What's Wrong if I Get Poor Sleep but Don't Have Sleep Apnea?

A fellow caregiver asked...

I feel exhausted in the morning and know I'm sleeping poorly, but I don't snore or have sleep apnea -- so how can I get help for poor sleep?

Expert Answer

Steven Y. Park, M.D., is a board-certified otolaryngologist specializing in diagnosing and treating sleep-breathing problems such as obstructive sleep apnea, snoring, and upper airway resistance syndrome. Park is a blogger (doctorstevenpark.com) and author of the book Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired.

It sounds like you might have a sleep problem called Upper Airway Resistance Syndrome (UARS), and the good news is that it's very treatable. But you'll need to be proactive and seek treatment from a knowledgeable expert, because many doctors aren't familiar with this disorder.

Like sleep apnea, UARS is a breathing problem that occurs while you sleep. (The official term is sleep-disordered breathing.) But the signs of UARS are much more subtle, and often the only way you know something's wrong is that you wake up in the morning feeling tired and unrefreshed. What's happening is that when you breathe, the incoming air is encountering resistance in your airways. Because your body is half-waking over and over again during the night, it prevents you from falling into a deep, restorative sleep.

To treat UARS, you have to identify the area of obstruction and relieve it. The most common cause is tongue position that blocks breathing during sleep. Another possibility is narrow or collapsed nostrils or chronic congestion.

Here are some characteristics common to people with UARS:

*Narrow face

*Inability to stay asleep on your back

*Small or narrow jaw

*Thin neck

*Dental crowding

*History of orthodontia for overcrowded teeth

*Low blood pressure

*Cold hands and feet

Although people with sleep apnea are often overweight, UARS is just as common in thin people. However, gaining weight can cause UARS to progress to sleep apnea.

If you suspect you may have UARS, you can experiment with treating yourself using over-the-counter products. If the resistance is in your nostrils, you'll likely benefit from breathing strips, such as BreatheRight. You might also try the nasal dilator Nozovent, available online. Other steps to try include irrigating the nasal passages with a saline nasal spray, available at most drug stores, and taking a nonsedating antihistamine such as Claritin-D or Allegra-D if you suspect congestion from allergies.

Two other important steps to take are cutting down on alcohol consumption and not eating at night. Snacking after dinner and drinking alcohol both increase the likelihood of UARS and interfere with quality sleep.

If these don't work, the next step is to ask your doctor for a referral for a sleep study. There are now home sleep test kits available, but many are not sensitive enough to pick up the subtle changes associated with UARS, so an in-lab sleep test is best. If you do have UARS, you'll want a referral to an ear, nose, and throat (ENT) specialist, who can help you with any structural congestion issues. Your options for treatment include either a dental device or a Continuous Positive Airway Pressure (CPAP) mask, a specially designed nasal mask that prevents your throat structures from collapsing and delivers air directly into your airway.

If the otolaryngologist determines that tongue position during sleep is causing your UARS, it's likely you'll benefit from sleeping with a dental device that pushes the jaw and tongue forward and prevents your tongue from blocking the opening to the throat. If the obstruction is in the nasal passages, this has to be addressed either medically or surgically before trying one of the treatment options. There are also minimally invasive surgical techniques available in cases where the obstruction is located in the area of the soft palate or the tongue.