Mary just gave birth to a baby girl, her first child. She had some minor sleep issues during her pregnancy, but the baby, Caroline, was perfect. Of course, babies take a lot of work and Mary insisted on breastfeeding too. She was always on call for Caroline, so it wasn’t unusual for Mary to feel tired.
When Caroline was 2 years old, Mary was no longer breastfeeding and was able to sleep through the night, but she still found herself tired. She thought it was her new normal—she was a mom to a toddler, after all.
One day, Mary developed a terrible pain in her jaw that radiated into her ear. She went from dentist to dentist, but none were able to find out what was wrong. She finally went to an Ear, Nose and Throat doctor, who gave her a sleep questionnaire. That questionnaire showed that she might have sleep apnea so a home sleep study was recommended. It showed only very mild evidence of sleep apnea, with an AHI score (you’ll read about AHI in chapter 16) was 4. She didn’t qualify for any treatment.
Mary’s primary care physician had diagnosed her with Epstein Barr and Fibromyalgia but that didn’t explain the jaw pain, so Mary kept searching.
She finally made her way to a dentist who was well trained in both dental sleep medicine and TMJ. It turned out that Mary suffered from a syndrome called UARS, Upper Airway Resistance Syndrome, which is very hard to diagnose by standard methods and tests.
As mentioned before, most people (including many doctors) think that a typical sleep apnea patient is an overweight, older male. We refer to this as “confirmation bias.” We see what we know. We don’t see what we don’t know. Excess weight is a common finding among people with sleep apnea and it is also more common in men and older people in general. Most of us are unaware that there is another phenomenon primarily affecting thin, young women, usually with thin noses and narrow faces.
You see, breathing is something that is done all day long, not just a night (obvious, I know!). Sometimes people with smaller airways can have a hard time getting airway to the lungs in a way that is efficient and allows for the proper absorption of oxygen. We refer to this kind of airflow as “turbulent.” In such a circumstance, the body will try and maneuver itself to get a smoother flow by positioning the head, neck, and jaw in different positions. Doctors refer to this as “posturing.” Really, it’s just a way for the body to adapt to get the oxygen it needs.
Such “better air” positions might be responsible for these people getting bad backs, muscle aches, headaches and even TMJ problems like Mary had. As we’ve seen in previous chapters, when the body has to work hard to get oxygen, it goes into a “fight or flight” mode. Cortisol is made that keeps the body UP. But, that’s not only unsustainable, it’s unhealthy and leads to many of the symptoms we see.
Because people with this phenomenon, called UARS, also have problems getting adequate air moving from their lungs to their organs at night, they often have all of the symptoms of people with Sleep Apnea:
- Difficulty initiating or maintaining sleep (Insomnia)
- Snoring – but not always
- Chronic Fatigue
- Cognitive impairment (brain fog)
- Non-refreshing sleep
- Excessive daytime sleepiness
- And many others.
Many people like Mary also complain of not being able to sleep on their backs. They need their bedroom environments just right: the right temperature, the right pillow, and minimal sounds or a noise machine. These people tend to not get adequate amounts of deeper sleep so they attempt to accommodate by altering their bedrooms in an attempt to improve their quality of sleep.
Upper Airway Resistance Syndrome
UARS is an ALL DAY problem, as we breathe all day long.
Mary wound up getting a night-time sleep appliance and a daytime, jaw repositioning appliance, that she wore on her lower teeth. These repositioned her jaw so that she was able to breathe better. The flow of air became smoother and gentler on her lungs. The pain in her jaw went away. Mary is now considering orthodontics so her jaw can be properly positioned without the use of an appliance.
UARS is often overlooked. If you suspect you might suffer from this, please find yourself a dentist who understands both dental sleep medicine as well as TMJ issues because, as mentioned before, they are often connected!
Mary is now happy, energetic, and pain free. She’s undoubtedly a better mommy to Caroline as well.