I’m fairly certain I’ve had this all my life. Now that I’m 35 and overweight I was finally taken seriously bc I’m having hypoaneas with oxygen desaturations. First 2 sleep studies over the years I was told “just don’t sleep on your back”. I’ve had pallet expanders as a kid, tonsils removed as an adult which made slight improvement and I have all the signs of UARS right down the low blood pressure and autonomic dysfunction.
Dr. Veer, Thank you so much, I've been trying since months to explain this to my doctor but he does not believe I have these symptoms, I am going to forward the vedio to him and hope he understands you.
I currently use full face mask CPAP, which I bought myself, to treat what I believe to be UARS. This was after a home sleep study (WatchPAT, negative for sleep apnia), lot of online research and discussion with a clinical respiratory physiologist. I am in the UK and decided to source a CPAP machine myself because it seemed very unlikely that I would be able to get one via an NHS diagnosis. Given my previously poor sleep quality it seemed to be worth trying. I fortunately have no problems in tolerating both CPAP and the full face mask, and the improvement in my sleep quality has been very substantial. I have the OSCAR software, and am currently trying to find good info on how to best interpret flow rate waveform analysis to judge how any improvements might be made, or whether I have already achieved best effect. The information you have provided in your videos has been extremely useful, -thank you.
Thank you for information. My daughter was diagnosed with UARS years ago. She suffers with drowsiness and has to take caffeine pills and Adderal to stay awake. I wish she could have another study and something could be done to help her! She’s miserable 😭.
Hi there thanks for your comment. I'm afraid I know nothing about America so I don't know about what they recognise or not. In the UK we accept UARS under the umbrella term of sleep disordered breathing and we have basic classification for this condition with our primary care commissioners which is separate from OSA. Once our patients meet these guidelines we provide treatment free on the NHS which in my population tends to be nasal and lingual tonsil related (hence why CPAP and bipap struggle with these patients and so we don't use them on the NHS.) Alpha Intrusion is just the way they record an arousal on a sleep study. My research shows that respiratory effort is a better indicator of symptoms than RERA arousals. Some patients can have a lot of RERAs normal AHI and no symptoms. Whereas I see quite a few people who have normal AHI and RDI but clearly have UARS. The RIP is far more useful when taken in context with the rest of the sleep parameters. It also seems to correlate better with patient symptoms. As I said, none of this is fact and since the American guidelines seem to change on an annual basis, this suggests no one knows what is going on. We need a lot more data to make a reasonable diagnostic protocol for these patients. I'm sure that the RDI is missing a lot of people, and perhaps my reading of sleep studies is also missing patients, but without data and a bit more medical togetherness we will continue to fail these patients. Just my two pence. Thanks again.
@@VikVeerENTSurgeon Great video! could you elaborate on this thou "which in my population tends to be nasal and lingual tonsil related"? What are the procedures you do? for "nasal" are we talking about simple things like septal deviation? Thanks! PS. Did you see Lanky's video? It seems like the "go to" treatment in the USA is Bi-Level (assuming people can even get it).
Another enjoyable and informative video Vik about UARS! BTW, I did call up Theatre Scheduling at Queen's, and they said my sinus op with you will be in another 6 months or less on the waiting list but I didn't know if it was meant from 6 months or less when you booked it in for me when I last saw you or from last week when I called them 🤔
@@VikVeerENTSurgeon When I hear more will let you know! + my CT scan images of my sinuses have been sent to radiology at Queen's as well 👍🏻 no probs about the update-hopefully will be sometime in Jan/Feb will I will see you. Update got a phone call this morning with a cancellation for Monday the 6th at 7am so see you then!
Hey. Thank you for your videos; they have been a great support to me whilst trying to navigate a lot of issues I've had historically with my mental health (anxiety, depression, paranoia) and cognition (memory, concentration). I was diagnosed with ADHD about 2 years ago and have been trying methods to treat/work with it since and nothing has really significantly worked so I decided to do a home sleep study. The test came back negative for OSA but detailed RDI as 103, with an average of 13.6 events per hour (25 event average for REM, which was interesting considering a long history of intense/exhausting dreaming that I've always remembered since childhood and a history of never feeling rested and struggling to get up/not make it to work. I feel this sounds like it very much could be URAS (in my unprofessional opinion) It worries me that there seems to be difficulty getting this diagnosed/acknowledged and I've certainly struggled with my GP in the past. My symptoms appear to be getting worse with age and I am really concerned for my overall quality of life. How would you suggest I proceed? Many thanks. Stephen
I am not in favour of using devices when we don't know what the reason is why you have UARS. I do a DISE and work out why you have this problem. Then you can offer treatment. I don't like swapping from CPAP to BiPAP to all the other masks until I understand the cause.
Thank you Dr. Veer! I just had a nasen-scopy in Singapore. My nasal is very congested and even on the awake sitting upright, my epiglottis is almost touching the back wall of my throat. Had a DISE procedure today. Tomorrow the doctor will go through the video/findings with me. I hope it would give me a clue why my sleep is so disrupted even on CPAP.
Haha - i'm afraid I doubt I will make it back in time to pick up and drop off the kids at school plus the NHS won't give me the time off either. I think UA-cam is the only way I'll manage to reach people. That sounds very much like an American doctor thing. We aren't quite so fabulous here in the UK.
Dr. Veer, this is extremely important work, but just the beginning. Many of us need _treatment_ options for UARS. In terms of diagnosis, it seems that just examining the characteristics of air flow via OSCAR should be able to give lots of insight. Perhaps hard to describe in YT comments, but rather than looking for individual events, the ongoing flow amplitude/shape/asymmetry etc. I plan to survive until you or someone else can help me improve my sleep. 💤
I guess, but that would mean you would need to start using a full face mask CPAP for UARS which seems cruel to me. I will look at OSCAR and ask my sleep lab about it. Thx
For CPAP to work, a totally confined upper airway is required. Some seem to come to this naturally with a lingual-soft palate seal. Some from full face mask. Some from nasal mask and mouth tape. Thanks for your work, videos, and concern.
Excellent video, more UARS information is always appreciated! It's still disheartening that the NHS doesn't even have an official page for UARS like they do for OSA, almost gives the impression that it doesn't exist... Just to clarify, can you also have UARS while being completely silent during sleep (i.e. no snoring or breathing sounds that mimic the ones you made at the start of this video)?
Thank you for making this video - it's really helping to raise awareness. Could you tell me what help is available on the NHS for UARS? NICE don't seem to have any guidance on it at all. I was told by an ENT consultant that works for the NHS that I didn't qualify for CPAP because of an AHI
Full treatment is available at the Royal National ENT Hospital completely free on the NHS. Ask your GP for a referral to the sleep department. You will need to try a MAD first. I'm sorry that you had to buy a bipap as that will only help a bit and isn't a particularly good treatment. It also doesn't work well to reduce respiratory effort. It upsets me that CPAP manufacturers have convinced so many people about this.
Thank for all the work you are doing Dr. Veer. Is cpap a better treatment than bipap in your opinion and if not what is the best form of treatment in your opinion? Thank you in advance.@@VikVeerENTSurgeon
Thank you for all the work you are doing. If Bipap is not good is cpap a better alternative if not what do you recommend as the best form of treatment? Also what is your opinion on double jaw surgery and expansion being a cure? Thank you in advance. @@VikVeerENTSurgeon
I believe a missing piece of the puzzle are transient temporary mini laryngospasms which happen when the superior laryngeal nerve is stimulated due to mucous entering the supraglottic larynx during snoring.
That wouldn't cause UARS but it is likely to be associated with hyper vigilance syndromes that will wake you up repeatedly giving you similar symptoms.
@@VikVeerENTSurgeon LPR aka Respitatory Reflux (as Dr. Jamie Koufman has "renamed") is quite ubiquitous and the culprit is not so much acid as it is tissue bound pepsin in the upper respiratory tract. This causes mucous secretions to increase in volume and viscosity as a physiologic repair process with the pH increasing to 8 to allow denatureing of the pepsin. Unfortunately this is not widely known and explained to patients.
I had applied CPAP for 3 years, followed by 2 years of mandíbular advancement by a dentition insert. Now tongue drawer as recommended to test. I have an average resting/lying heart rate of 47/min, and a sleeping rate of 52. Is that counterintuitive finding a consequence of upper airway resistance?
1:33 My only concern with this video is that some people have no snoring or only very light snoring with UARS, right? I understand that you’re exaggerating for effect, but people should be aware that it doesn’t always involve loud noises like this. Thank you for spreading knowledge and awareness! 👍🏼
Didn’t know I had sleep apnea until sleep study showing AHI of 40 but this all started with discovering 13,000+ PACS a day almost a year ago that suddenly started. Not on a CPAP yet as am waiting for ENT consult for Sleep Induced endoscopy. But just a few weeks ago had a cold and use NyQuil nighttime and Sudafed with pseudoephedrine HCI 30 mg and doxylamine succinate 6.25 mg and my PACS went almost zero and went back up after the meds timed out. I am thinking the meds opened up airways. Kind of opposite of what you would expect to happen. As I am working through these issues your information has helped to think outside of the box CPAP wise and looking deeper. Thank you
This is very intresting to watch, thank you for raising awareness on this topic. After my surgery, my inner lining of the nose was perferated and they had to add a button inside. The main problem is that I struggle to breathe fully at night and I feel really tired in the morning but because of the lack of awareness on this issue, noone really cares or thinks it's a big issue so it's often just ignored and forgotten about.
I am doing a video on empty nose syndrome and I think I mention septal perforations in that. they give very similar symptoms. Hope you get better soon.
@@VikVeerENTSurgeon Thank you, it kind of feels hopeless at the moment to be honest. Nasal dialators don't seem to help that much since I end up with a blocked nose shortly after falling asleep and the doctor's attitude is basically 'we've done all we can, you're on your own'. Oh well, life expectancy is lower through mouth breathing so there's that to look forward to 😅
What are your thoughts on the diagnostic value of the WatchPat pRDI? My understanding is it measures peripheral arterial tone and sympathetic nervous system activation by proxy. I had two PSGs done with AHIs of 0 and 3 and no RDI scored. Then did two WatchPat studies with AHI 20 pRDI 40 and AHI 20 pRDI 32. Then had a DISE done which showed "impressive" (their words) hypertrophied lingual tonsils and tongue base collapse. The surgeon that did the DISE confirmed UARS and said he thought this explained the disparity between the in lab PSGs and the Watchpat studies.
Would a septoplasty and turbinate reduction surgery have any impact on UARS? I had 6 hyponeas an hour on my sleep study and was diagnosed with OSA but I think I may have UARS because Cpap has done nothing in 6 months.
It does indirectly. But it's difficult to explain. I've tried in some of my videos which I hope will help you. In short, if you have nasal obstruction, get that fixed. Then worry about UARS / OSA etc.
hello sir ive been having a complex sleep issue since march of 2020 which is not being diagnosed properly but i also dont have the means to travel to london right now can u help me with diagnosing it here in india in any way ? would be very very helpful.
VERY interested here! I have nasal obstruction and I think I may have UARS. The sleep center I have access to seems single-mindedly hell-bent on getting me into CPAP, regardless of my actual condition. Work like yours is badly needed.
@@VikVeerENTSurgeon I also have UARS type symptons causing stress in cardiovascular system. Each night one side of my nose completely blocks and I am getting fragmented sleep. You mentioned sorting the nasal obstruction out first. Please can you advise how to go about this? I live in Wales, UK. Thank you!
How do I get tested for this? I had the full UPPP surgery about 15 years ago and had turbinate reduction surgery 7 years ago yet I still have sleep apnea. I'm using the CPA but hate it and I don't use it every night.
Newly diagnosed with OSA, after using Resmed11 (p30i, Dreamwear nasal) all night (no issues) my lungs feel tired and a bit sore. Any idea what is causing this? Do I just need a longer adjustment period?
But why doesn't a CPAP help for UARS? if its opening up the airway and forcing air in, could CPAP make this worse? im at my wits end trying to figure out why im so ill all the time, im under all NHS care from sleep, ent, cardiology, respiratory and they are all clueless about my illness here in Manchester, maxillofacial were just down right rude when my sleep doctor refered me to them, i had to make a complaint to PALS just for them to see me and Dr Patel told me i had 5 minutes to explain my issues which he then said my case is pointless, i just have been to see an orthodontist thats told me i am a case 3 and have an extremely high narrow palate, whats wrong with the care we get? when i want to see or speak to somebody about it, i have to wait a minimum of 6 months, i dont understand why im just left to suffer, im so bad i really contemplate suicide on a daily basis!
Since you have to breathe against CPAP air, your respiratory effort goes up and that is generally not what we want for UARS. Happy to see you on the NHS for free. I will try and help you through this. Ask your GP for a referral.
@@VikVeerENTSurgeon Hi Vik, we need more people like you, i told my Sleep Service last year that the CPAP was making me worse, they told me that UARS is quite a new thing when i questioned them about it , (i just dont think they have a clue about it here) is it possible to have both conditions ie SA and UARS? would a BIPAP help? i was on the verge of giving up in all honesty until i seen your comment, maybe there is some hope for me, my GP has sent a referral to you but knowing my Doctors etc they will have sent the wrong information, i dont want to leave my information here of course but my name will be Matthew Simpson, thanks so much for taking the time to reach out to somebody thats been suffering their entire life with no solution. By the way ive tried pretty much everything now, mandibular devices etc and my symptoms still persist and are getting worse, im pretty much bed/house bound, ive also had 2 operations on my nose for septum and turbinates, holter monitor and Eco for my heart, lung function test all normal, only thing that i can think of is my airways via mouth and throat but like i say maxillofacial didnt want to know, my dentist has referred me to the hospital but i get the feeling they will triage it and also dismiss my case.
It seems I have UARS but instead of my body staying asleep, struggling to breathe through a narrow airway, I wake up, and this happens every time I go into REM. 5 years on CPAP without ever having a good night sleep. Drug induced endoscopy didn’t pick this up and I can only imagine the drug they used blocked REM sleep like most drugs do. Been referred to Papworth hospital the other day and hopefully we can get to the bottom of what’s going on. Looking at surgery
Nice video! A couple bits of feedback and questions for you: 1) As far as I understand, in 99% of cases (at least in the US), the term UARS is not recognized as a separately diagnosable condition from OSA at all, let alone known about in the first place. While I agree it's debatable how distinct of a condition it is, the AASM and insurance companies have folded it under OSA for quite some time now. Do you think it's worth being upfront about this in your videos? It might help prevent confusion when patients raise this with their doctors - I and many others have certainly experienced it. 2) You attempt to make the distinction between "respiratory effort" and "arousals" as metrics for diagnosing and validating symptom severity in UARS. In the literature, I've seen a third potential sign/metric mentioned: "alpha intrusion". I'm wondering if you have any thoughts on the idea that the brain may experience more "continuous" signs of sleep disruption as opposed to discrete, abrupt arousals. This sounds different than the simple increased physical effort of breathing.
I think I replied to this but my comment got deleted? Sorry about that. In the UK we recognise UARS as a separate entity and I'm sorry I don't know anything about America. Alpha Intrusion is just a way we use to measure arousals on sleep study eeg data. It's not a respiratory effort indicator. Hope that helps.
Can increased heart rate during sleep be a symptom of this? My heart rate is consistently high when i sleep, and i wonder if this is how my body is compensating for the decrease in oxygen in my blood...by just pumping more to get the oxygen where it needs to be faster.
I get stuffed up every night , no matter where I am so I don’t think it’s something in the air. Since this happens, I breathe thru my mouth. I don’t sleep well either, but for other reasons My Dr mentioned a sleepstudy a few times but I already knew that wouldn’t help. I have a strange question , can glue ear travel to your nasal passage? After learning more about it I swear I had that discharge in my nose for about a week a few months ago
In the USA the business known as "sleep medicine" does not want to know- they want you to be a patient on CPAP for life. No one will use manometry anymore.
I´ve got nasal valve collapse on both sides of the nose. Managed to most likely detach the upper lateral cartilage and alar cartiage(complicated story). This has given me nasal valve collapse and I´m using breathe right strips and other nasal dilators to counter it during the night. I had myself checked for sleep apnea, but the test showed nothing. This was with a Polygraphy-set I got. Most likely I´m suffering from UARS. I have yet to have a Polysomnography-test. I also struggle with POTS-symptoms and severe tooth-grinding so I think UARS is pretty accurate. How are the statistic of the effectiveness of nasal dilators during the night if you have UARS? Keep up the good work!
@@kazman_6899 From what I've understood the cartilage has to be reattached using sutures. Spreader grafts can also further widen the valves. Edit: But it seems like there isnt much expertise on the field in my country.
Does UARS cause a high respiration rate? Both my cpap machine & my Fitbit watch tell me my breaths per minute are always 22+ I’m a 34F so it concerns me why I’m breathing so fast.
UARS can cause a high respiratory rate, but also CPAP can cause a high respiratory rate too. Look into OSCAR so you get clues from your CPAP data for why you're breathing so fast.
I have upper airway resistance that was found by recent overnight sleep study. I have the symptoms you describe. The sleep tech mentioned adrenaline as a result of breathing issue and the startle-awake as a result. This makes perfect sense to Me! I wake up multiple times during the night and I’m wide awake. Takes a long time to go back to sleep. Usually just get up and wait until I get sleepy again. It is miserable. Can’t find info on the adrenaline issue. Have been on CPAP for many years, but can no longer tolerate it. Plus I’ve lost 150 lbs What do you think? Thank you!
@@BettyGone hey when you say adrenaline issues what do you mean? Can you describe what you're going through? I also have adrenaline issues and severe sleep onset delay along with numerous wakeups. I also have myclonic jerks in my limbs and heart racing etc. I only slepe 1hr-2hrs with numerous wakeups.
To be honest I didn't completely understand. I asked my friend who is a GP to watch this with me. He considered UARS as kind of on the same spectrum of sleep apnea with both having the same causes that make it more difficult to breathe but with sleep apena just being severe enough to the point of forcing the patient awake and UARS not reaching that threshold. I asked him after he watched it if he could explain to me why they're not the same problem on a different scale. And now he's not sure. On one hand, he didn't think Vik Veer would be wrong but on the other hand he didn't completely understand why URAS wouldn't just be a less serve version of the same thing even after we watched together.
DISE only informs you where the problem is. It doesn't tell you how bad you are. You need a NoxT3 or NoxA1 sleep study (or something up to that standard, not a simple watchpat etc)
How would you get this? Where would the referral come from? You understand how hard it is, because the sleep studies we do get dont show the problem so then that's it, we get kind of ignored after that.
Net: 1) Dr. Veer thinks there is a distinct breathing disorder which he calls UARS, but it is currently impossible to diagnose with any certainty (7:48). YES! 2) Also, he thinks sleep breathing disorders are interrelated and complex and should not be measured by a single number (AHI, 9:26). YES! 3) He thinks Exovent project can help. HUM? Is there any scientific evidence regarding the correlation of RERAs, UARS, and quality of life? He mentioned that studies have been done showing high RERA counts do not correlate with quality of life issues (5:38). I would like to see details! This is counterintuitive to me. Seems to me that any sleep arousal would be problematic regardless of cause. Sure O2 desat or gasping to breath would expected to be more problematic than a mild arousal. But, if the arousals are preventing deep sleep (or other issues) then that would be problematic. I think UARS causes continuous/ongoing arousals ruining the quality of sleep. Yeah perhaps there is some minor muscular effort related issues, but sleep is more a mental process. Focus on effort as the primary cause of quality-of-life issues seems misguided to me. The measurement of breathing effort may be a great indicator of UARS though. So you talk about using Esophageal Manometry (2:05) to indicate "respiratory effort". This again seems odd to me. Why would using pressure in esophagus to quantify pressure in the airway (trachea and lungs) with its problems as you mention (tube in airway), be better than using the data from chest and abdomen straps? From there you go on to say RERAs are not good for diagnosing UARS. According to US National Inst. of Health: RERA is a breathing [incident] characterized by obstructive upper airway airflow reduction, which does not meet the criteria of apnea or hypopnea, associated with increased respiratory effort that resolves with the appearance of arousals. The common understanding seems to be that you can measure both effort and arousal with a sleep study. Flow limitations may be meaningless when measured from nasal canula, but should be meaningful when measured from a PAP with full-face mask or nasal mask while using mouth tape. With _current_ technology we should be able to _quantify_ UARS. Why isn't anyone doing this?
My condition is very disturbing... I have this feeling where I'm breathing too much air and it's never satisfying. It's very similar to ens but I never got a surgery so I'm left with some type of unknown illness
It works well in muscular tongue base collapse and also those with a small amount of lateral wall collapse so long as you have a good technique and an open nose. I can't provide the details as iNAP has been removed from UK distribution so I don't want people to be left with a device that has no consumables. Sorry.
Hello Dr Veer Thanks again for another video. We had a phone call last November and we decided to do the 3 prong approach, Sleep study, Mouth guard and drug enduce endoscopy. Still waiting for the endoscopy, I would always love to be a case study or any help I cssn be to collect data and help the millions of people who suffer with this. Thanks again
Let's talk about it. I worry about using real patients as we have strict GDPR rules here in Europe. Also my viewers seem not to be interested in these videos (I made a video on a tired woman I think). But let's talk about it next time.
I have all appreciations for your work 🏵!! but please, talk a bit slower because this is topic with many difficult words and beside is also a lot to process!
god I wish we had ENTs who cared this much in the states. thank you so much for all of the info you provide for people suffering from this condition
How good to know you're working so passionately on our behalf!
Thank you for being so understanding and thorough
You are so welcome!
Thank goodness you're so passionate in researching this.....for us.
Great point ... UARS about effort and not arousals.
Thank you very much, your films are always thorough and informative.
Great video. Can you do a followup with approach to treatment/management. Thanks !!!
Another great video Dr Veer! Always looking forward to more
So nice of you - lets see if people want more on UARS
I’m fairly certain I’ve had this all my life. Now that I’m 35 and overweight I was finally taken seriously bc I’m having hypoaneas with oxygen desaturations. First 2 sleep studies over the years I was told “just don’t sleep on your back”. I’ve had pallet expanders as a kid, tonsils removed as an adult which made slight improvement and I have all the signs of UARS right down the low blood pressure and autonomic dysfunction.
Sounds exactly the same as me, and we are the same age. Have you found any helpful treatment?
Dr. Veer, Thank you so much, I've been trying since months to explain this to my doctor but he does not believe I have these symptoms, I am going to forward the vedio to him and hope he understands you.
I currently use full face mask CPAP, which I bought myself, to treat what I believe to be UARS. This was after a home sleep study (WatchPAT, negative for sleep apnia), lot of online research and discussion with a clinical respiratory physiologist. I am in the UK and decided to source a CPAP machine myself because it seemed very unlikely that I would be able to get one via an NHS diagnosis. Given my previously poor sleep quality it seemed to be worth trying. I fortunately have no problems in tolerating both CPAP and the full face mask, and the improvement in my sleep quality has been very substantial. I have the OSCAR software, and am currently trying to find good info on how to best interpret flow rate waveform analysis to judge how any improvements might be made, or whether I have already achieved best effect. The information you have provided in your videos has been extremely useful, -thank you.
May I ask if the result from the watchPAT showed reras? I'm in a very similar situation as you, that's why I'm asking
Hi Dr. Veer, is it possible a patient with UARS would only have symptoms occasionally (1-2 times a week) instead of daily. Great content thank you!
Thank you for information. My daughter was diagnosed with UARS years ago. She suffers with drowsiness and has to take caffeine pills and Adderal to stay awake. I wish she could have another study and something could be done to help her! She’s miserable 😭.
Hi there thanks for your comment.
I'm afraid I know nothing about America so I don't know about what they recognise or not. In the UK we accept UARS under the umbrella term of sleep disordered breathing and we have basic classification for this condition with our primary care commissioners which is separate from OSA. Once our patients meet these guidelines we provide treatment free on the NHS which in my population tends to be nasal and lingual tonsil related (hence why CPAP and bipap struggle with these patients and so we don't use them on the NHS.)
Alpha Intrusion is just the way they record an arousal on a sleep study. My research shows that respiratory effort is a better indicator of symptoms than RERA arousals. Some patients can have a lot of RERAs normal AHI and no symptoms. Whereas I see quite a few people who have normal AHI and RDI but clearly have UARS. The RIP is far more useful when taken in context with the rest of the sleep parameters. It also seems to correlate better with patient symptoms.
As I said, none of this is fact and since the American guidelines seem to change on an annual basis, this suggests no one knows what is going on. We need a lot more data to make a reasonable diagnostic protocol for these patients. I'm sure that the RDI is missing a lot of people, and perhaps my reading of sleep studies is also missing patients, but without data and a bit more medical togetherness we will continue to fail these patients. Just my two pence. Thanks again.
Thank you, Dr. Veer
@@VikVeerENTSurgeon Great video! could you elaborate on this thou "which in my population tends to be nasal and lingual tonsil related"? What are the procedures you do?
for "nasal" are we talking about simple things like septal deviation? Thanks!
PS. Did you see Lanky's video? It seems like the "go to" treatment in the USA is Bi-Level (assuming people can even get it).
Another enjoyable and informative video Vik about UARS!
BTW, I did call up Theatre Scheduling at Queen's, and they said my sinus op with you will be in another 6 months or less on the waiting list but I didn't know if it was meant from 6 months or less when you booked it in for me when I last saw you or from last week when I called them 🤔
I don't understand the NHS or how it works. all we can do is wait. thanks for the update.
@@VikVeerENTSurgeon When I hear more will let you know!
+ my CT scan images of my sinuses have been sent to radiology at Queen's as well 👍🏻
no probs about the update-hopefully will be sometime in Jan/Feb will I will see you. Update got a phone call this morning with a cancellation for Monday the 6th at 7am so see you then!
Hey.
Thank you for your videos; they have been a great support to me whilst trying to navigate a lot of issues I've had historically with my mental health (anxiety, depression, paranoia) and cognition (memory, concentration). I was diagnosed with ADHD about 2 years ago and have been trying methods to treat/work with it since and nothing has really significantly worked so I decided to do a home sleep study.
The test came back negative for OSA but detailed RDI as 103, with an average of 13.6 events per hour (25 event average for REM, which was interesting considering a long history of intense/exhausting dreaming that I've always remembered since childhood and a history of never feeling rested and struggling to get up/not make it to work.
I feel this sounds like it very much could be URAS (in my unprofessional opinion) It worries me that there seems to be difficulty getting this diagnosed/acknowledged and I've certainly struggled with my GP in the past. My symptoms appear to be getting worse with age and I am really concerned for my overall quality of life. How would you suggest I proceed?
Many thanks. Stephen
Thanks for another great video, Vik. You hinted that bi-pap isn't effective for UARS, but what about ASV (adaptive servo-ventilation) devices?
I am not in favour of using devices when we don't know what the reason is why you have UARS. I do a DISE and work out why you have this problem. Then you can offer treatment. I don't like swapping from CPAP to BiPAP to all the other masks until I understand the cause.
Thank you Dr. Veer! I just had a nasen-scopy in Singapore. My nasal is very congested and even on the awake sitting upright, my epiglottis is almost touching the back wall of my throat. Had a DISE procedure today. Tomorrow the doctor will go through the video/findings with me. I hope it would give me a clue why my sleep is so disrupted even on CPAP.
Best of luck!
Thank you! Your videos are very helpful.
Glad to hear that!
After your approach and protocol is stable, you should go on a world tour to spread it.
Haha - i'm afraid I doubt I will make it back in time to pick up and drop off the kids at school plus the NHS won't give me the time off either. I think UA-cam is the only way I'll manage to reach people. That sounds very much like an American doctor thing. We aren't quite so fabulous here in the UK.
Dr. Veer, this is extremely important work, but just the beginning. Many of us need _treatment_ options for UARS.
In terms of diagnosis, it seems that just examining the characteristics of air flow via OSCAR should be able to give lots of insight. Perhaps hard to describe in YT comments, but rather than looking for individual events, the ongoing flow amplitude/shape/asymmetry etc.
I plan to survive until you or someone else can help me improve my sleep. 💤
I plan to be around for that, too, but they'd better hurry!
@@nancylindsay4255lol. I had originally written "I _hope_ to survive until..." but decided that was to negative. 😂
I guess, but that would mean you would need to start using a full face mask CPAP for UARS which seems cruel to me. I will look at OSCAR and ask my sleep lab about it. Thx
For CPAP to work, a totally confined upper airway is required. Some seem to come to this naturally with a lingual-soft palate seal. Some from full face mask. Some from nasal mask and mouth tape. Thanks for your work, videos, and concern.
Excellent video, more UARS information is always appreciated! It's still disheartening that the NHS doesn't even have an official page for UARS like they do for OSA, almost gives the impression that it doesn't exist...
Just to clarify, can you also have UARS while being completely silent during sleep (i.e. no snoring or breathing sounds that mimic the ones you made at the start of this video)?
Quite rare. However About 5% of people are silent.
Thank you very much for the information.
Most informative
Best
Do you have any videos about fungal infections of the nasal and paranasal sinuses?
Thank you for making this video - it's really helping to raise awareness. Could you tell me what help is available on the NHS for UARS? NICE don't seem to have any guidance on it at all.
I was told by an ENT consultant that works for the NHS that I didn't qualify for CPAP because of an AHI
Full treatment is available at the Royal National ENT Hospital completely free on the NHS. Ask your GP for a referral to the sleep department. You will need to try a MAD first.
I'm sorry that you had to buy a bipap as that will only help a bit and isn't a particularly good treatment. It also doesn't work well to reduce respiratory effort. It upsets me that CPAP manufacturers have convinced so many people about this.
Thank for all the work you are doing Dr. Veer. Is cpap a better treatment than bipap in your opinion and if not what is the best form of treatment in your opinion? Thank you in advance.@@VikVeerENTSurgeon
Thank you for all the work you are doing. If Bipap is not good is cpap a better alternative if not what do you recommend as the best form of treatment? Also what is your opinion on double jaw surgery and expansion being a cure? Thank you in advance. @@VikVeerENTSurgeon
Hope2Sleep charity in the U.K. has helped me a lot with information. They’re the ones that told me about UCL. X
@@VikVeerENTSurgeon well not just them. Barry Krakow as well it appears. Except his solution seems to be ASV.
Thank you so much for this video. I found it very helpful and informative.
I believe a missing piece of the puzzle are transient temporary mini laryngospasms which happen when the superior laryngeal nerve is stimulated due to mucous entering the supraglottic larynx during snoring.
That wouldn't cause UARS but it is likely to be associated with hyper vigilance syndromes that will wake you up repeatedly giving you similar symptoms.
@@VikVeerENTSurgeon LPR aka Respitatory Reflux (as Dr. Jamie Koufman has "renamed") is quite ubiquitous and the culprit is not so much acid as it is tissue bound pepsin in the upper respiratory tract. This causes mucous secretions to increase in volume and viscosity as a physiologic repair process with the pH increasing to 8 to allow denatureing of the pepsin. Unfortunately this is not widely known and explained to patients.
I believe the impact of pepsin is well known (at least in the UK). I have a video on the subject - ua-cam.com/video/ifU0qQlFRAA/v-deo.html
If you have an issue with pepsin problems I would contact Mr Kiran Jumani as he has a specialist interest in this.
@@VikVeerENTSurgeon Thank you. I personally do not but many people do unfortunately. Nikki Johnston pHD is tackling LPR. N-Zyme Biomedical.
I had applied CPAP for 3 years, followed by 2 years of mandíbular advancement by a dentition insert. Now tongue drawer as recommended to test. I have an average resting/lying heart rate of 47/min, and a sleeping rate of 52. Is that counterintuitive finding a consequence of upper airway resistance?
1:33 My only concern with this video is that some people have no snoring or only very light snoring with UARS, right? I understand that you’re exaggerating for effect, but people should be aware that it doesn’t always involve loud noises like this. Thank you for spreading knowledge and awareness! 👍🏼
He was giving examples. Not exaggerating.
Didn’t know I had sleep apnea until sleep study showing AHI of 40 but this all started with discovering 13,000+ PACS a day almost a year ago that suddenly started. Not on a CPAP yet as am waiting for ENT consult for Sleep Induced endoscopy. But just a few weeks ago had a cold and use NyQuil nighttime and Sudafed with pseudoephedrine HCI 30 mg and doxylamine succinate 6.25 mg and my PACS went almost zero and went back up after the meds timed out. I am thinking the meds opened up airways. Kind of opposite of what you would expect to happen. As I am working through these issues your information has helped to think outside of the box CPAP wise and looking deeper. Thank you
I would have a close look at your nasal breathing.
Are there any new surgical procedures other than expire to treat narrow air passage?
Where can I find the next video about bipap and cars? Or how to treat uars?
This is very intresting to watch, thank you for raising awareness on this topic. After my surgery, my inner lining of the nose was perferated and they had to add a button inside. The main problem is that I struggle to breathe fully at night and I feel really tired in the morning but because of the lack of awareness on this issue, noone really cares or thinks it's a big issue so it's often just ignored and forgotten about.
I am doing a video on empty nose syndrome and I think I mention septal perforations in that. they give very similar symptoms. Hope you get better soon.
@@VikVeerENTSurgeon Thank you, it kind of feels hopeless at the moment to be honest. Nasal dialators don't seem to help that much since I end up with a blocked nose shortly after falling asleep and the doctor's attitude is basically 'we've done all we can, you're on your own'. Oh well, life expectancy is lower through mouth breathing so there's that to look forward to 😅
@@Oblivionplayer12345try MARPE expansion and nasal valve surgery
What are your thoughts on the diagnostic value of the WatchPat pRDI? My understanding is it measures peripheral arterial tone and sympathetic nervous system activation by proxy. I had two PSGs done with AHIs of 0 and 3 and no RDI scored. Then did two WatchPat studies with AHI 20 pRDI 40 and AHI 20 pRDI 32. Then had a DISE done which showed "impressive" (their words) hypertrophied lingual tonsils and tongue base collapse. The surgeon that did the DISE confirmed UARS and said he thought this explained the disparity between the in lab PSGs and the Watchpat studies.
I cannot comment on this case but large lingual tonsils is a very common finding in people with UARS.
Many thanks for this useful video. Are you aware of any « like-minded » colleagues (as in aware of UARS) in France?
Would a septoplasty and turbinate reduction surgery have any impact on UARS? I had 6 hyponeas an hour on my sleep study and was diagnosed with OSA but I think I may have UARS because Cpap has done nothing in 6 months.
It does indirectly. But it's difficult to explain. I've tried in some of my videos which I hope will help you.
In short, if you have nasal obstruction, get that fixed. Then worry about UARS / OSA etc.
hello sir ive been having a complex sleep issue since march of 2020 which is not being diagnosed properly but i also dont have the means to travel to london right now can u help me with diagnosing it here in india in any way ? would be very very helpful.
I'm not allowed to do that, sorry.
VERY interested here! I have nasal obstruction and I think I may have UARS. The sleep center I have access to seems single-mindedly hell-bent on getting me into CPAP, regardless of my actual condition. Work like yours is badly needed.
I would sort out the nasal obstruction first.
@@VikVeerENTSurgeon I also have UARS type symptons causing stress in cardiovascular system. Each night one side of my nose completely blocks and I am getting fragmented sleep. You mentioned sorting the nasal obstruction out first. Please can you advise how to go about this? I live in Wales, UK. Thank you!
i don't need an ent but i just love your videos. ❤❤❤
Hahaha, that's nice of you to say. Welcome anyway
@@VikVeerENTSurgeon :)
How do I get tested for this? I had the full UPPP surgery about 15 years ago and had turbinate reduction surgery 7 years ago yet I still have sleep apnea. I'm using the CPA but hate it and I don't use it every night.
Newly diagnosed with OSA, after using Resmed11 (p30i, Dreamwear nasal) all night (no issues) my lungs feel tired and a bit sore. Any idea what is causing this? Do I just need a longer adjustment period?
But why doesn't a CPAP help for UARS? if its opening up the airway and forcing air in, could CPAP make this worse? im at my wits end trying to figure out why im so ill all the time, im under all NHS care from sleep, ent, cardiology, respiratory and they are all clueless about my illness here in Manchester, maxillofacial were just down right rude when my sleep doctor refered me to them, i had to make a complaint to PALS just for them to see me and Dr Patel told me i had 5 minutes to explain my issues which he then said my case is pointless, i just have been to see an orthodontist thats told me i am a case 3 and have an extremely high narrow palate, whats wrong with the care we get? when i want to see or speak to somebody about it, i have to wait a minimum of 6 months, i dont understand why im just left to suffer, im so bad i really contemplate suicide on a daily basis!
Since you have to breathe against CPAP air, your respiratory effort goes up and that is generally not what we want for UARS. Happy to see you on the NHS for free. I will try and help you through this. Ask your GP for a referral.
@@VikVeerENTSurgeon Hi Vik, we need more people like you, i told my Sleep Service last year that the CPAP was making me worse, they told me that UARS is quite a new thing when i questioned them about it , (i just dont think they have a clue about it here) is it possible to have both conditions ie SA and UARS? would a BIPAP help? i was on the verge of giving up in all honesty until i seen your comment, maybe there is some hope for me, my GP has sent a referral to you but knowing my Doctors etc they will have sent the wrong information, i dont want to leave my information here of course but my name will be Matthew Simpson, thanks so much for taking the time to reach out to somebody thats been suffering their entire life with no solution.
By the way ive tried pretty much everything now, mandibular devices etc and my symptoms still persist and are getting worse, im pretty much bed/house bound, ive also had 2 operations on my nose for septum and turbinates, holter monitor and Eco for my heart, lung function test all normal, only thing that i can think of is my airways via mouth and throat but like i say maxillofacial didnt want to know, my dentist has referred me to the hospital but i get the feeling they will triage it and also dismiss my case.
It seems I have UARS but instead of my body staying asleep, struggling to breathe through a narrow airway, I wake up, and this happens every time I go into REM.
5 years on CPAP without ever having a good night sleep.
Drug induced endoscopy didn’t pick this up and I can only imagine the drug they used blocked REM sleep like most drugs do.
Been referred to Papworth hospital the other day and hopefully we can get to the bottom of what’s going on.
Looking at surgery
Are you on the NHS?
@@MsFiFix1yes
Nice video! A couple bits of feedback and questions for you:
1) As far as I understand, in 99% of cases (at least in the US), the term UARS is not recognized as a separately diagnosable condition from OSA at all, let alone known about in the first place. While I agree it's debatable how distinct of a condition it is, the AASM and insurance companies have folded it under OSA for quite some time now. Do you think it's worth being upfront about this in your videos? It might help prevent confusion when patients raise this with their doctors - I and many others have certainly experienced it.
2) You attempt to make the distinction between "respiratory effort" and "arousals" as metrics for diagnosing and validating symptom severity in UARS. In the literature, I've seen a third potential sign/metric mentioned: "alpha intrusion". I'm wondering if you have any thoughts on the idea that the brain may experience more "continuous" signs of sleep disruption as opposed to discrete, abrupt arousals. This sounds different than the simple increased physical effort of breathing.
I think I replied to this but my comment got deleted? Sorry about that.
In the UK we recognise UARS as a separate entity and I'm sorry I don't know anything about America.
Alpha Intrusion is just a way we use to measure arousals on sleep study eeg data. It's not a respiratory effort indicator.
Hope that helps.
Would this cause a person that uses their cpap machine every night excessive daytime sleepiness?
Can increased heart rate during sleep be a symptom of this? My heart rate is consistently high when i sleep, and i wonder if this is how my body is compensating for the decrease in oxygen in my blood...by just pumping more to get the oxygen where it needs to be faster.
I get stuffed up every night , no matter where I am so I don’t think it’s something in the air. Since this happens, I breathe thru my mouth. I don’t sleep well either, but for other reasons My Dr mentioned a sleepstudy a few times but I already knew that wouldn’t help. I have a strange question , can glue ear travel to your nasal passage? After learning more about it I swear I had that discharge in my nose for about a week a few months ago
In the USA the business known as "sleep medicine" does not want to know- they want you to be a patient on CPAP for life. No one will use manometry anymore.
I´ve got nasal valve collapse on both sides of the nose. Managed to most likely detach the upper lateral cartilage and alar cartiage(complicated story). This has given me nasal valve collapse and I´m using breathe right strips and other nasal dilators to counter it during the night. I had myself checked for sleep apnea, but the test showed nothing. This was with a Polygraphy-set I got. Most likely I´m suffering from UARS. I have yet to have a Polysomnography-test. I also struggle with POTS-symptoms and severe tooth-grinding so I think UARS is pretty accurate. How are the statistic of the effectiveness of nasal dilators during the night if you have UARS? Keep up the good work!
Is there some surgery that can rectify this?
@@kazman_6899 From what I've understood the cartilage has to be reattached using sutures. Spreader grafts can also further widen the valves.
Edit: But it seems like there isnt much expertise on the field in my country.
Does UARS cause a high respiration rate? Both my cpap machine & my Fitbit watch tell me my breaths per minute are always 22+ I’m a 34F so it concerns me why I’m breathing so fast.
UARS can cause a high respiratory rate, but also CPAP can cause a high respiratory rate too. Look into OSCAR so you get clues from your CPAP data for why you're breathing so fast.
I have upper airway resistance that was found by recent overnight sleep study. I have the symptoms you describe.
The sleep tech mentioned adrenaline as a result of breathing issue and the startle-awake as a result. This makes perfect sense to
Me! I wake up multiple times during the night and I’m wide awake. Takes a long time to go back to sleep. Usually just get up and wait until I get sleepy again. It is miserable. Can’t find info on the adrenaline issue.
Have been on CPAP for many years, but can no longer tolerate it. Plus I’ve lost 150 lbs
What do you think?
Thank you!
@@BettyGone hey when you say adrenaline issues what do you mean? Can you describe what you're going through? I also have adrenaline issues and severe sleep onset delay along with numerous wakeups. I also have myclonic jerks in my limbs and heart racing etc. I only slepe 1hr-2hrs with numerous wakeups.
@@Amaadification this is me too.
To be honest I didn't completely understand. I asked my friend who is a GP to watch this with me. He considered UARS as kind of on the same spectrum of sleep apnea with both having the same causes that make it more difficult to breathe but with sleep apena just being severe enough to the point of forcing the patient awake and UARS not reaching that threshold. I asked him after he watched it if he could explain to me why they're not the same problem on a different scale. And now he's not sure. On one hand, he didn't think Vik Veer would be wrong but on the other hand he didn't completely understand why URAS wouldn't just be a less serve version of the same thing even after we watched together.
I have UARS how to cure/treat?
Since it’s difficult to diagnose UARS , I believe, Drug induced sleep endoscopy is the Golden standard for diagnosis of UARS/Sleep apnea
DISE only informs you where the problem is. It doesn't tell you how bad you are. You need a NoxT3 or NoxA1 sleep study (or something up to that standard, not a simple watchpat etc)
How would you get this? Where would the referral come from? You understand how hard it is, because the sleep studies we do get dont show the problem so then that's it, we get kind of ignored after that.
@@VikVeerENTSurgeon does the Nox T3 score RERA's, or what would you look for on the Nox? The RIP channel?
@@VikVeerENTSurgeonI understand dr , you are right , how about if the patient can’t sleep at all . Then what will we do with the sleep study ?
Where can I find your stamp questionnaire?
Net: 1) Dr. Veer thinks there is a distinct breathing disorder which he calls UARS, but it is currently impossible to diagnose with any certainty (7:48). YES!
2) Also, he thinks sleep breathing disorders are interrelated and complex and should not be measured by a single number (AHI, 9:26). YES!
3) He thinks Exovent project can help. HUM?
Is there any scientific evidence regarding the correlation of RERAs, UARS, and quality of life? He mentioned that studies have been done showing high RERA counts do not correlate with quality of life issues (5:38). I would like to see details! This is counterintuitive to me. Seems to me that any sleep arousal would be problematic regardless of cause. Sure O2 desat or gasping to breath would expected to be more problematic than a mild arousal. But, if the arousals are preventing deep sleep (or other issues) then that would be problematic.
I think UARS causes continuous/ongoing arousals ruining the quality of sleep. Yeah perhaps there is some minor muscular effort related issues, but sleep is more a mental process. Focus on effort as the primary cause of quality-of-life issues seems misguided to me. The measurement of breathing effort may be a great indicator of UARS though.
So you talk about using Esophageal Manometry (2:05) to indicate "respiratory effort". This again seems odd to me. Why would using pressure in esophagus to quantify pressure in the airway (trachea and lungs) with its problems as you mention (tube in airway), be better than using the data from chest and abdomen straps?
From there you go on to say RERAs are not good for diagnosing UARS. According to US National Inst. of Health: RERA is a breathing [incident] characterized by obstructive upper airway airflow reduction, which does not meet the criteria of apnea or hypopnea, associated with increased respiratory effort that resolves with the appearance of arousals. The common understanding seems to be that you can measure both effort and arousal with a sleep study.
Flow limitations may be meaningless when measured from nasal canula, but should be meaningful when measured from a PAP with full-face mask or nasal mask while using mouth tape.
With _current_ technology we should be able to _quantify_ UARS. Why isn't anyone doing this?
My condition is very disturbing... I have this feeling where I'm breathing too much air and it's never satisfying. It's very similar to ens but I never got a surgery so I'm left with some type of unknown illness
We need ent like you in north Carolina
Nackered? Is that a medical term?
Your videos are always so informative, thanks for all you do. Can you clone yourself and come to Glasgow please❤
I will look into that for you, no problem ☺️
Still waiting for your results of the iNAP, you never posted those, it didnt work as the 90% of apnea products didnt it?
It works well in muscular tongue base collapse and also those with a small amount of lateral wall collapse so long as you have a good technique and an open nose. I can't provide the details as iNAP has been removed from UK distribution so I don't want people to be left with a device that has no consumables. Sorry.
Hello Dr Veer Thanks again for another video. We had a phone call last November and we decided to do the 3 prong approach, Sleep study, Mouth guard and drug enduce endoscopy. Still waiting for the endoscopy, I would always love to be a case study or any help I cssn be to collect data and help the millions of people who suffer with this. Thanks again
Let's talk about it. I worry about using real patients as we have strict GDPR rules here in Europe. Also my viewers seem not to be interested in these videos (I made a video on a tired woman I think). But let's talk about it next time.
Good on ya m8
So I just have to continue to suffer daily as I have for the past 35 years because Aussie doctors refuse to even acknowledge this stuff.
👏🏻👏🏻👏🏻
I have all appreciations for your work 🏵!! but please, talk a bit slower because this is topic with many difficult words and beside is also a lot to process!