by doctors in the USA. I would be happy to have a permanent tracheostomy and live with that rather than left out to struggle with UARS every single day. Please let me know if you have any suggestions.

[sabianova]

How can I get diagnosed in California?? My in lab sleep tests shows I have nothing but a Watchpat showed I have UARS.

[NicGiollaMhichil]

Thank you for going to the effort of making these videos, Dr. Veer, you explain these topics very well. Would you have any information about tonsil-stones and why they occur? I would love to learn more about them

[SajidKhan-ktrz]

I'm on CPAP and iNap. Combination therapy improved my oxygen. Not a single drop below 90 but I'm still waking up tired and sleepy during day

[juliehand]

I wish there was more research or help in NZ, I can't use mandibular device, I have arthritis in my neck, cpap was horrible and blew straight into stomach, even dentist makes me panic as I can't breath properly, we have to pay for private treatment as sleep clinic can't help, would dearly love to sleep and wake refreshed, thank you for your videos, so helpful 💕