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2011年3月31日 星期四

UARS: hidden sleep condition


You've gained some weight this year, and you just not sleeping well. Your husband says you have begun to snoring. You know that your father has obstructive sleep apnea and doing well with CPAP. You mention this to your doctor and she orders a sleep study. Sleep study comes back completely normal. Now what?

The real cause of your chronic fatigue

Before you begin to search for other reasons for your chronic fatigue, not to exclude a sleep-breathing problem too quickly, even if you don't have obstructive sleep apnea. In fact, a sleep-breathing problem cause if not aggravate conditions such as hypothyroidism, chronic fatigue, depression, insomniaand even prickly bowel syndrome.

Doctors have defined obstructive sleep sleep apnea have at least 5 apneas or hypopneas per hour on average. An apnea means that you stop breathing completely in 10 seconds or longer. Hypopneas are similar 10 sec or longer pauses, but with restricted air flow. But what what happens if you stop breathing 25 times per hour, but each episode only lasts a few seconds?

At the beginning of 1990, Dr. Christian Guilleminault of Stanford University on young, thin men and women who were tired all the time, regardless of how long they slept. These people were found not to have obstructive sleep apnea after undergoing formal sleep studies. When they are placed on the thin pressure guiding catheters, in their breast and neck, they found, however, had the the frequent incidents partly obstructionism, which led to a subtle, but significant reduction of the nasal air flow along with the very negative vacuum pressure in the throat. Most of these smaller incidents were not apneas or hypopneas, but still lead to an arousal-from deep sleep to light. What was happening was more partial blockages and arousals which were not serious enough to be called apneas or hypopneas, but enough to cause destruction in deep sleep quality.

It has been demonstrated that even very subtle levels of restricted breathing can lead to deep brain stimulation and arousals which prevents your ability to live in deep sleep. These retro-reflecting signals in the brain can be so weak that it does not yet reach the outer layers of the brain, where standard scalp electrodes can intercept these disturbances.

Blame It On your parents (and your Jaws)

The fundamental problem in UARS is due to the smaller upper airway Anatomy, caused by smaller jaws and dental crowding. The smaller the space behind the tongue more likely you will prevent while breathing on their backs (due to gravity, the tongue may fall back), and when in deeper levels of sleep (when your muscles relax). Therefore, most people with UARS cannot or do not want to sleep on their backs. The problem is that you can still breathing problems despite sleeping on your side or stomach, just not as bad as being on the back.

Lack of sleep and deep sleep, in particular, have been found to cause a wide range of physiological changes. Generally this happens because of chronic over stimulation of your sympathetic nervous system. This is the fight or flight half of your involuntary nervous system. Because your body thinks it is under attack, increases your nervous system, you make a garde edgy, hypersensitive or overreact to normal situations. This will also lead to diversion of blood flow, energy and resources away from the less essential body parts and organs, such as your digestive system, reproductive organs, skin, hands, feet and other "end organs."

Because of this "hypersensitivity," the nose and sinuses to be overly sensitive, responds to stimulants such as weather changes, chemicals, perfumes and even allergies. Chronic stress resulting from sleep deprivation can also whet your immune system.

It is hormones or your breathing?

A number of other studies point out that UARS patients are more likely to have cold hands and feet, hypothyroidism, irritable bowel syndrome, depression, chronic fatigue and various other "somatic" syndromes. I see this all the time in my practice. A recent study showed, in fact, even that chronic long-term sleep deprivation caused considerable reduction of TSH and T4 levels in women are much more susceptible to this effect in comparison with men.

With time, as people age, and in particular as they gain weight, most people want progress in true obstructive sleep apnea. You will find that most younger, thinner people with UARS will have one or two parents with significant obstructive sleep apnea.

Now that you are convinced that you may have this condition, what can you do it? For the most part, it is treated as obstructive sleep apnea. You should start with conservative settings first, such as weight loss (if you are overweight), diet, exercise, improve your nasal breathing and do not eat late. If these options do not work, all the formal opportunities to treat obstructive sleep apnea possible including CPAP, oral appliances and even surgery.

Unfortunately, if you do not officially have sleep apnea diagnosis based on a study, sleep, then insurance generally does not cover any of the treatments. Irony is that our health system does not treat or prevent diseases in their early stages, and would rather wait until it is far more serious before cover for medical services.

If you think you have upper airway resistance syndrome, you may be disappointed to find that the medical community generally do not want to be responsive to your queries. With a few exceptions, many sleep doctors are not convinced that the UARS is still a legitimate condition, and would rather cut it in spectrum snoring to obstructive sleep apnea. Time and time again, when I see patients who hear they don't have obstructive sleep apnea and upper airway narrowing and inflammation is treated, the patients almost always feel better. Your best option is to continue to educate yourself and be persistent. Your first priority should be to be able to breathe better, so you can sleep better.








Steven y. Park, M.D., author of the book, sleep, Interrupted: a medical doctor reveals the # 1 reason why so many of us are sick and tired. Endorsed by the New York Times best-selling authors Christiane Northrup, M.D., Dean Ornish, M.D., Mark Liponis, M.D., and Mary Shomon For a free e-book about how UN-Stuff your stuffy nose, click here: http://doctorstevenpark.com/unstuff-your-stuffy-nose.


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