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Sleep Apnea and UARS (Upper Airway Resistance Syndrome)

 
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Sleep Apnea and UARS (Upper Airway Resistance Syndrome)
by brian harrington - Tuesday, 29 August 2017, 9:10 PM
 

Hello Dr. Schubiner,

I want to thank you again for your graciousness and service to so many. There are scores of physicians out there whose ambition is clearly to make as much money as possible off of those who are suffering, whereas you are the true embodiment of a physician and the Hippocratic oath so many flaunt.

I am writing to ask you about sleep apnea and UARS (upper airway resistance syndrome). While I for the most part have been following Dr. Sarno's advice to "think psychologically, not physically", I am seeing a sleep specialist right now who points out that unhealthy practices such as orthodontics, lack of breast-feeding, mouth-breathing, and poor diet in the West have led to severe anatomical changes in people's upper respiratory apparatus (ie., severe dental crowding, small mouth/chin in relation to oversized tongue which collapses into the airway during sleep, general obesity etc.). I recently had a procedure to correct a severely deviated septum (I can now breath through my left nostril for the first time in years), trim my nasal turbinates, stiffen my nostrils, and - not least - had a sleep endoscopy performed. The endoscopy revealed severe blockages through tongue collapse, soft pallet collapse, and uvula collapse. I was able to view some of this later on camera, and noticed a very small airway behind the tongue. Basically what seems to be happening in my case is that when I start to go into deeper stages of sleep, my body is tired but my brain goes into "high alert" and I awaken 8-10-12-15 times over a 7-8 hr period, never getting restorative sleep.

The sum total of this problem (labeled UARS) is that I am unable to enter into stage 3 sleep and have not for about 4 years. The recommended solutions in order are CPAP, a custom fitted oral appliance designed to move the jaw forward (thus opening the airway), or - most seriously - maxo-mandibular surgery, wherein the upper and lower jaws are moved forward (the estimated success rate for that is very high). The doctor does NOT perform that surgery himself such that I have reason to believe he is not simply offering a surgical option to benefit himself.

My question to you is whether you would consider certain cases of sleep disturbance like this to be anatomical and not inherently a form of TMS/MBS, and whether you have had patients, friends or colleagues overcome sleep disturbances of this nature.

Unfortunately, my former sleep doctor was largely clueless about UARS (only looking for "sleep apnea" which is detected differently) and prescribed 1mg of Klonopin and 30 mg of Remeron to help me sleep. I have been on these for almost 3 years, and yet all the while, it would seem this was not strictly speaking a "brain" problem, but an upper airway blockage problem.

It is very hard to press on toward healing when one is presented with 2-3-4 different diagnoses, as I have been. Thank you for any insight you might have here, and thank you again for all that you do for patients.

Blessings,

Brian

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Re: Sleep Apnea and UARS (Upper Airway Resistance Syndrome)
by Supriya Jadhav - Wednesday, 30 August 2017, 4:31 AM
 

Hi Brian. 

You didn't mention what your symptoms are which made you think of URAS. I was diagnosed with exactly the same thing. Bad orthodontics then narrow upper jaw. I went into splint treatment for almost 2 yrs. Splint treatment was suppose to correct my bite and keep my lower jaw forward so that at night I can breath. My symptoms were head face pain. I also underwent DNS surgery like you but the pain persisted. Loads of myofuntional exercises,  tapping the mouth etc. Finally I left it all and started reading about Tms. now I don't have the initial pain to that intensity to start with but have symptom imperative.  Like pain in heel and frequent urination. So don't overthink much about it.. You have been breathing and sleeping exactly the same way for last so many years without symptoms. It's not physical.. It's emotional.

Regards,

Supriya 

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Re: Sleep Apnea and UARS (Upper Airway Resistance Syndrome)
by brian harrington - Wednesday, 30 August 2017, 3:32 PM
 

Hi Supriya - The symptoms would be repeated arousals at night (not due to cognitions or worries), right at the cusp of entering deeper stages of sleep. This leads to significant brain fog in the day, fatigue during the day, a "tired/wired" feeling, and as if both the parasympathetic and sympathetic nervous system are both on at the same time. I am sleeping "but not sleeping". Also with this has come an absence of drive, in several areas. My emotional affect has taken a heavy hit as well. 

This led another doctor to have me tested for HGH levels, HGH being produced only in stages 3-4 of sleep. My HGH levels were on the low end of the range. 

The sleep endoscopy, wherein a camera is run through the nose/back of throat to check for obstructions, revealed multiple obstructions to my upper airway Similarly, after the study, the doctor showed me what was a miniscule space between my tongue and airway (made significantly worse when sleeping on my back) and it was clear that there was significant anatomical obstruction. 

This sleep issue has gone on more acutely for the last 5 years, but has been hanging around for 15 yrs, not tied to a traumatic event, or other obvious factors. 

The fact that many have seen this problem solved with CPAP lends creedence to the notion that there is a real physical obstruction occurring. Obviously, not every patient is the same, and while I have great conviction in TMS/MBS (studying it has basically cured my back pain), I think this is something that may fall outside that diagnosis for some of the reasons I mentioned. 

Best, 

Brian

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Re: Sleep Apnea and UARS (Upper Airway Resistance Syndrome)
by Howard Schubiner - Friday, 1 September 2017, 3:18 AM
 

Hi Brian.

I would think that airway obstruction is just that; and not TMS. You need a good night's sleep and using the methods suggested make sense to me, in order to get that restorative sleep.

Does that help?

Best, Howard

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Re: Sleep Apnea and UARS (Upper Airway Resistance Syndrome)
by brian harrington - Thursday, 7 September 2017, 4:14 PM
 

Thank you, Dr. Schubiner. Where I still remain a bit perplexed is that the explanation given by my Sleep Doctor is that the literally tens of millions of people in the USA who have slightly developed chins, dental crowding due to braces or having teeth removed, narrow arches, tongue and soft palet collapse - these are all anatomical problems which necessitate either CPAP or surgery. But what happens to some of these same people when inescapable stressors are removed (ie., they go away to a warm climate for 2 weeks and sleep like rocks). Could the "it's anatomical" argument re sleep be another form of what Dr Sarno and Dr Ron Ruden have called "physicalism". 

Are CPAP and surgery then treating symptoms vs removing causes, and could a symptom resurface elsewhere if CPAP became the "solution" to poor sleep. 

Thank you again for all the work you do!

Sincerely

Brian

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Re: Sleep Apnea and UARS (Upper Airway Resistance Syndrome)
by Howard Schubiner - Friday, 8 September 2017, 3:11 AM
 

Hey Brian.

I think we have to look at it as not only one thing or the other. There is a relationship between the anatomical stuff and the mental stuff. Some people have severe anatomical abnormalities and will need CPAP or surgery, no matter what is going on in their minds. 

Other people will not get apnea no matter how much mental issues are going on, as their airways are quite clear. Of course, they can get other manifestations of TMS/MBS.

Some are in the middle.

Does that make sense?

Best, Howard