Found this while searching microarousals

[Mark Douglas]

Ben .

Daniel Pardi is correct . Get a sleep trudy done but make sure that the sleep clinic you choose is able to manually measure the RERAS ( respiratory effort related arousals ) to diagnose UARS ( upper airways resistance syndrome ) . If they only measure the apneas and hypopneas – AHI index , they may miss the UARS diagnosis .

For more information on this syndrome there is a great book Sleep Interrupted by an ENT dr Steven Parker . He interviews many experts on this subject including Dr Christian Guilleminault who first identified this syndrome in 1993 . Check it out on his website (removed link just in case)or search for this on the Podcast app .

The following is from a flyer on UARS that I prepared and hand out to my patients : A lot of my information was supplied from a paper written on UARS by Dr Clyde Keevy.

Hope this helps
Dr Maureen Allem

UARS is classified under Obstructive Sleep apnea OSA and is a Sleep Breathing Disorder SBD that is associated with numerous FSS Functional Somatic syndromes and Anxiety disorders .

Symptoms of UARS can overlap with OSA . UARS patients are more likely to complain of daytime fatigue rather than sleepiness.

UARS is a form of sleep disordered breathing associated with fragmentation of sleep and is associated with inspiratory flow limitation whilst breathing during sleep . This inspiratory airflow limitation does not drop the oxygen saturation as per OSA .

Chronic insomnias are more common with UARS . These patients find it difficult to fall asleep (Sleep onset) and then find it difficult to stay asleep ( sleep maintainance ) These patients have nocturnal awakenings and find it difficult to return to sleep .
Studies report that Chronic insomnia is more prevalent with UARS than OSA

50% of UARS have cold hands and feet especially in childhood
30 % have light headedness when standing up or bending over abruptly due to parasympathetic over activity
UARS patients have more sleep disturbance than OSA patients
UARS patients have more sleep fragmentation that causes daytime sleepiness/ fatigue

What initiates the UARS ? Any Physical or emotional trauma can sensitize the limbic system which modulates emotions .The limbic system then activates the HPA axis .
The physical trauma can be a Motor vehicle accident , physical abuse, assault , home invasion , hijackings, rape , attempted rape etc . The initial trauma can also be emotional abuse . These traumas activate the HPA axis and sensitize the limbic system thereby altering the brain response to external or internal stimuli .
This activation can also lead to the Functional Somatic Syndromes FSS

Patients with UARS have usually consulted numerous doctors who are not able to diagnose the condition as they are unaware of this newly documented condition . These doctors have not manage to improve their patients symptoms of anxiety , depression, insomnia, ADHD and these FSS disorders .

Antidepressants are usually prescribed to alleviate symptoms but the underlying cause goes undiagnosed until a sleep study is ordered by a doctor who is aware of this new sleep disordered breathing called UARS . The sleep study is usually a last resort .
Once diagnosed, UARS is better treated with a mandibular advancement device which opens the airway and up improves these FSS symptoms .

The sleep study must measure RERAS ( respiratory effort related arousals ) manually . Automated computer analysis of polysonograms PMG do not measure RERAs and are unable to diagnose the sleep disordered breathing of UARS .
PSG have to be manually analyzed to diagnose this condition

What are the Main FSS symptoms ?
Body pain , headaches , insomnias and irritable bowels

What are the main anxiety disorders that UARS is associated with ?
Anxiety, depression, Bipolar , ADHD and Insomnia

Other FSS syndromes that doctors must be aware of that are associated with UARS are:
Insomnia
Chronic fatigue syndrome
IBS
Restless leg syndrome
Gastrointestinal Hyper mobility / Hypomobility
Joint hyper mobility syndrome
Mitral valve prolapse syndrome
Fibromyalgia
TMJ syndrome
Sick house syndrome / multiple chemical sensitivity syndrome
Gulf war illness
Tension headaches / migraines
Problems of concentration and memory
Hyper somnolence / sleepiness
Daytime fatigue

Improvement of sleep disordered breathing with a mandibular advancement device improves symptoms . However one must Identify and manage the the initial trauma that activated the limbic system and HPA axis . There will be little success if the patient continues to suffer emotional/ physical stress

[storywizard]

Nice article...

Barry Krakow also describes this in his book...
very hard to convince sleep docs/sleep clinics to test for it..

thanks for posting Mark...

Storywizard

[cate1898]

Interesting! Wonder if this is something that sleep analysis will delve into in more detail as the field of sleep medicine evolves? It's only recently that I have heard of people I know talking about this, which is in part how I came to self-diagnose before speaking to my GP.

[Ghost1958]

Why would only a mandular device treat it when a cpap wouldnt? Both open the airway only cpap does a better job.

[49er]

Nice article...

Barry Krakow also describes this in his book...
very hard to convince sleep docs/sleep clinics to test for it..

thanks for posting Mark...

Storywizard

Not only is it hard to get sleep docs/sleep clinics to test for it, when most sleep docs look at your data during an office visit, they will completely minimize this issue. As long as the AHI looks great, that is all they care about.

[cate1898]

You are right. My sleep doc is wanting to see my results and he mentioned that AHI is what he looks at. RT at DME confirmed that that is the only number he will want.

[49er]

You are right. My sleep doc is wanting to see my results and he mentioned that AHI is what he looks at. RT at DME confirmed that that is the only number he will want.

When I had a sleep study with my former sleep doctor, my apnea was mild but the scored RERAS put me in the mid moderate range. No matter how many times I corrected her, she kept referring to my situation as mild.

When I had an updated on a few months ago as I wanted to see where things stood after my septoplasty, all my sleep breathing events were scored as hypopneas/apneas with just about the same moderate score as the the last sleep study had with the combination of RERAS and apneas/hypopneas.

But interestingly, 60 arousals were reported which I asked my sleep doc about and unfortunately, didn't really understand the explanation for. I am just wondering if some of those were unaccounted for RERAS.

49er

[49er]

Why would only a mandular device treat it when a cpap wouldnt? Both open the airway only cpap does a better job.

I think the reasoning of the doctor is which I don't necessarily agree with is due to people with UARS being extremely hypersensitive which leads worsened sleep on the machine, they might do better with a dental device, particularly if they have mild to moderate apnea. A 2011 study I posted previously on this forum showed that for mild to moderate ranges, adjustable appliances generally have about a 60 to 75% chance of getting the apnea below 5. The more mild the apnea is, the better the chances are of success.

The reason I disagree is many folks who are hypersensitive might not like trying to sleep with something in their mouth. Dr. Park wrote about a patient with mild apnea/UARs who couldn't tolerate either treatment and ended up having surgery which cured her condition.

49er

[drtrech]

What I read in the OP sounds amazingly like what my wife is experiencing, right down to the emotional/physical trauma and the fatigue vs sleepiness issues. Does a PSG contain the needed information, such that we could consult with a different doctor to evaluate for RERAS manually? Or would another sleep study be required?

Her ahi was in the "mild" category, while her FSS symptoms are nearly disabling. There has been some improvement with Cpap therapy (she says 10-20%), but nowhere near true relief. Time to look further, and this direction looks promising.

[wishicansleep]

I wonder if there any other "disorders" that are not found! My doctor just looked at AHI (19 based on one hour sleep in sleep study) and typically average 1 AHI with CPAP on (Icon macine). I get to sleep quick enough but cannot stay asleep in the middle of the night. The CPAP definitely improves the reduction in snoring and non-breathing events (my wife says) but the continual leaking from the mask is just as bad (my wife says) leading to interrupted sleep and feeling no better. Awaiting my new Respironics Auto machine and see if there is a difference. Will try a larger nasal pillow to see if I get a lower leak. Some nights leak stable 20-30 sometimes upto 50. What concerns me is my mother suffers from Sleep Deprived Psychosis and if I cannot sleep well I may be going the same way.........