Here is a good article on Chris Kresser’s website by Daniel Pardi, sleep researcher. Source: How Much Sleep Do You Need?


I’m going to paste in a comment (from Dr Maureen Allem) because I know I am going to want to share this info with someone. I have heard of sleep apnea but not UARS (upper airways resistance syndrome).



Daniel Pardi is correct . Get a sleep study done but make sure that the sleep clinic you choose is able to manually measure the RERAS (respiratory effort related arousals ) to diagnose UARS (upper airways resistance syndrome) . If they only measure the apneas and hypopneas – AHI index , they may miss the UARS diagnosis .

For more information on this syndrome there is a great book Sleep Interrupted by an ENT dr Steven Parker . He interviews many experts on this subject including Dr Christian Guilleminault who first identified this syndrome in 1993 . Check it out on his website or search for this on the Podcast app .

The following is from a flyer on UARS that I prepared and hand out to my patients : A lot of my information was supplied from a paper written on UARS by Dr Clyde Keevy.

Hope this helps
Dr Maureen Allem

UARS is classified under Obstructive Sleep apnea OSA and is a Sleep Breathing Disorder SBD that is associated with numerous FSS Functional Somatic syndromes and Anxiety disorders .

Symptoms of UARS can overlap with OSA . UARS patients are more likely to complain of daytime fatigue rather than sleepiness.

UARS is a form of sleep disordered breathing associated with fragmentation of sleep and is associated with inspiratory flow limitation whilst breathing during sleep . This inspiratory airflow limitation does not drop the oxygen saturation as per OSA .

Chronic insomnias are more common with UARS . These patients find it difficult to fall asleep (Sleep onset) and then find it difficult to stay asleep ( sleep maintainance ) These patients have nocturnal awakenings and find it difficult to return to sleep .
Studies report that Chronic insomnia is more prevalent with UARS than OSA

50% of UARS have cold hands and feet especially in childhood
30 % have light headedness when standing up or bending over abruptly due to parasympathetic over activity
UARS patients have more sleep disturbance than OSA patients
UARS patients have more sleep fragmentation that causes daytime sleepiness/ fatigue

What initiates the UARS ? Any Physical or emotional trauma can sensitize the limbic system which modulates emotions .The limbic system then activates the HPA axis .
The physical trauma can be a Motor vehicle accident , physical abuse, assault , home invasion , hijackings, rape , attempted rape etc . The initial trauma can also be emotional abuse . These traumas activate the HPA axis and sensitize the limbic system thereby altering the brain response to external or internal stimuli .
This activation can also lead to the Functional Somatic Syndromes FSS

Patients with UARS have usually consulted numerous doctors who are not able to diagnose the condition as they are unaware of this newly documented condition . These doctors have not manage to improve their patients symptoms of anxiety , depression, insomnia, ADHD and these FSS disorders .

Antidepressants are usually prescribed to alleviate symptoms but the underlying cause goes undiagnosed until a sleep study is ordered by a doctor who is aware of this new sleep disordered breathing called UARS . The sleep study is usually a last resort .
Once diagnosed, UARS is better treated with a mandibular advancement device which opens the airway and up improves these FSS symptoms .

The sleep study must measure RERAS ( respiratory effort related arousals ) manually . Automated computer analysis of polysonograms PMG do not measure RERAs and are unable to diagnose the sleep disordered breathing of UARS .
PSG have to be manually analyzed to diagnose this condition

What are the Main FSS symptoms ?
Body pain , headaches , insomnias and irritable bowels

What are the main anxiety disorders that UARS is associated with ?
Anxiety, depression, Bipolar , ADHD and Insomnia

Other FSS syndromes that doctors must be aware of that are associated with UARS are:
Chronic fatigue syndrome
Restless leg syndrome
Gastrointestinal Hyper mobility / Hypomobility
Joint hyper mobility syndrome
Mitral valve prolapse syndrome
TMJ syndrome
Sick house syndrome / multiple chemical sensitivity syndrome
Gulf war illness
Tension headaches / migraines
Problems of concentration and memory
Hyper somnolence / sleepiness
Daytime fatigue

Improvement of sleep disordered breathing with a mandibular advancement device improves symptoms . However one must Identify and manage the the initial trauma that activated the limbic system and HPA axis . There will be little success if the patient continues to suffer emotional/ physical stress