Upper Airway Resistance Syndrome

airway disorders

When the snoring and resistance through the airway is significant enough to disrupt the quality of sleep, we call this disorder “Upper Airway Resistance Syndrome” or UARS. In patients with UARS, the sleep quality is generally disrupted to the point of causing clinical consequences such as difficulty initiating or maintaining sleep (insomnia), non-refreshing sleep, or excessive daytime sleepiness. Because of the very brief nature of the many arousals triggered by snoring, patients with UARS are typically unaware of these awakenings and generally do not know that they may be snoring if it were not for the witnessed reports from a bed partner or family member.

It is also important to note that not all patients with UARS have audible snoring. Some patients may have an increase in respiratory effort during inhalation or inspiration because of an anatomical limitation to the airway such as from an enlarged tongue base, which may be heard as “heavy breathing” instead of snoring. The increased effort to inhale can lead to EEG (brain wave) arousals and has been referred to in the sleep medicine field as “respiratory effort-related arousals” (RERAs). For this reason, an absence of snoring does not imply an absence of obstructive breathing in sleep. Such individuals, however, may have other symptoms such as a dry mouth upon awakening, morning headaches, symptoms of insomnia or daytime sleepiness.

We now believe that UARS represents a progression of disease bridging the transition from “benign snoring” to obstructive sleep apnea. Patients simply do not go to bed normal one night, only to awaken the next morning with obstructive sleep apnea. Instead, they typically go through natural progression over time or following weight gain from “benign snoring”, to UARS, and finally to obstructive sleep apnea. This progression may take years or decades to occur.

An important reason to treat UARS is to allow the patient to obtain a better quality of sleep. Opening the airway or decreasing the upper airway resistance can reduce the number of awakenings or arousals during sleep. This not only improves the ability to initiate and maintain sleep, but leads to increased sleep quality and daytime alertness.

Consequences of Upper Airway Resistance Syndrome

Often mistaken for other health conditions, many people with UARS are unaware of their condition. UARS is referred to as the forgotten child of sleep medicine since more focus is placed on obstructive sleep apnea.

Upper Airway Resistance Syndrome commonly contributes to:

A condition that causes continued and severe tiredness, not relieved by rest, and is not caused by another health problem.

Intense headaches that affect millions may inflict symptoms, including light sensitivity, nausea, or vomiting.

Depression provokes feelings of sadness, unhappy, miserable, or blue. Children exhibit symptoms of hyperactivity or are cranky and act out. They can be disruptive in school and at home. Adults that suffer from inadequate sleep may be easily prone to developing depression. Unfortunately, mental health professionals hardly ever evaluate patients for sleep-breathing or airway disorders. 

Diagnosing UARS can be difficult. It takes someone specially trained to pick up on the subtleties of the disorder. Through a detailed interview, clinical examination, radiologic examination, and High-Resolution Pulse Oximeter to help identify if a patient is suffering from UARS and/or SDB (sleep-disordered breathing) or OSA (obstructive sleep apnea), our doctors create a more collaborative contribution with other health care providers to treat these patients successfully. This integrative approach to treatment utilizes ENTs, Myofunctional Therapists, Sleep MDs., Breathing Retraining Specialists, Airway Orthodontists, and Pediatric Specialists.

Upper Airway Resistance Syndrome vs. Obstructive Sleep Apnea

UARS and sleep apnea both cause insufficient airflow while sleeping. There are crucial differences between the two and the problems they cause. Chronic insomnia including waking frequently with the inability to fall back asleep is usually is more common among patients with UARS than with sleep apnea.

  • Sleep apnea sufferers are more likely to fall asleep easily during the day, for example, when driving. However, patients with UARS are likely to experience fatigue rather than sleepiness.
  • Sleep apnea patients tend to struggle with weight gain or are overweight. However, UARS sufferers may be any weight.
  • About 9 percent of sleep apnea sufferers are female, while about half of those with UARS are women.
  • UARS patients usually suffer from spastic colon, low blood pressure, and lightheadedness upon standing while sleep apnea is often associated with high blood pressure. UARS patients can also present with other health issues such as cold extremities, hypothyroidism, and fibromyalgia.

Our approach to structure, function and behavior treatment can help to eliminate and/or manage UARS. To learn more or to schedule an appointment, please contact About Face Collaborative by calling (804) 387-7002.