~Upper Airway Resistance Syndrome and FMS~

November 9, 2004

Upper Airway Resistance Syndrome and FMSFrom the October issue of the Fibromyalgia Network Newsletter:"FMS patients often say they wake up stiff and achy. This would make sense if the oxygen supply to the muscles was impaired during the night. Yet, people with Obstructive Sleep Apena Syndrome (OSAS), who have airflow blockagaes occurring at least 5-10 times per hour, usually don't have widespread pain. Their primary symptoms are morning headaches and daytime fatigue. FMS/CFS patients have these symptoms and many more.Several different research studies have shown that the level of blood oxygenation dropped significantly during the night in the majority of female fibro patients. Theses patients did not meet the criteria for OSAS, but they did spend a significant portion of the night with their blood oxygen concentration well below optimal levels. The doctor doing one of the studies suggested that alterations in breathing during sleep reduced muscle tissue oxygenation. This in turn produced morning pain and other FMS/CFS symptoms.The investigators suspected that the breathing pattern could be caused by upper airway resistance in the nose and throat regions, but discounted this possibility because many of the patients did not snore. Although snoring is always present in OSAS, it is not a prerequisite for Upper Airway Resistance Syndrome (UARS).For many people with airway restrictions, difficulty sleeping and a variety of symptoms reminiscent of FMS/CFS will develop. As the lungs expand to suck in air, there is so much resistance in the airway that it takes much more effort to draw in each breath. This is hard on the heart, which is why physicians check for OSAS. Unfortunately, methods for testing UARS have only recently been developed, so this disorder is often overlooked.Christian Guilleminalult, M.D. at the Stanford Sleep Center in California has directed a large number of the studies on UARS. He discovered that UARS patients have a higher frequency of structural abnormalities in their upper airway than those without UARS and has looked at blood pressure, age, gender, and menopause as predisposing risk factors for the condition.Sleep researcher Avram R. Gold, M.D., at SUNY-Stony Brook in New York, collaborated with Joan Broderick, Ph.D. to determine how often UARS occurred in 28 women diagnosed with FMS. Between the overnight sleep lab data and the physical findings about the airflow openings, the study revealed that 27 of the 28 FMS patients met the criteria for UARS. After 3 weeks on a nasal CPAP a substantial reduction in FMS symptoms (ranging from 23-47%) was achieved.Despite dramatic symptom improvements only 36% of the patients placed on CPAP were still using it nine months later. Two-thirds of the patients in the study had rhinitis with nasal stuffiness, post nasal drip, or nasal allergies. When chronic sinus problems exist, it increases nasal resistance and impairs one's ability to breathe nasally. Other situations that prevented the CPAP usage included skin rashes caused by the device's mask, inability to vary sleep position and difficulty breathing against a positive pressure. Fortunately, CPAP is not the only way to treat UARS.In 1993, May, M.D., looked for sleep apnea in patients with FMS (92 females and 25 males). The incidence of OSAS was only 2% in the women, but was 44% in the group of men with FMS. She concluded that sleep apnea may be a marker for undiagnosed FMS in men.UARS involves a restriction in airflow during sleep, produces an alpha-EEG sleep pattern similar to that found in FMS, and causes more frequent arousal's than OSAS. In fact, studies in recent years have documented that individuals with UARS exhibit many symptoms in common with FMS, such as daytime fatigue, difficulty falling asleep, headaches, irritable bowel syndrome, and bruxism ( teeth grinding caused by unconscious jaw movements during sleep). Even low blood pressure which is a frequent sign of orthostatic intolerance and cold extremities are significantly more common in people with UARS.The blood oxygen levels typically dip below 88% several times an hour in OSAS patients but there is no evidence of alpha-EEGs or awake-like brain waves upon deep sleep- a finding in patients with UARS. This alpha-EEG in UARS suggests that the brain is in constant state of arousal even during sleep, and this could be why the two syndromes exhibit different symptoms. Conversely, the blood oxygen levels in UARS patients hover between 88-92% throughout the entire night. OSAS and UARS are bad for one's health, but UARS tends to be more destructive to the sleep process. This may also explain why UARS patients have more symptoms which happen to overlap with those found in FMS/CFS patients. It is quite possible that many diagnosed with FMS or CFS also have UARS, but they are not being treated for the latter.Treatment for UARS vary from invasive surgeries to simple, self-administered remedies. Typically, multiple approaches are needed and sometimes the best place to start is with a sleep study to determine if you have UARS, and if so , its severity. Details for treatment will be provided in the January 2005 issue.Structural defects that may interfere with breathing, especially during sleep when the head is in a reclined position:-small nostrils and/or deviated septum-excessive cartilage in the nose-large, swollen turbinate due to allergens for infections-upward arched palate-long , dangling soft palate (uvula)-small nasopharnyx or oropharnyx-large tongue in comparison to chin size-narrow upper maxillary bone-tonsils or adenoids present and swollen-protruding discs: soft tissue injury such as whiplash-enlarge thyroid gland-tight or knotted masseter muscle that stretches from the upper cheek bone to the lower jaw bone which draws the jaw up and back towards the throat, especially when laying down."Since I do have nasal problems and a deviated septum, I am going to follow my doctor's advice and seek a good ear, nose and throat doctor who may be able to help me as I have all the symptoms of UARS!

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