Learning with laughter

Do you or your patients suffer from UARS? (Upper Airway Resistance Syndrome)

June 27th, 2011

Have you ever heard the words “Come back in 2 weeks and see me if you still have the symptoms.”

CR July11-1 self helpIf a patient comes into a doctor’s office with excessive daytime sleepiness, depression, and excessive fatigue! Cognitive impairment, un-refreshing sleep, frequent awakenings, and chronic pain, this could be many things. Symptoms are often treated with medication.

“However, medications may have side effects!”

Often, after a serious disease has been eliminated as to cause of those symptoms, oxygen intake and excessive CO2 build up in blood stream could be considered as part or source of a problem.

IfCR July11-3 Cartoon you suffer from the above symptoms, ask your health care professional to send you for investigations to evaluate sleep disordered breathing, and intake & absorption of Oxygen

Last month I wrote about Sleep Apnea. This month I ask you to think about “Are you or loved ones breathing properly? Has it become another job on your “to do” list? Clinically I see the results of poor breathing habits daily… Make time to breathe! This cartoon says it all.

You may suffer from UARS, “Upper Airway Resistance Syndrome” which is a sleep disorder characterized by airway resistance to breathing during sleep.

Read more on Wikipedia for difficulty doctors have to confirm diagnosis, explanation & treatment. Alternatively, I have full information on my blog.

Over time poor breathing habits can lead to symptoms of UARS which show up as low blood pressure/ Hypotension, excessive daytime sleepiness, depression, snoring and excessive fatigue! Also maybe present are, cognitive impairment, un-refreshing sleep, frequent awakenings, and chronic pain. As this mimics other dis-eases in the body, UARS is often misdiagnosed as Fibromyalgia or similar disorders.[2] Guilleminault et al. write that up to 75% of adult patients with sleepwalking have UARS.

CR July11-4 TwinkleQuick test to feel effects of poor prolonged breathing can be felt when trying to breathe through a regular/or coffee straw with tissue in both nostrils and walking up a flight of stairs. Please only try this if no previous medical condition. One starts to feel chest tightness, light headedness, unable to focus. A patient tried this. Only then did he understand that poor breathing could be affecting his heart and blood pressure as well as mind.

At a recent lecture given by a dentist, Dr Steve Olmos, I realized that many of my patients may suffer from sleep apnea or Upper airway resistance syndrome.

One of the problems with criteria for sleep apnea is that if you stop breathing for 9 seconds at a time, and you stop breathing 50 times every hour, then officially you won’t have the diagnosis of sleep apnea and then you get into the realm of UARS which is not widely known about.

(There is question in the medical community as to not only the existence of this syndrome, but whether it should be classified as a separate syndrome or part of the larger group Sleep-disordered Breathing (SDB). This unfortunately has led to a poor understanding of the illness by the medical community at large).

Diagnosis
It is difficult to confirm diagnosis, as few sleep testing centers have the proper test equipment to recognize the illness.

Treatment
CR July11-5Rule-babyThere are a number of conservative measures that are recommended to treat UARS, Learn from kids. They sleep more, take work seriously but selves lightly, play often and live in moment.

Seriously, treatment of snoring and sleep apnea includes weight loss, positional therapy. In theory this is fine except, it’s hard to lose weight because you’re so tired and it’s hard to exercise!

In terms of trying to sleep on your side or on your back, you only have so much control over that when you’re sleeping.

One note about snoring treatments: over-the-counter snoring treatments have been found to work sometimes in a recent controlled study, which looked at three popular snore aids, including a nasodilator strip, an oral lubricant and a pillow. All were found objectively not to have any significant benefit. However, I have many patients who swear by these over-the-counter snore aids, but in my experience, it only works with some people.

CR July11-6 Dog-BabyIf you’re found to have obstructive sleep apnea, the best way to treat this condition is via what’s called a Continuous Positive Airway Pressure machine, or CPAP. This is a small device that acts as an air pump which blows some positive gentle air pressure through your nose and it stents your airway open so you don’t stop breathing at night. When used effectively, it works. You wake up feeling much more refreshed; have much more energy and all the medical problems start to get better. One of the problems with CPAP, however, is that people just don’t like to use it, but with good counselling and proper follow-up from clinic staff and the equipment people that administer the device, many people can do well with this device.

However, there are certain people who just can’t use CPAP for other reasons despite trying different kinds of masks, headgear and devices. These people end up going to different devices, one of which is a mandibular advancement device, which are oral appliances that dentists make. They make an impression of your teeth and the bottom part, the mandible. The jaw bone slowly is pushed forward.  The way this works is that it pulls the tongue forward, which is one of the reasons for sleep apnea, amongst many other reasons. Again, when applied properly and when patients use it, this device does work especially for snoring and for mild to moderate sleep apnea.  As with medication side effects can be horrible. Therefore compliance is a problem due to jaw pain, dry mouth, ear pain, headaches, and bite problems. In summary “Just Breathe, it makes life worth living!”

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