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.
@@orgonitehealingnl4431 Ik zou het niet aanraden omdat ik er nu achter ben gekomen dat mijn neuroloog het onderzoek niet erkent en de resultaten dikwijls ondermijnt. Het beste wat je kunt doen is toch echt een onderzoek via het ziekenhuis, als jij zoals in mijn geval het idee hebt dat het onderzoek niet goed was gegaan en daardoor zware twijfels hebt aan de conclusie dan heb je het recht op een second opinion en dan zou ik je aanraden bij de tweede specialist aan te geven waarom jij twijfels hebt over het eerste onderzoek en luid en duidelijk aangeven dat jij alleen genoegen neemt met een tweede slaaponderzoek. Dit heb ik zelf ook gedaan en nu moet ik wachten voor een vervolgonderzoek, gewoon geen genoegen nemen met die onzin van de artsen van tegenwoordig die alles afschuiven op stress en psychologische oorzaken.
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.
Please excuse all of the typos -- I'm not great writing from my phone. I forgot to mention all the mental health issues I've had, and who knows if that would have happened I'd been able to sleep! And my stamina compared to others my age has always been just atrocious. P.S. I also clench my jaw like crazy all night. And I've been diagnosed with "vocal cord disorder".
If it makes you feel any better, even when diagnosed, there's not much you can do beside wear a cpap, or get quite intensive facial plastic surgery. I can't sleep with a sleep with a cpap, and the surgery didn't work. So, I'm basically fucked.
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.
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.
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.
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
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
@@cebruthius I started having problems with CPAP compliance 2 years ago, after 4 years of excellent compliance. I lost 45 lbs during that time and it changed everything. AHI was 64.5 on first PS. Now AHI is 8.4 but have 20 RERAs on my last test. DISE scheduled for next week.
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.
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
that's a great question, and a good video idea. I will add that to the list. basically it's pus that has been around too long and become hard. They are caused by chronic infection.
@@VikVeerENTSurgeon Thanks for your response! I look forward seeing it, Otorhinolaryngology is so interesting :) I have always wondered if there's any correlation between tonsil-stones, permanently enlarged tonsils and eustachian tube dysfunction or otitis media.
tonsil stones and large tonsils - yes definitely there is a link. Inflamed tonsils and Eustachian tube - I think so yes, but i'm not sure about the evidence on this. Eustachian tube and Otitis media - definitely Hope that helps
As always,great videos with so many details.I do have a moderate sleep apnea,unable to use any device.Now with constant swallowing problems , I always check your videos in a search for help...Thanks
Very informative video! Very glad you are spreading awareness of what can be a debilitating syndrome. I have a question though, would an WatchPat be a useful screening tool for further NHS testing? I am exactly the fit of the typical UARS case so this will prove very helpful. THANKS!
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.
I'm so sorry you are having a tough time, and it does sound like your doctors are trying very hard. Very hard for me to give advice on a complex case without doing all the background work. Sounds like you need to have a close look at your own sleep study and puzzle it out for yourself. I am putting together a video on how to read your own sleep study, that might help?
@@VikVeerENTSurgeon Thanks a lot for replying. Sure I will watch the video and all information is helpful. A quick question: As you mentioned PSG has some limitations to detect UARS what would be the preferable test to detect it. I wanted to do the Esophagus manometry but my doctor said even though it is helpful to detect some parameters correctly but it makes the sleep disturbed and so we lose other parameters. So he stopped doing it 5 years ago. Another thing maybe a Natural sleep endoscopy as you mentioned DISE is a debatable issue. But I do not think anybody does a natural sleep endoscopy anymore.
Its just too expensive to do Natural Sleep Endoscopy, no one will do it anymore. If someone is able to fall asleep whenever they want, I'm happy to try. There is a chap in Egypt who does this as well (he talked me into it in the first place), Prof Baghat.
Hi @@JustinRM20. Thanks for your reply. Are you talking about Maxilo-mandibular advancement surgery? I got evaluated for that too. Unfortunately, my lower jaw is already in a 3rd-degree advanced position which limits the highest possible advancement to 3-4 mm. Still, some doctors are in favor of this. However, it is a very invasive surgery and my jaw will be weakened forever, the face will be changed drastically. At this stage after so many surgeries, I do not want to go for another surgery that may not completely solve the issue. I am rather inclined to have a permanent tubeless tracheostomy. As I have read about it: It is a less invasive surgery from a surgery perspective. Theoretically, it should be able to solve the issue completely. The main challenge is post-surgery management. As it will be only for sleep apnea so I can keep it completely closed with adhesive tape in the daytime and avoid all the troubles. At night I can add a filter to be safe. My works are a 100% desk job so it should not bother me much. And it is reversible, so after 5-10 years, if a sleep apnea solution is discovered which works for me, I can reverse it easily. The problem is, I need a doctor who would proceed with this surgery.
No idea, the evidence isn't out there yet. On the other hand there are no real risks for giving it a go, and we are learning every day what works and what doesn't.
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 💕
Thank you. I've have congested sinuses for as long as I can remember. My nose sinus congestion, in turn, seems to have effected my uvula, causing it to swell/lengthen do to constraint strain in breathing. I'm just now figuring this out after years, and having seen a number of doctors.
Hey. I've been suffering from sleep bruxism for years now and I started to suspect that it might be related to breathing. When I clench my teeth together I can definitely breathe a lot better, so I suspect I am doing this subconsiously during the night to improve airflow. Is it even possible to detect UARS in that case?
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
how does the Watchpat show you have UARS? I had a Watchpat study done but the doctor only gave me a summary of AHI and O2 level. Wonder if there's info I'm missing
@@estyzesty I just had a Watchpat study done. If you have the report, look at the pRDI number. This is the number of respiratory related arousals you had in the night, and includes the pAHI number (your apneas). If the pRDH number is significantly higher than the pAHI -- double or more -- then this indicates you may have UARS. In other words, something else besides apneas is causing wakefulness.
I got confused at the beginning of the video! Snoring happens with osa or uars? Also what are the causes of uars? Does the throat relax with everyone but only those with risk factors develop sleep apnea and/or uars? Can you talk about the right criteria for sleep study to be considered done properly? Does every study detect reras?
Hi Dr. For patient with moderate UARS (closed to severe) and mild OSA who opt for surgery, what are the criteria that are being used by ent specialist/surgeon to ensure these patients are a great fit? What sort of surgery would you recommend?
Dr. Veer, is it possible that UARS is triggered by enlarged turbinates, in which case the need to work hard while sleeping is caused by the diminished airflow through the nose? Thanks for a very informative video!
Yes it’s 100% possible thats whats causing my UARS im waiting for surgery to relieve from it . Some people cant breath through their mouth during sleep no matter how blocked their nose is and end up struggling to breath at night feeling tired and unrefreshed when wake up , i’m sure that Mr. Veer will agree aswell.
@@keyanno4111 I don't think UARS is as a result of a blocked nose - see Dr. Veer's comments at the 7min mark of his video. I think he mentions that the real issue is lower down in the throat, and that the blocked nose just makes it appear worse. The blocked nose just complicates the issue, but is not the cause of the UARS. I'm sure he'll clarify this item when he gets some time to respond.
Having a blocked nose will often confuse sleep studies and make it look like you have UARS, and sorting out the nose will make the problem go away. If you are good at looking at these studies you will be able to tell the difference (have a look at my 'how to read a sleep study'). True UARS would not improve with unblocking your nose as it's a throat problem like OSA.
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
Thank you so much for making this! For the past 7 years I have been waking up feeling like I'm gasping for air and have been experiencing memory loss and fatigue which has changed my whole life for the worse. I have had a couple sleep studies done and I always test as if I don't have apnea, my doctors have removed my tonsils/adenoids and told me to tape my mouth shut so I stop mouth breathing. I was confused as to how this was supposed to help with my problem but now I understand, I don't have apnea.
Hi Dr Veer, I'm curious if a nasal obstruction on its own can cause UARS? Or must there be an obstruction further down in the throat for UARS to occur? I ask because I have a deviated septum which has persisted through two septoplasties (my septum seems to have significant cartilage memory) and I am unsure if this is contributing to my symptoms. I do also have a slightly recessed mandible. Despite the septal deviation, my nasal breathing is still good enough that I don't mouth breathe during the day and I don't believe I mouth breathe during the night. I would really appreciate your advice on whether the mandible recession is the primary factor I need to address or whether my deviated septum may also have a significant contribution. Thank you
Personally I do not believe that UARS can be caused by nasal obstruction - it can look like that on a sleep study though. I think it's just misinterpretation of the data. It sounds like you need a functional septorhinoplasty. see a good rhinologist. one way to tell is to tape your mouth shut for a few hours during the day and see how you get on.
@@VikVeerENTSurgeon I don't understand. @Ash-on7ld said that they have a deviated septum and a slightly recessed mandible. You then responded that you do not believe that UARS can be caused by nasal obstruction, but then you said "it sounds like you need a functional septorhinoplasty". If UARS is not caused by nasal obstruction, why did you recommend a rhinologist?
@@VikVeerENTSurgeon Understood and thanks for the reply. Sorry I did not mention I've already had an in-lab sleep study and had an AHI of 4 and an RDI of 60! I've had nose surgery in the past and breath fairy well through the nose so there must an obstruction somewhere else. I'll report back after the DISE, are Mandibular devices helpful at all for this condition? Thanks.
Thanks again dr. Veer. Would love to hear your thoughts on actually measuring respiratory muscle strength, as I (tall, thin male) have tried everything and have been diagnosed by a variety of specialists (even lung-specialistst!) but it took a physiotherapist to diagnose my weakness in respiratory strength (causing UARS like symptoms). I'd say testing respiratory strenght should be mandatory before supplying someone with MRA or CPAP devices. Even though you seem to cover everything, I have not heard you about respiratory strenght. Might I have been a very rare case?
oh and eversince I am training my respiratory muscle I have better breathing and therefore better sleep and way more energy (I am still bothered by some fatigue though, so I am very interested in my tonsil size especially since my tonsils are often irritated
Thanks Vick, I think I may well have this. Very informative. I’m wondering what your thoughts are on dentist made mandibular advancement devices for people with OSA and chronic rhinitis?
I was wondering if anyone knows how to effectively do a sleep study on a patient who has delayed sleep phase and typically doesn’t go to sleep until 5am.
Has anyone tried monitoring a person in an Iron Lung style device to measure breathing volume, via changes in lower body displacement? If air goes into the head, it's going to expand the lower body by an almost equal amount. You could measure the flow profile of each breath during the study. Not sure how to make a comfortable seal around the neck, though.
Thanks for this Video, its seems that in Australia nobody has heard of UARS I am wondering if you know of any specialists over here? I have been using a CPAP machine for the past 10 years even though I've been told I don't have Sleep apnea on my last sleep study. I have a AHI average of 1.09 over the past year according to my cpap stats
e11ave wait so did the CPAP make a difference in your sleep ? My home sleep study showed 7 AHI so they say I should be good but I'm 28 feeling like 78 ..
How do i get to see you on the NHS when i cant even get a sleep study? I know this is my issue and i know exactly why too. I really hope to hear back from you.
A lot of people think of it like that, but there are some populations of patients who look like they are in a completely different population. Personally I think we don't know enough about sleep apnoea and all the different sleep related breathing disorders. more research needed.
I think I have UARS because I have a thin nose that is blocked + my removed back jaws. I have 10 desaturations per hour but only 0.4 respiratory effort arousals per hour… I think I have more than 0.4 but it didn’t detect because I’m a mouth breather and my flow limitation may have been too high… Are you agree with this theory ?
Hi Dr. ive been having unrefreshing poor sleep and feel sort of drowsy all the time. i had an in lab study a couple years ago, only had an AHI of 2. however the AHI during rem sleep were about 10. i know that isnt that high but i was wondering if my symptoms were due to UARS and some apnea. i did not quality for cpap/apap treatment but still having symptoms. im not sure what to do. any thoughts would be appreciated. Thanks.
I haven't been able to get a UARS diagnosis yet. My psg-tests showed AHI=1 No flow limitations or RERA's were monitored. I'm from the Netherlands and UARS is not recognised. Mouth breather from birth, retractive braces (headgear) worsened my health: high narrow palate, IMW 30.9MM , forward head posture, lip incompetence. I'm 38 years old female, struggling for 26 years, I get episodes of anxiety, insomnia, depressive mood. Please help 😪
That will be hard as you have a number of issues there. I think it would be best to go to a sleep centre in Amsterdam or something, and get seen by all the doctors you need to in one place. Unblocking your nose, doing a proper sleep study, dealing with insomnia and depression, etc. Otherwise you may have to do all of these things by seeing different people for each condition. I agree this is going to be hard for you. I would start with the depression & anxiety first and then think about getting you breathing through your nose. Good luck!
@@VikVeerENTSurgeon thank you dr. Veer. I found a sleep centre (Kempenhaeghe) in the Netherlands, hopefully they are able to diagnose UARS. I think it's all connected to sleep disordered breathing (anxiety, insomnia and depressive mood) Watch these case studies of children: ruclips.net/video/3oXY5R2wyOI/видео.html
Oh good question I have gerd too, didn't ever link it, or think about it, my doc tells me to take pantaprozol, but I don't like taking too much medicine,
@@VikVeerENTSurgeon To me I would think Gerd Causes Sleep Apean and or UARS.. Think about it acid is shooting back up into the esophagus and throat (LPR). This would in turn swell the soft tissues blocking the airway.
Thanks for covering UARS. As usual, your explanation is certified "layman compatible." How often do you encounter patients with evidence of both OSA and UARS? Is your treatment protocol different in these "mixed" cases as opposed to cases where patients have either OSA or UARS exclusively?
Hi Sir , I am suffering from a unique probkem ..I am able to breath from nose but it get obstructed when coming out when I lay down on bed (not sleep)...Dr done endoscopy but don't find anything .please help me in this ..what is it..
sounds like house dust mite allergy or something similar from your bedroom / pillow / mattress. Very common for this to happen, try a spray of Otrivine 30 mins before going to bed and see if it happens. if it less bad that night - then speak to your ENT surgeon about a steroid spray - you can't use otrivine long term (see my nasal spray video).
Thank you for taking the time to educate us all. Can you comment on Nasal EPAP ? Scientific journals report a reduction of AHI by 30-40%, and that it stops snoring. The most recent 2021 review article in Journal of Sleep Medicine & Disorders by Hakim TS et al. looked at the different devices available in US and concluded the same. I just can't understand how this would work with snorers, mouth breathers where a significant part of exhaled breath is through the mouth then how is the EPAP generated ? Then say some level of EPAP is created, will that be enough to completely open the upper airway and stop snoring/mouth breathing/apnea ? In your experience, does it work? I will accept non-biased empirical evidence. Thank you
Here in America sleep studies are big business. They even make offices into a make shift sleep studies, it's so cheap and obvious. Life time patient! I've been on cpap for two years now and I'm so tired. Even on power 16 out of 20 I'll have up to 21 events per night. Last night was 14 events per hour. Almost to the max. Started on power 7. When the sleep doctor bumped me up to power 11 and I had Aerophagia then got used to it and had to keep going up in power. I get used to it and it doesn't work anymore. I'm a 30 year brain tumor survivor this year. I'm 42 and I already had 3 strokes. I'm tired. Sleep apnea can cause strokes. Don't be surprised if your sleep doctor is almost impossible to contact. I'm about to quit cpap. I can get bad sleep without a mask stuck on my face.
Hi Dr. Veer, apologies in advance for the information dump. This is out of pure desperation, and I do appreciate your time. I have a similar situation as Shaikh Tanveer Hossain below. I was diagnosed with UARS in 2016 and have had a UPPP, tonsillectomy, bi-turbinate reduction, and septoplasty. MAD does not work, and Bi-PAP has made little difference to the bulk of my symptoms. I have not had a Drug-Induced Sleep Endoscopy, however, I have had a fiberoptic laryngoscopy. As far as I am aware, I sit somewhere between partial and significant obstruction - appears my epiglottis makes two-point contact with the posterior pharyngeal wall. Your point on lingual tonsils made me think if I would benefit from potentially having surgery to have this removed? Am I able to please get your opinion on this?
I think this is me as I am a tall,thin male who is ALWAYS tired and I don’t seem to snore. Question - would heart rate suddenly increasing during sleep be indicative of this? Beau sue my sleeping heart rate is in the 50s, but several times a night it jumps to the 70s. Makes me think I have this or an apnea of some sort. Making an appt for sleep dr.
Oh I see you answered this in the affirmative later in the video. My issue though is endless sinus issues (multiple turbinate reductions, balloon sinuplasty) that have still been unresolved that causes me to be congested at night. Still working on this.
Very interesting video. Thank you very much for this information. Do you have colleagues in Germany who have experience with UARS? I have been struggling with this syndrome for years. Unfortunately, no one understands it and no one can help me.... I have been to several sleep labs and had several surgeries. All without success. Maybe you can point me in the right direction? Best regards, Mathias
If the source of the airway resistance is in the nose, say a deviated septum, would a mandibular advancement device be of any help? If not, would there be any option other than CPAP?
How in the heck can an American find someone who thinks like you do here in the US? Do you have any American colleagues you know from conferences you can recommend?
Hi, I was diagnosed with UARS last year after 2 sleep studies. Apnoea was ruled out as I had normal AHI, my oxygen levels were dropping though, averaged 95% over the night. you say oxygen levels don’t drop with UARS, so could it be something else? Or is 95% still in the range for it to be UARS! I was given CPAP.
okay, maybe I simplified this a little too much. you can get desaturation if you get exhausted, or if there is a coexistence of OSA but it doesn't meet the criteria for a diagnosis. sorry it can get quite complicated.
I’ve been told the mandibular device isn’t good as it changes the bite or causes issues in the long term, and to do cpap as it’s the standard and definitely works? So what is the best thing to do? I’m overweight but I did a lofta study and it was RDI 22 and AHI 4. I assume losing weight can fix it but also can’t it also be possible it has to do with a high narrowing palate or not enough forward growth?
My sleep study said I don't have apnea bit I do have Periodic Limb Movement Disorder. Can this go together with this? Because I was actually shocked, SHOCKED! when they said I didn't have apnea.
This is pretty typical when the underlying sleep breathing disorder (UARS) is not detected in the sleep study, they just think it's "unexplained" PLMs.
I'm wondering if this more related to allergies. I'm highly allergic to dust mites, mold & pollen. Medication doesn't help much. I got so use to feeling terrible at night and the morning by the time i was adult. In my 40s i started having more health concerns that are most likely related to this condition. I just had the modern version of the UPPP/Lateral expansion and a tonsillectomy last week because i take my cpap off in my sleep without knowing it and feel worse with it in general. I couldn't believe the difference in my nasal breathing after the surgery. It felt like a miracle. My tonsils and Uvula where massive and always swollen. Everything is starting to make sense now.
@@VikVeerENTSurgeon I just had a sleep test here in Nederlands and doc told me I'm "clean" I don't have OSA... I will show him a video of me sleeping showing clear signs of UARS probably this will tell him something.... Thank you for the great work you do sir
Can you have UARS in day time too? I have most of the time blocked one nostril and I only realize that when I do things like cooking, my nostril closing completely, and after breathing with one nostril for like 10 minutes I feel weak, dizzy almost like fainting... Can UARS be the cause? My oxygen levels are normal... P.s I'm coming to you doctor for consultation 😀
UARS is not something that can be treated with one treatment. there are multiple treatment options. In young thin tall patients there seems to be a propensity to a tongue based obstruction (but not in all), therefore MAD is an option for those patients. Ive had complete resolution of symptoms and sleep study events with over 100 patients with UARS,
Having recently done a noxt3 test some of my results seem likely to be UARS 21/ph 48 when in supine position mixed with 21ahi on my back but 2.1 on my sides . Doctors seem to think those numbers are fine 🤣
Doctor my kid is 6 yr old nd just had adenoidectomy ..now he sleeps sound on his sides but in supine position he can't breathe in deep sleep....can you tell what could be the reason as our surgeon is saying there is no problem in his airway...n this breathing issue only occurs when he is in deep sleep n on his back.
Great video, thank you. More needs to be done to try and raise awareness about this amongst GP's. Just a thought but I wonder if the reason it seems more prevalent in men is because women are more likely to be misdiagnosed earlier on as having something like fibromyalgia, chronic fatigue or, good old Mr Freud's favourite, hysteria(/"it's all in your head") 🤔
Hard to say. Women are better at pushing for a correct diagnosis, whereas men tend to accept what has been said to them. I agree though, lots of fibromyagia, ADHD etc that is actually OSA/UARS
@@VikVeerENTSurgeon It took me 3,5 years to get a diagnosis. I only went so far because by some coincidences I had the opportunity to experiment with BiPAP on myself with *great* success!
Hey doc can deviated septum cause Uars? I have brain fog, chest congestion, sometimes palpitations, memory issues . Often wake up to my own snoring. Also feels like i don't sleep adequately even if i sleep 10 hours.
Is there a german in here who can tell me a ent-doctor or a sleep Clincic in germany who is actually knowing about this in germany? My current doctors just told me to go to do "behavioral sleep therapy" even though my symptoms could be very well explained by UARS. I am pretty desperate, as it really makes life miserable. Should i just buy a CPAP myself and try it that way?
Is anyone here familiar with OSCAR data from a PAP machine? I am trying to see if I have UARS by looking at that. I suspect I do, I was diagnosed with nasal valve collapse. My AHI looks great but I am still tired all of the time and wake up frequently throughout the night.
Hey guys! My symptoms improved a lot just from fixing my posture!!! You know you have good posture if the back of your neck is straight and also look up anterior pelvic tilt. Also had to fix my muscle imbalances. When you’re standing upright your jaw should move forward. Takes some time to develop muscles though. Also I would sleep with my lower jaw pressing into my pillow. My lower jaw would squeeze my throat lol My ent told me that surgeries don’t usually work and cpap is for life, so I would highly recommend that you guys try fixing your posture too?! It’s worth a try, but go see an ent too, you might have a physical thing going on?
Thank you for this video, the struggle to find a doctor well aware of UARS is real. Would you happen to know of anyone knowledgeable in Quebec, Canada?!
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.
What is the name of the private clinic?
Your story sounds exactly like mine. What did the doctors at the hospitals say when you got sent back?
I thought Cpap is not effective for UARS? Actually Im considering MMA surgery
@@orgonitehealingnl4431 Ik zou het niet aanraden omdat ik er nu achter ben gekomen dat mijn neuroloog het onderzoek niet erkent en de resultaten dikwijls ondermijnt.
Het beste wat je kunt doen is toch echt een onderzoek via het ziekenhuis, als jij zoals in mijn geval het idee hebt dat het onderzoek niet goed was gegaan en daardoor zware twijfels hebt aan de conclusie dan heb je het recht op een second opinion en dan zou ik je aanraden bij de tweede specialist aan te geven waarom jij twijfels hebt over het eerste onderzoek en luid en duidelijk aangeven dat jij alleen genoegen neemt met een tweede slaaponderzoek.
Dit heb ik zelf ook gedaan en nu moet ik wachten voor een vervolgonderzoek, gewoon geen genoegen nemen met die onzin van de artsen van tegenwoordig die alles afschuiven op stress en psychologische oorzaken.
Was your UARS related to nasal or throat obstruction?
Oh my gosh... everything, all the pieces just fall into places as you speak... thank you so much doctor.
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.
Please excuse all of the typos -- I'm not great writing from my phone.
I forgot to mention all the mental health issues I've had, and who knows if that would have happened I'd been able to sleep!
And my stamina compared to others my age has always been just atrocious.
P.S. I also clench my jaw like crazy all night. And I've been diagnosed with "vocal cord disorder".
Hey friend, you seem awfully lucid for someone who has gone through that - your body protected you. remember that!
how did CPAP help since?
Ive been going to doctors for 30 years telling them about unrefreshing sleep. Finally a sleep study found uars.
were u able to get cpap or some other therapy for that? and did it help ?
Please let us know what happened and how you're doing now?
If it makes you feel any better, even when diagnosed, there's not much you can do beside wear a cpap, or get quite intensive facial plastic surgery. I can't sleep with a sleep with a cpap, and the surgery didn't work. So, I'm basically fucked.
@@kenaultman7499 which surgery did you have if you don’t mind me asking. I’m considering palate expansion surgery for my symptoms
@@joannem8066 which palatel procedure are you thinking to do?
Concise and precise.
Great explanations!
Glad you think so!
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.
Thanks for this very interesting information! I really enjoyed listening to this having just had a UARS diagnosis .
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.
You are so intelligent and helpful as always nice mimic of all sounds
Hahaha, thank you! I spend a lot of time listening to people snoring at night.
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.
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
I'm editing a video on how to pick this up on your own sleep study. Its taking me a long time to do - it's quite long.
@@VikVeerENTSurgeon I'm looking forward to that!
Vik Veer - ENT Surgeon Can you please send the link of that video ? I can't find it on your channel
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
best of luck to you.
You can check your flow waveform in OSCAR for flow limitation
@@cebruthius I started having problems with CPAP compliance 2 years ago, after 4 years of excellent compliance. I lost 45 lbs during that time and it changed everything. AHI was 64.5 on first PS. Now AHI is 8.4 but have 20 RERAs on my last test. DISE scheduled for next week.
This guy is brilliant! Thank you so much 🙏
Thanks for watching!
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.
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
that's a great question, and a good video idea. I will add that to the list. basically it's pus that has been around too long and become hard. They are caused by chronic infection.
it takes me a long time to make videos, but when it comes out, you can pay yourself on the back.
@@VikVeerENTSurgeon Thanks for your response! I look forward seeing it, Otorhinolaryngology is so interesting :) I have always wondered if there's any correlation between tonsil-stones, permanently enlarged tonsils and eustachian tube dysfunction or otitis media.
tonsil stones and large tonsils - yes definitely there is a link.
Inflamed tonsils and Eustachian tube - I think so yes, but i'm not sure about the evidence on this.
Eustachian tube and Otitis media - definitely
Hope that helps
As always,great videos with so many details.I do have a moderate sleep apnea,unable to use any device.Now with constant swallowing problems , I always check your videos in a search for help...Thanks
Thank you very much Dr Vik. Your videos help us all around the world.
Very informative video! Very glad you are spreading awareness of what can be a debilitating syndrome. I have a question though, would an WatchPat be a useful screening tool for further NHS testing? I am exactly the fit of the typical UARS case so this will prove very helpful. THANKS!
WatchPat isn't great, but it can be a good screening tool. I would do an inhouse PSG or a NoxT3
be carefull, many doctors just tell you nothing is wrong because they dont believe in uars.Vic Veer is an exception.
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.
I'm so sorry you are having a tough time, and it does sound like your doctors are trying very hard. Very hard for me to give advice on a complex case without doing all the background work. Sounds like you need to have a close look at your own sleep study and puzzle it out for yourself. I am putting together a video on how to read your own sleep study, that might help?
@@VikVeerENTSurgeon Thanks a lot for replying. Sure I will watch the video and all information is helpful. A quick question: As you mentioned PSG has some limitations to detect UARS what would be the preferable test to detect it. I wanted to do the Esophagus manometry but my doctor said even though it is helpful to detect some parameters correctly but it makes the sleep disturbed and so we lose other parameters. So he stopped doing it 5 years ago. Another thing maybe a Natural sleep endoscopy as you mentioned DISE is a debatable issue. But I do not think anybody
does a natural sleep endoscopy anymore.
@@shaikhtanveerhossain9089 What’s keeping you from seeing maxfac surgeons? There are only so many soft tissue surgeries you can do
Its just too expensive to do Natural Sleep Endoscopy, no one will do it anymore. If someone is able to fall asleep whenever they want, I'm happy to try. There is a chap in Egypt who does this as well (he talked me into it in the first place), Prof Baghat.
Hi @@JustinRM20. Thanks for your reply. Are you talking about Maxilo-mandibular advancement surgery? I got evaluated for that too. Unfortunately, my lower jaw is already in a 3rd-degree advanced position which limits the highest possible advancement to 3-4 mm. Still, some doctors are in favor of this. However, it is a very invasive surgery and my jaw will be weakened forever, the face will be changed drastically. At this stage after so many surgeries, I do not want to go for another surgery that may not completely solve the issue. I am rather inclined to have a permanent tubeless tracheostomy. As I have read about it: It is a less invasive surgery from a surgery perspective. Theoretically, it should be able to solve the issue completely. The main challenge is post-surgery management. As it will be only for sleep apnea so I can keep it completely closed with adhesive tape in the daytime and avoid all the troubles. At night I can add a filter to be safe. My works are a 100% desk job so it should not bother me much. And it is reversible, so after 5-10 years, if a sleep apnea solution is discovered which works for me, I can reverse it easily. The problem is, I need a doctor who would proceed with this surgery.
Thank you for your precise information, you are incredible keep up the good work!
Is there evidence that elevating the head of the bed helps?
How effective is a myofunctional therapy program for helping with UARS?
No idea, the evidence isn't out there yet. On the other hand there are no real risks for giving it a go, and we are learning every day what works and what doesn't.
Thanks for the great explanation.
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 💕
There is a video coming out soon which I think might be helpful for you. keep an eye out for a new device that'll reveal.
Thank you. I've have congested sinuses for as long as I can remember. My nose sinus congestion, in turn, seems to have effected my uvula, causing it to swell/lengthen do to constraint strain in breathing. I'm just now figuring this out after years, and having seen a number of doctors.
thank you for your videos! Could you please do a video dealing with treatment for UARS?
Hey. I've been suffering from sleep bruxism for years now and I started to suspect that it might be related to breathing. When I clench my teeth together I can definitely breathe a lot better, so I suspect I am doing this subconsiously during the night to improve airflow. Is it even possible to detect UARS in that case?
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
CPAP isn't necessarily 100% effective. I used BiPAP and only when I applied ASV I achieved complete resolution.
How can I get diagnosed in California?? My in lab sleep tests shows I have nothing but a Watchpat showed I have UARS.
how does the Watchpat show you have UARS? I had a Watchpat study done but the doctor only gave me a summary of AHI and O2 level. Wonder if there's info I'm missing
@@estyzesty I just had a Watchpat study done. If you have the report, look at the pRDI number. This is the number of respiratory related arousals you had in the night, and includes the pAHI number (your apneas). If the pRDH number is significantly higher than the pAHI -- double or more -- then this indicates you may have UARS. In other words, something else besides apneas is causing wakefulness.
I got confused at the beginning of the video! Snoring happens with osa or uars?
Also what are the causes of uars? Does the throat relax with everyone but only those with risk factors develop sleep apnea and/or uars?
Can you talk about the right criteria for sleep study to be considered done properly? Does every study detect reras?
my dude, just watch it again
Hi Dr.
For patient with moderate UARS (closed to severe) and mild OSA who opt for surgery, what are the criteria that are being used by ent specialist/surgeon to ensure these patients are a great fit?
What sort of surgery would you recommend?
DISE is the only thing I use
@@VikVeerENTSurgeon Can drug-induced sleep endoscopy (DISE) also be used to increase the likelihood of the surgery?
Dr. Veer, is it possible that UARS is triggered by enlarged turbinates, in which case the need to work hard while sleeping is caused by the diminished airflow through the nose? Thanks for a very informative video!
Yes it’s 100% possible thats whats causing my UARS im waiting for surgery to relieve from it . Some people cant breath through their mouth during sleep no matter how blocked their nose is and end up struggling to breath at night feeling tired and unrefreshed when wake up , i’m sure that Mr. Veer will agree aswell.
@@keyanno4111 I don't think UARS is as a result of a blocked nose - see Dr. Veer's comments at the 7min mark of his video. I think he mentions that the real issue is lower down in the throat, and that the blocked nose just makes it appear worse. The blocked nose just complicates the issue, but is not the cause of the UARS. I'm sure he'll clarify this item when he gets some time to respond.
Having a blocked nose will often confuse sleep studies and make it look like you have UARS, and sorting out the nose will make the problem go away. If you are good at looking at these studies you will be able to tell the difference (have a look at my 'how to read a sleep study'). True UARS would not improve with unblocking your nose as it's a throat problem like OSA.
@@VikVeerENTSurgeonHi
So what needs to be done for this?
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
Are you better?
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
I've had to fight every step of the way trying to get treatment for this but it's so hard because I am so sick. I can barely function
I wish you all the best. Not getting good quality sleep can be very hard on people, can't imagine what 10 years would do.
Have you tried BiPAP? Some people find it more effective than CPAP for treating UARS.
Thank you so much for making this! For the past 7 years I have been waking up feeling like I'm gasping for air and have been experiencing memory loss and fatigue which has changed my whole life for the worse. I have had a couple sleep studies done and I always test as if I don't have apnea, my doctors have removed my tonsils/adenoids and told me to tape my mouth shut so I stop mouth breathing. I was confused as to how this was supposed to help with my problem but now I understand, I don't have apnea.
Glad you feel this has helped you. I hope you get better soon.
Try cpap
@@yahyaelmi8435 CPAP isnt good for UARS
Very good teaching. Thanks
Hi Dr Veer,
I'm curious if a nasal obstruction on its own can cause UARS? Or must there be an obstruction further down in the throat for UARS to occur? I ask because I have a deviated septum which has persisted through two septoplasties (my septum seems to have significant cartilage memory) and I am unsure if this is contributing to my symptoms. I do also have a slightly recessed mandible. Despite the septal deviation, my nasal breathing is still good enough that I don't mouth breathe during the day and I don't believe I mouth breathe during the night. I would really appreciate your advice on whether the mandible recession is the primary factor I need to address or whether my deviated septum may also have a significant contribution.
Thank you
Personally I do not believe that UARS can be caused by nasal obstruction - it can look like that on a sleep study though. I think it's just misinterpretation of the data.
It sounds like you need a functional septorhinoplasty. see a good rhinologist.
one way to tell is to tape your mouth shut for a few hours during the day and see how you get on.
@@VikVeerENTSurgeon I don't understand. @Ash-on7ld said that they have a deviated septum and a slightly recessed mandible. You then responded that you do not believe that UARS can be caused by nasal obstruction, but then you said "it sounds like you need a functional septorhinoplasty". If UARS is not caused by nasal obstruction, why did you recommend a rhinologist?
Hi there, this is great. I'm currently being investigated for UARS. Do you think drug induced sleep endoscopy would helpful to diagnose this? Thanks.
Not to diagnose it, sorry - you need a proper sleep study (not a watchpat etc). DISE only helps to work out why you have it.
@@VikVeerENTSurgeon Understood and thanks for the reply. Sorry I did not mention I've already had an in-lab sleep study and had an AHI of 4 and an RDI of 60! I've had nose surgery in the past and breath fairy well through the nose so there must an obstruction somewhere else. I'll report back after the DISE, are Mandibular devices helpful at all for this condition? Thanks.
@@baswold7979can you update us?
Thanks again dr. Veer. Would love to hear your thoughts on actually measuring respiratory muscle strength, as I (tall, thin male) have tried everything and have been diagnosed by a variety of specialists (even lung-specialistst!) but it took a physiotherapist to diagnose my weakness in respiratory strength (causing UARS like symptoms). I'd say testing respiratory strenght should be mandatory before supplying someone with MRA or CPAP devices. Even though you seem to cover everything, I have not heard you about respiratory strenght. Might I have been a very rare case?
oh and eversince I am training my respiratory muscle I have better breathing and therefore better sleep and way more energy (I am still bothered by some fatigue though, so I am very interested in my tonsil size especially since my tonsils are often irritated
it can cause a rare cause of sleep problems. thank you for sharing.
@@CypressHigh1 my tonsils are also all the time irritated, how did it went, did you find a solution?
is it common for PTs to be able to diagnose weakness in respiratory strength? what was your treatment like?
thank you very much, could you please tell me if this condition exist in children ?
Yes
I probably had it from age 12 onwards.
Thanks Vick, I think I may well have this. Very informative. I’m wondering what your thoughts are on dentist made mandibular advancement devices for people with OSA and chronic rhinitis?
You are a god sender doctor, wish you all the best!
Excellent video. Good job!
Thank you very much!
I was wondering if anyone knows how to effectively do a sleep study on a patient who has delayed sleep phase and typically doesn’t go to sleep until 5am.
you just start the recording at 5am. we do the same for night shift workers
@@VikVeerENTSurgeon gotcha. thanks so much for responding
Could a racing heart (upon awakening) be another symptom of UARS?
yes I've heard this is
Has anyone tried monitoring a person in an Iron Lung style device to measure breathing volume, via changes in lower body displacement? If air goes into the head, it's going to expand the lower body by an almost equal amount. You could measure the flow profile of each breath during the study. Not sure how to make a comfortable seal around the neck, though.
Thanks for the info doc! Recommend anyone in Singapore?
Professor Kenny Pang! Great guy. I think he has a clinic at the Orchard centre? Say Hi from me when you see him.
@@VikVeerENTSurgeon Thank you! :)
Thanks for this Video, its seems that in Australia nobody has heard of UARS I am wondering if you know of any specialists over here? I have been using a CPAP machine for the past 10 years even though I've been told I don't have Sleep apnea on my last sleep study. I have a AHI average of 1.09 over the past year according to my cpap stats
Stuart MacKay (I think that's how to spell his name), has an awesome reputation. I think he works in Wollongong?
@@VikVeerENTSurgeon thanks Vik
e11ave wait so did the CPAP make a difference in your sleep ? My home sleep study showed 7 AHI so they say I should be good but I'm 28 feeling like 78 ..
How do i get to see you on the NHS when i cant even get a sleep study? I know this is my issue and i know exactly why too. I really hope to hear back from you.
Is UARS just halfway on the spectrum between snoring and OSA?
A lot of people think of it like that, but there are some populations of patients who look like they are in a completely different population. Personally I think we don't know enough about sleep apnoea and all the different sleep related breathing disorders. more research needed.
Why is it particularly tall people? (In terms of the classical patient)
how can u determine UARS vs trachael stenosis/narrowing? I have tested negative for sleep apnea but still notice my throat closing in on me
Hi what have you done to help sleep? Do you have a c pap
I have a question sir. Are 13.6 microarousals per hour a lot ?
it would make a difference. I would work out why you are getting them.
I think I have UARS because I have a thin nose that is blocked + my removed back jaws. I have 10 desaturations per hour but only 0.4 respiratory effort arousals per hour… I think I have more than 0.4 but it didn’t detect because I’m a mouth breather and my flow limitation may have been too high… Are you agree with this theory ?
Hi Dr. ive been having unrefreshing poor sleep and feel sort of drowsy all the time. i had an in lab study a couple years ago, only had an AHI of 2. however the AHI during rem sleep were about 10. i know that isnt that high but i was wondering if my symptoms were due to UARS and some apnea. i did not quality for cpap/apap treatment but still having symptoms. im not sure what to do. any thoughts would be appreciated. Thanks.
I haven't been able to get a UARS diagnosis yet. My psg-tests showed AHI=1 No flow limitations or RERA's were monitored.
I'm from the Netherlands and UARS is not recognised.
Mouth breather from birth, retractive braces (headgear) worsened my health:
high narrow palate, IMW 30.9MM , forward head posture, lip incompetence.
I'm 38 years old female, struggling for 26 years, I get episodes of anxiety, insomnia, depressive mood. Please help 😪
That will be hard as you have a number of issues there. I think it would be best to go to a sleep centre in Amsterdam or something, and get seen by all the doctors you need to in one place. Unblocking your nose, doing a proper sleep study, dealing with insomnia and depression, etc. Otherwise you may have to do all of these things by seeing different people for each condition. I agree this is going to be hard for you. I would start with the depression & anxiety first and then think about getting you breathing through your nose. Good luck!
@@VikVeerENTSurgeon thank you dr. Veer. I found a sleep centre (Kempenhaeghe) in the Netherlands, hopefully they are able to diagnose UARS. I think it's all connected to sleep disordered breathing (anxiety, insomnia and depressive mood)
Watch these case studies of children:
ruclips.net/video/3oXY5R2wyOI/видео.html
Have you posted on Apneuvereniging Forum?
Does Gerd cause UARS? I have pretty bad gerd and keep waking up at night. Also have a high rdi that indicates UARS. Normal ahi
strong association, but we think Sleep Disordered breathing causes GERD, not the other way round. but you could be right
Oh good question I have gerd too, didn't ever link it, or think about it, my doc tells me to take pantaprozol, but I don't like taking too much medicine,
@@VikVeerENTSurgeon To me I would think Gerd Causes Sleep Apean and or UARS.. Think about it acid is shooting back up into the esophagus and throat (LPR). This would in turn swell the soft tissues blocking the airway.
Thank you sir.. love from Nepal ❤💙🙏
So nice of you
Thanks for covering UARS.
As usual, your explanation is certified "layman compatible."
How often do you encounter patients with evidence of both OSA and UARS?
Is your treatment protocol different in these "mixed" cases as opposed to cases where patients have either OSA or UARS exclusively?
I barely qualify for OSA (ahi 5.1) and will get a CPAP soon. but suspect I have UARS *too* because UARS makes much more sense given my history.
You mentioned shrinking the tonsils to treat this and how do I convince my doctor this is what I have?
Hi Sir , I am suffering from a unique probkem ..I am able to breath from nose but it get obstructed when coming out when I lay down on bed (not sleep)...Dr done endoscopy but don't find anything .please help me in this ..what is it..
sounds like house dust mite allergy or something similar from your bedroom / pillow / mattress. Very common for this to happen, try a spray of Otrivine 30 mins before going to bed and see if it happens. if it less bad that night - then speak to your ENT surgeon about a steroid spray - you can't use otrivine long term (see my nasal spray video).
Thank you for taking the time to educate us all.
Can you comment on Nasal EPAP ? Scientific journals report a reduction of AHI by 30-40%, and that it stops snoring. The most recent 2021 review article in Journal of Sleep Medicine & Disorders by Hakim TS et al. looked at the different devices available in US and concluded the same.
I just can't understand how this would work with snorers, mouth breathers where a significant part of exhaled breath is through the mouth then how is the EPAP generated ? Then say some level of EPAP is created, will that be enough to completely open the upper airway and stop snoring/mouth breathing/apnea ?
In your experience, does it work? I will accept non-biased empirical evidence.
Thank you
Can iNAP help with UARS?
Here in America sleep studies are big business. They even make offices into a make shift sleep studies, it's so cheap and obvious. Life time patient! I've been on cpap for two years now and I'm so tired. Even on power 16 out of 20 I'll have up to 21 events per night. Last night was 14 events per hour. Almost to the max. Started on power 7. When the sleep doctor bumped me up to power 11 and I had Aerophagia then got used to it and had to keep going up in power. I get used to it and it doesn't work anymore. I'm a 30 year brain tumor survivor this year. I'm 42 and I already had 3 strokes. I'm tired. Sleep apnea can cause strokes. Don't be surprised if your sleep doctor is almost impossible to contact. I'm about to quit cpap. I can get bad sleep without a mask stuck on my face.
Hi Dr. Veer, apologies in advance for the information dump. This is out of pure desperation, and I do appreciate your time. I have a similar situation as Shaikh Tanveer Hossain below. I was diagnosed with UARS in 2016 and have had a UPPP, tonsillectomy, bi-turbinate reduction, and septoplasty. MAD does not work, and Bi-PAP has made little difference to the bulk of my symptoms. I have not had a Drug-Induced Sleep Endoscopy, however, I have had a fiberoptic laryngoscopy. As far as I am aware, I sit somewhere between partial and significant obstruction - appears my epiglottis makes two-point contact with the posterior pharyngeal wall.
Your point on lingual tonsils made me think if I would benefit from potentially having surgery to have this removed? Am I able to please get your opinion on this?
A mandibular what device?
mandibular advancement device
Any recommendations on finding a doctor who specializes in UARS? I'm in Michigan and many doctors only diagnose and treat sleep apnea
I think this is me as I am a tall,thin male who is ALWAYS tired and I don’t seem to snore. Question - would heart rate suddenly increasing during sleep be indicative of this? Beau sue my sleeping heart rate is in the 50s, but several times a night it jumps to the 70s. Makes me think I have this or an apnea of some sort. Making an appt for sleep dr.
Oh I see you answered this in the affirmative later in the video. My issue though is endless sinus issues (multiple turbinate reductions, balloon sinuplasty) that have still been unresolved that causes me to be congested at night. Still working on this.
@@Maxmaxmax63 Untreated sleep breathing disorders can *cause* nasal congestion. This wasn't addressed in this video.
Very interesting video. Thank you very much for this information. Do you have colleagues in Germany who have experience with UARS? I have been struggling with this syndrome for years. Unfortunately, no one understands it and no one can help me....
I have been to several sleep labs and had several surgeries. All without success.
Maybe you can point me in the right direction?
Best regards, Mathias
Das somnolab in Dortmund!
If the source of the airway resistance is in the nose, say a deviated septum, would a mandibular advancement device be of any help? If not, would there be any option other than CPAP?
How in the heck can an American find someone who thinks like you do here in the US? Do you have any American colleagues you know from conferences you can recommend?
Hi, I was diagnosed with UARS last year after 2 sleep studies. Apnoea was ruled out as I had normal AHI, my oxygen levels were dropping though, averaged 95% over the night. you say oxygen levels don’t drop with UARS, so could it be something else? Or is 95% still in the range for it to be UARS! I was given CPAP.
okay, maybe I simplified this a little too much. you can get desaturation if you get exhausted, or if there is a coexistence of OSA but it doesn't meet the criteria for a diagnosis. sorry it can get quite complicated.
@@VikVeerENTSurgeon thanks for replying 😊. My morning headaches have gone since being on cpap, but sadly still don’t wake feeling refreshed.
Do I have sleep apnea or UARS if I have 90% oxygen levels while sleeping?
I’ve been told the mandibular device isn’t good as it changes the bite or causes issues in the long term, and to do cpap as it’s the standard and definitely works? So what is the best thing to do?
I’m overweight but I did a lofta study and it was RDI 22 and AHI 4. I assume losing weight can fix it but also can’t it also be possible it has to do with a high narrowing palate or not enough forward growth?
Helpful
Glad you think so!
My sleep study said I don't have apnea bit I do have Periodic Limb Movement Disorder. Can this go together with this? Because I was actually shocked, SHOCKED! when they said I didn't have apnea.
Especially as one of nostrils collapses if I lie on one side and I have gigantic crushing boobs
This is pretty typical when the underlying sleep breathing disorder (UARS) is not detected in the sleep study, they just think it's "unexplained" PLMs.
What about Maxillo-Mandibular advancement surgery for curing UARS
Thanks
I'm wondering if this more related to allergies. I'm highly allergic to dust mites, mold & pollen. Medication doesn't help much. I got so use to feeling terrible at night and the morning by the time i was adult. In my 40s i started having more health concerns that are most likely related to this condition. I just had the modern version of the UPPP/Lateral expansion and a tonsillectomy last week because i take my cpap off in my sleep without knowing it and feel worse with it in general. I couldn't believe the difference in my nasal breathing after the surgery. It felt like a miracle. My tonsils and Uvula where massive and always swollen. Everything is starting to make sense now.
Can UARS be treated with PAP therapy?
Yes! although some people prefer biPAP
@@VikVeerENTSurgeon I just had a sleep test here in Nederlands and doc told me I'm "clean" I don't have OSA... I will show him a video of me sleeping showing clear signs of UARS probably this will tell him something....
Thank you for the great work you do sir
@@dragosdiaconu629did you find a specialist in the Netherlands who is aware of UARS? I would love to know the name.
Can you have UARS in day time too? I have most of the time blocked one nostril and I only realize that when I do things like cooking, my nostril closing completely, and after breathing with one nostril for like 10 minutes I feel weak, dizzy almost like fainting... Can UARS be the cause? My oxygen levels are normal...
P.s I'm coming to you doctor for consultation 😀
you are saying that MAD works well for UARS ?
UARS is not something that can be treated with one treatment. there are multiple treatment options. In young thin tall patients there seems to be a propensity to a tongue based obstruction (but not in all), therefore MAD is an option for those patients. Ive had complete resolution of symptoms and sleep study events with over 100 patients with UARS,
I found the snoreeze mouth piece at night works for me
Having recently done a noxt3 test some of my results seem likely to be UARS 21/ph 48 when in supine position mixed with 21ahi on my back but 2.1 on my sides . Doctors seem to think those numbers are fine 🤣
Bongo Rx works wonderfully for UARS because it inflates the airway
Doctor my kid is 6 yr old nd just had adenoidectomy ..now he sleeps sound on his sides but in supine position he can't breathe in deep sleep....can you tell what could be the reason as our surgeon is saying there is no problem in his airway...n this breathing issue only occurs when he is in deep sleep n on his back.
Great video, thank you. More needs to be done to try and raise awareness about this amongst GP's. Just a thought but I wonder if the reason it seems more prevalent in men is because women are more likely to be misdiagnosed earlier on as having something like fibromyalgia, chronic fatigue or, good old Mr Freud's favourite, hysteria(/"it's all in your head") 🤔
Hard to say. Women are better at pushing for a correct diagnosis, whereas men tend to accept what has been said to them. I agree though, lots of fibromyagia, ADHD etc that is actually OSA/UARS
@@VikVeerENTSurgeon It took me 3,5 years to get a diagnosis. I only went so far because by some coincidences I had the opportunity to experiment with BiPAP on myself with *great* success!
Hey doc can deviated septum cause Uars? I have brain fog, chest congestion, sometimes palpitations, memory issues . Often wake up to my own snoring. Also feels like i don't sleep adequately even if i sleep 10 hours.
How do I get my Dr to take me seriously and not just fob this off as over researching the internet?
Some doctors are basically black holes of ignorance so get second opinions.
What sleep study would you recommend for diagnosing UARS? Do you know if Apnealink home respiratory test would detect UARS?
Apnoea link doesn't. the only home sleep study that does it as far as i know is the NoxT3
@@VikVeerENTSurgeon thanks! Do you know of any sleep clinics in London or England that offer this home sleep study?
We provide this at the Royal National ENT Hospital (as well as a Watchpat and a proper PSG in house).
Is there a german in here who can tell me a ent-doctor or a sleep Clincic in germany who is actually knowing about this in germany? My current doctors just told me to go to do "behavioral sleep therapy" even though my symptoms could be very well explained by UARS. I am pretty desperate, as it really makes life miserable. Should i just buy a CPAP myself and try it that way?
Bin in genau der gleichen Situation. Hast du dir eine Maske gekauft und kannst etwas berichten?
🤣love your mimicking wish it was funny except it isn’t when you just don’t know how to bloody fix this annoying problem. Thanks great video
Keep going, I'm sure you'll find the right doctor to fix it. Good luck!
If you have UARS would you disrupt your rem and deep sleep ang give you wake ups !
Yes you would feel unrefreshed at the mornings. I think I have this too. Get a palate expander, maxilofacial surgery and get your allergies solved.
Is anyone here familiar with OSCAR data from a PAP machine? I am trying to see if I have UARS by looking at that. I suspect I do, I was diagnosed with nasal valve collapse. My AHI looks great but I am still tired all of the time and wake up frequently throughout the night.
Hey guys! My symptoms improved a lot just from fixing my posture!!! You know you have good posture if the back of your neck is straight and also look up anterior pelvic tilt. Also had to fix my muscle imbalances. When you’re standing upright your jaw should move forward. Takes some time to develop muscles though. Also I would sleep with my lower jaw pressing into my pillow. My lower jaw would squeeze my throat lol
My ent told me that surgeries don’t usually work and cpap is for life, so I would highly recommend that you guys try fixing your posture too?! It’s worth a try, but go see an ent too, you might have a physical thing going on?
Anyone in India who can diagnose this?
wish you were in Morocco :( my life is ruined
How funny...i just sent you an email!!!
Thank you for this video, the struggle to find a doctor well aware of UARS is real.
Would you happen to know of anyone knowledgeable in Quebec, Canada?!