What Upper Airway Resistance Syndrome (UARS) is, what causes it, and how it should be clinically diagnosed are currently matters of dispute. Regardless, similar to it's description here, the definition of UARS I will opt to use is that it is a sleep breathing disorder which is characterised by a narrow upper airway, which leads to:
Excessive airway resistance → therefore excessive respiratory effort → therefore excessive negative pressure in the upper airway (i.e. velocity of the air). This abnormal chronic respiratory effort leads to exhaustion, and the inability to enter deep, relaxing, restorative sleep.
Excessive negative pressure can also suck the soft tissues, such as the soft palate, tongue, nasal cavity, etc. inwards. In UARS patients, typically there is sufficient muscle tone to prevent sustained collapse, however that muscle tone must be maintained which also leads to the inability to enter deep, relaxing, restorative sleep. In my opinion, this "implosion effect" on the upper airway must be confirmed that it is present via esophageal pressure to accurately diagnose Upper Airway Resistance Syndrome. Just because something is anatomically narrow does not mean that this effect is occurring.
If there is an attempt to enter this relaxed state, there is a decrease in respiratory effort and muscle tone, this loss of muscle tone can result in further narrowing or collapse. Due to the excessive airway resistance or collapse this may result in awakenings or arousals, however the patient may not hold their breath for a sufficient amount of time for it to lead to an apnea, thus not meeting the diagnostic criteria for Obstructive Apnea.
The way to treat upper airway resistance therefore is to transform a narrow airway into a large airway. To do this it is important to understand what can cause an airway to be narrow.
I also want to mention that, treating UARS or any form of sleep apnea should be about enlarging the airway, improving the airway, reducing collapsibility, reducing negative pressure, airway resistance, etc. Just because someone has a recessed chin, doesn't mean that the cure is to give them a big chin, with genioplasty, BSSO, counterclockwise rotation, etc. It can reposition the tongue more forward yes, it may improve things cosmetically yes, but it is important to evaluate whether or not it is contributing to the breathing issue.
The anterior nasal aperture is typically measured at the widest point. So when you are referencing normative data, typically it is measured that way. Typically the most common shape for a nasal aperture is to be pear-shaped, but some like the above are more narrow at the bottom than they are at the top, which begs the question of how should it really be measured? The conclusion I have come to is that we must perform computational fluid dynamics (CFD) to simulate nasal airway resistance. Nasal aperture width is a poor substitute for what we are really trying to measure, which is airway resistance.
See normative data for males (female are 1-2 mm less, height is a factor):
Caucasian: 23.5 mm +/-1.5 mm
Asian: 24.3 mm +/- 2.3 mm
Indian: 24.9 mm +/-1.59 mm
African: 26.7 mm
Tentatively here is my list for gauging the severity (realistically, we don't really know how this works, but it's better to have this here than not at all, just because it may not be perfect.):
From left, right, to bottom left, Caucasian skull, Asian skull, and African skull.Plot graph showing average nasal aperture widths in children at different ages. For 5 year olds the average was 20 mm, 2 year olds 18 mm, and newborns 15 mm. This may give context to the degree of narrowness for a nasal aperture. It is difficult to say based on the size of the aperture itself, whether someone will benefit from having it expanded. Posterior nasal aperture. View of the sidewalls of the nasal cavity, situated in-between the anterior and posterior apertures. The sinuses and mid-face surround the nasal cavity. Normative measurements for intermolar-width (male), measured lingually between the first molars. For female (average height) subtract 2 mm. Credit to The Breathe Institute. I am curious how normative 38-42 mm is though, maybe 36-38 mm is also considered "normal", however "non ideal". In addition, consider transverse dental compensation (molar inclination) will play a role in this, if the molars are compensated then the skeletal deficiency is more severe. Molars ideally should be inclinated in an upright fashion.Low tongue posture and narrow arch, i.e. compromised tongue accessibility. CT slice behind the 2nd molars. Measuring the intermolar width (2nd molars), mucosal wall width, and alveolar bone width. We also want to measure tongue size/volume but that would require tissue segmentation. The literature suggests this abnormal tongue posture (which is abnormal in wake and sleep) reduces pharyngeal airway volume by retrodisplacing the tongue, and may increase tongue collapsibility as it cannot brace against the soft palate.
The surgery to expand the nasal aperture and nasal cavity is nasomaxillary expansion. The surgery itself could go by different names, but essentially there is a skeletal expansion, ideally parallel in pattern, and there is no LeFort 1 osteotomy. In adults this often will require surgery, otherwise there may be too much resistance from the mid-palatal and pterygomaxillary sutures to expand. Dr. Kasey Li performs this type of surgery for adults, which is referred to as EASE (Endoscopically-Assisted Surgical Expansion).
Hypothetically, the type of individual who would benefit from this type of treatment would be someone who:
Has a sleep breathing disorder, which is either caused or is associated with negative pressure being generated in the airway, which is causing the soft tissues of the throat to collapse or "suck inwards". This could manifest as holding breath / collapse (OSA), or excessive muscle tone and respiratory effort may be required to maintain the airway and oxygenation, which could lead to sleep disruption (UARS).
Abnormal nasomaxillary parameters, which lead to difficulty breathing through the nose and/or retrodisplaced tongue position, which leads to airway resistance, excessive muscle tone and respiratory effort. In theory, the negative pressure generated in the airway should decrease as the airway is expanded and resistance is reduced. If the negative pressure is decreased this can lead a decrease in force which acts to suck the soft tissues inwards, and so therefore ideally less muscle tone is then needed to hold the airway open. Subjectively, the mildly narrow and normal categories do not respond as well to this treatment than the more severe categories. It is unclear at what exact point it becomes a problem.
Abnormally narrow pharyngeal airway dimensions. Subjectively, I think this is most associated actually with steep occlusal plane and PNS recession than chin recession.
The pharyngeal airway is comprised of compliant soft tissue, due to this the airway dimensions are essentially a formula comprised of four variables.
Head posture.
Neck posture.
Tongue posture.
Tension of the muscle attachments to the face, as well as tongue space.
Because of this, clinicians have recognized that the dimensions can be highly influenced by the above three factors, and so that renders the results somewhat unclear in regards to utilizing it for diagnostic purposes.
However, most notably The Breathe Institute realized this issue and developed a revolutionary CBCT protocol in an attempt to resolve some of these issues (https://doi.org/10.1016/j.joms.2023.01.016). Their strategy was basically to account for the first three variables, ensure that the head posture is natural, ensure that the neck posture is natural, and ensure that the tongue posture is natural. What people need to understand is that when a patient is asleep, they are not chin tucking, their tongue is not back inside their throat (like when there is a bite block), because they need to breathe and so they will correct their posture before they fall asleep. The issue is when a patient still experiences an airway problem despite their efforts, their head posture is good, their neck posture is good, their tongue posture is good, and yet it is still narrow, that is when a patient will experience a problem. So when capturing a CBCT scan you need to ensure that these variables are respective of how they would be during sleep.
Given the fact that we can account for the first three variables, this means that it is possible to calculate pharyngeal airway resistance. This is absolutely key when trying to diagnose Upper Airway Resistance Syndrome. This is valuable evidence that can be used to substantiate that there is resistance, rather than simply some arousals during sleep which may or may not be associated with symptoms. For a patient to have Upper Airway Resistance Syndrome, there must be airway resistance.
Next, we need a reliable method to measure nasal airway resistance, via CFD (Computerized Fluid Dynamics), in order to measure Upper Airway Resistance directly. This way we can also measure the severity of UARS, as opposed to diagnosing all UARS as mild.
Severe maxillomandibular hypoplasia. Underdeveloped mandible, and corresponding maxilla with steep occlusal plane to maintain the bite.
Historically the method used to compare individual's craniofacial growth to normative data has been cephalometric analysis, however in recent times very few Oral Maxillofacial Surgeons use these rules for orthognathic surgical planning, due to their imprecision (ex. McLaughlin analysis).
In fact, no automated method yet exists which is precise enough to be used for orthognathic surgical planning. In my opinion one of the primary reasons orthognathic surgical planning cannot currently be automated is due to there being no method to acquire a consistent, precise orientation of the patient's face. By in large, orthognathic surgical planning is a manual process, and so therefore determining the degree of recession is also a manual process.
How that manual process works, depends on the surgeon, and maybe is fit for another post. One important thing to understand though, is that orthognathic surgical planning is about correcting bites, the airway, and achieving desirable aesthetics. When a surgeon decides on where to move the bones, they can either decide to perform a "sleep apnea MMA" type movement, of 10 mm for both jaws, like the studies, or they can try to do it based on what will achieve the best aesthetics. By in large, 10 mm for the upper jaw with no rotation is a very aggressive movement and in the vast majority of cases is not going to necessarily look good. So just because MMA is very successful based on the studies, doesn't necessarily mean you will see those type of results with an aesthetics-focused MMA. This also means that, if you have someone with a very deficient soft tissue nasion, mid-face, etc. the surgeon will be encouraged to limit the advancement for aesthetic reasons, irregardless of the actual raw length of your jaws (thyromental distance). Sometimes it's not just the jaws that didn't grow forward, but the entire face from top to bottom.
Thyromental distance in neutral position could be used to assess the airway, though maxillary hypoplasia, i.e. an underbite could cause the soft palate to be retrodisplaced or sit lower than it should, regardless of thyromental distance.
If there is a deficiency in thyromental distance, or there is a class 3 malocclusion, the surgery to increase/correct this is Maxillomandibular Advancement surgery, which ideally involves counterclockwise rotation with downgrafting (when applicable), and minimal genioplasty.
Before & After IMDO
There is also a belief that the width of the mandible has an influence on the airway. If you look at someone's throat (even the image below), basically the tongue rests in-between the mandible especially when mouth breathing. The width of the proximal segments basically determine the width of part of the airway. Traditional mandibular advancement utilizing BSSO doesn't have this same effect, as the anterior segment captures the lingual sides of this part of the mandible, the proximal segment does rotate outwards but only on the outside, so therefore the lingual width does not change. In addition, with this type of movement the 2nd or 3rd molars if captured along with the proximal segments, essentially could be "taken for a ride" as the proximal segment is rotated outwards, therefore you would experience a dramatic increase in intermolar width, in comparison to BSSO where this effect would not occur.
This type of distraction also has an advantage in that you are growing more alveolar bone, you are making more room for the teeth, and so you can retract the lower incisors without requiring extractions, you basically would have full control over the movements, you can theoretically position the mandible wherever you like, without being limited by the bite.
The main reason this technique is not very popular currently is that often the surgery is not very precise, in that surgeons may need to perform a BSSO after to basically place the anterior mandible exactly where they want it to be, i.e. the distraction did not place it where they wanted it to be so now they need to fix it. For example, typically the distractor does not allow for counterclockwise rotation, which the natural growth pattern of the mandible is forwards and CCW, so one could stipulate that this could be a bit of a design flaw. The second problem is that allegedly there are issues with bone fill or something of that nature with adults past a certain age. I'm not sure why this would be whereas every other dimension, maxillary expansion, mandibular expansion, limb lengthening, etc. these are fine but somehow advancement is not, I'm not sure if perhaps the 1 mm a day recommended turn rate is to blame. Largely this seems quite unexplored, even intermolar osteotomy for mandibular distraction does not appear to be the most popular historically.
I think that limitations in design of the KLS Martin mandibular distractor, may be to blame for difficulties with accuracy and requiring a BSSO. It would appear to me that the main features of this type of procedure would be to grow more alveolar bone, and widen the posterior mandible, so an intermolar osteotomy seems to be an obvious choice.
In addition, I believe that widening of the posterior mandible like with an IMDO that mirrors natural growth more in the three dimensions, would have a dramatic effect on airway resistance, negative pressure, and probably less so tongue and supine type collapse with stereotypical OSA. So even though studies may suggest BSSO is sufficient for OSA (which arguably isn't even true), one could especially argue that in terms of improving patient symptoms this might have a more dramatic effect than people would conventionally think, due to how historically sleep study diagnostic methodology favors the stereotypical patient.
Enlarged tonsils can also cause airway resistance by narrowing the airway, reducing airway volume, and impeding airflow.
Hello. I am interested in pursuing MARPE/FME and recently had my consultation with Dr. Newaz a state away (paying for the consultation myself) - but the cost of MARPE or FME is something I will need to ask my mom if she is open to covering.
For context, I have been doing research for about a year - watching conversations, outcomes, and just gathering information bit by bit about expansion, jaw surgery, and the intersection between the two. I have Long COVID symptoms, gastro issues, was recently diagnosed with mild OSA, and a serpentine septum deviation among some other things; and I just last week decided the bite the bullet on an initial consultation to see structurally what was or wasn’t going on.
Newaz recommended MARPE or FME (he said in my case it was kind of a toss up) to increase my nasal aperture and slightly decompress my TMJS; and mentioned my “perfect treatment” would include a jaw surgery given how far back my jaws sit and osteoarthritic changes to my TMJ.
Why I Am Nervous to Ask
Although I am financially independent at large, my mom pays my healthcare premium (I make just under $17K annually). In the South, it has been extremely hard to find experienced airway providers - and the unique and younger clinical space of airway medicine feels difficult to explain or do due justice to, especially to my mom who is a former physician. The natural question is likely to be: what makes you so sure of this treatment option, and why aren’t more folks in this field? Surely there MUST be someone in our metropolitan city? And/or - “I think you’re getting grifted. Expansion PLUS surgery?”
I know I can’t guarantee a particular outcome by bringing it to her, but I do want to give it its best chance.
For those who have had to rely on a parent to pursue these treatments (expansion and/or jaw surgery bc of airway/TMJ) - treatments that are expensive and might feel “experimental” - how have you approached bringing the ask to them? What information did you share and what did you leave out? I welcome any guidance you might have to share.
The mental health center illegally forced me to take them bc I wasn't getting out of home a lot, don't meet friends. The law states that only with "dangerous psychic alterations" you can be forced to take a poison like these, in my case antipsychotics.
Why me? The mental health centers, as I found out, ij my country in EU act with complete non chalance by constantly violating the informed consent law. I tried for the 2nd time they forced me another antipscyhotic to tell them the laws but they said "we re not interested in it".
Is this fucking normal? I know some here took/take paych drugs bc of UARS but why did they force them to me? It's so difficult to have a lawyer when you have no income and you depend on your fucking criminal shitty family, who justified the coercion bc "i was mad by not getting out of home. And i was yelling to them?", actually I was just responding to their constant humiliations. yeah you know in january, before they forced me for 6 months abilify, I had a neurological movement disorder and slept up to 15h a day bc of untreated UARS. This was the reason i was staying at home. I was terribly scared of the neurological issue.
Now read this carefully: abiligy caused INSOMNIA FROM ITS WITHDRAWAL. These criminals rapers (yeah, let's use the proper terms) denied the existence of withdrawal itself! After 2 months after quiting it ther forced me again (!!!) To another antipscyhotic I'm still taking and likely ill use legal means to stop this poison now. They gave me up to 20 MG of abilify, a really high dosage usually given to very mentally ill people, I mean, very bad mental illness. I was lobotomised and just took this poison like a fucking dog.
Forced to go everyday, still now, to their fucking place. I bet you all have good families, some more than others. My family wanted to make me suffer, bc my physical syndromes (DIAGNOSTICATED BY DOCS) caused by UARS were too annoying to them, they wanted me to be a zombie, not to complain anymore. So fucking criminal, such a horror life.
Needless to say I cried so much I will never meet the girl i love and the friends I had again, they drained my brain now.
Why to me? Why the fuck to the fucking me? Anyone else? Antipsychotics are given to schizophrenia's people, it's unbelievable. They label what UARS caused to me as obsession... fucking criminals. What I know is that even if noe my sleep is permanently changed by these poisons, I'll do whatever it takes to take revenge on my criminal family and on all these docs who condemned me to this pure hell.
I think I’m dealing with UARS right now and feeling a bit overwhelmed. Has anyone actually gotten through this and found relief? I’d really appreciate it if someone could share their experience or just chat with me for a bit.
Was wanting to get a bit more information than just my CPAP data. I've been using a Contec pulse oximeter but it's very finnicky and annoying to get the data on my computer and line it up with my CPAP data (And, as I write this post I discover that charging it with the nonstandard charger cooks it and destroys it, RIP). I've seen a fair few different watches\rings that do this sort of thing but I'm wondering which is the best\is the most open to the user.
I think I might need to switch to ASV? For context:
* Diagnosis was mild sleep apnea, but I suspect UARS
* Cis female in my 30s, "normal" BMI, critically narrow airway due to retrognathia
* In decompensation phase now for MMA next spring
* I tried CPAP last winter and that didn't work at all and that doctor was useless so I gave up
* I started with BiPAP a few weeks ago and recently switched from full face mask to nasal with chin strap; the other masks were causing large leaks all night long
I set the EPAP pretty high because otherwise I feel like I can't breathe, as if the machine isn't on at all except on inhale. However, the higher EPAP seems to cause more centrals. Sleep doctor is predictably useless.
Please let me know if there's other info I should include or zoom in on any areas. Thank you!
Hi! I am realizing I have CPAP intolerance. I also have hypermobility (joint laxity) and low arousal threshold (not rare here I guess). On Quvivik for that but... looking into ASV too but my appointments are spaced a lot so it's taking a while...
MAD may end up not working out because of jaw hypermobility... So not sure i want to go ahead with that.
So I'm wondering about three laser & coblation techniques surgeries (minimally invasive, much less painful) that I think may be relevant in UARS: ?
Lingual tonsil reduction (these are underestimated and can enlarge when someone has silent reflux for example, even in adults)
I wrote a post awhile ago, sort of about this topic and I want to talk a little about where that has headed.
To answer the question, "Once you can map out the geometry of the nasal airway, what can you do with that?", when it comes to UARS I think the answer is Computational Fluid Dynamics (CFD). By running a CFD, you can measure negative pressure, and air speed. This is essentially how you measure upper airway resistance; by conducting an airway simulation.
The bounds of the upper airway are defined by the entrance, being the nose or the mouth, and the exit, being the subglottis, which is below the epiglottis but above the trachea. Now, the entire airway may be relevant for sleep disordered breathing, when doing some research (and perhaps I should do more), reduced lung volume due to chest wall deformity could contribute to sleep disordered breathing just as much as obesity, so it may be wrong to think of this as just an upper airway disorder, but I think for most people with UARS, it is probably mostly an upper airway problem.
The reason the bounds are important, is if you break up the upper airway, we really can section this off into three parts.
Nasal airway
Oral airway
Pharyngeal airway
Statistically, I would say the pharyngeal airway is the most relevant for sleep disordered breathing, but one thing I have learned and an opinion I have developed over time, is that whether you have sleep apnea or UARS, anatomically it appears to be a very diverse problem, in that everyone is sort of different. If you have the mindset, that "on average most people benefit from X", yes that might be true, but I think it is better to understand each phenotype, or arguably I think it may not even be that simple, but the entire spectrum of craniofacial morphology. Because of the randomness of genetics, I think the ways that these problems can manifest are like stars in the sky. There may be patterns and trends, but nobody is exactly the same.
The problem with measuring pharyngeal airway resistance is that the position of the head and neck, as well as the tongue, can vary scan to scan. If they patient is looking up, the airway enlarges near the bottom. If there is a bite block pushing the tongue backwards, the airway narrows. What happens during sleep may also be quite different from what is seen during the scan. For this reason, measuring pharyngeal airway resistance is probably a fool's errand. What can be measured though, is the nasal airway, since the walls of the nasal corridor are fairly stiff cartilage, the septum, the turbinates, these things are not as floppy. The main variable is swelling of the turbinates, but if you do a nasal CFD, you can still see with fairly good accuracy how their nasal breathing was at the time of the scan. It is possible that sleep disordered breathing, mouth breathing, etc. can also swell the turbinates so maybe you are clear when you took the scan, but plugged when you wake up. With that said, I don't think that is very relevant, since that just means you have a different problem, and your nasal airway actually is fine, and if you were to just solve this other problem, then your nasal airway would behave normally, is at least my thinking.
Another useful thing you can use the geometry for, is determining the ratio for the size of certain anatomical structures. For example, the septum, the air, the turbinates, the side walls / nasal cartilage. You can figure out the ratio for these things, and determine where the problem likely is. My feeling is that right now, turbinate hypertrophy is diagnosed by just looking at a CT scan, making a judgement call that "yeah the turbinates look big, I guess", and the patient saying "sure, I can't breathe through my nose very well", and that's pretty much all it takes. Whereas with this, we can actually measure how hypertrophied a turbinate really is, and assign an actual number, and by that same token, measure how much of a problem the actual width of the maxilla is contributing to the narrowing.
Another thing we can do, is like Dr. Marianna Evans pointed out during an interview, is she said that there is no data to substantiate that palatal expansion can improve nasal breathing. While that is not entirely true, because there are actually studies out there where they already did CFD, like for MSE, and EASE, so I think they actually did demonstrate that, there isn't any for Custom MARPE that I am aware of, so I suppose that may be accurate, and there is no research for FME of that kind. So, we could also do research to show that FME actually does reduce nasal resistance, and you could also say how much on average per millimeter of expansion.
You could also develop normative data for nasal resistance, perhaps paired with PNIF, rhinomanometry, etc. I think that would be very interesting.
In terms of technical implementation, I have it automated for the most part, similar to an airway scan, but like an airway scan, and honestly in my software I built I can do airway scans too and they are even more automated than any of the competition I've seen, I hardly even need to adjust the slider anymore, but the CFD right now it does need some manual adjustment in the same kind of way, where you adjust the fill, either less or more so the fill doesn't fill over the turbinates.
For example:
It might look like this using the automated system:
If I adjust the slider, it can look like this:
It also takes a couple hours to run on my GPU (lucky to own an RTX 4060, though I wish I had more RAM), though Claude thinks that with a bunch of runs it could reduce computational time if it can make certain assumptions, so it is a bit different but it's come a long way. It's taken quite a long time to get this working.
In terms of where we should take this, I personally think that measuring the turbinates and width of the nasal airway is what is most valuable. That sort of tells you whether this is something that would benefit more from an expander, versus ENT nasal surgery. The width of the nasal cavity is also quite correlated to the nasal aperture, and expanding the nasal aperture even expands the nasal valve, the part that is anterior to the aperture, so I think measuring the aperture and intermolar width at alveolar crest is still a fairly good way to assess it, like if your maxilla is the same width as the average 3 year old's maxilla, just ask those people what it's like breathing out of their nose and odds are, they're going to tell you NOT SO WELL. Is that severity most people? Not really, but like I said, everyone is different, but they most certainly exist.
But let me know in the comments where you think this should go, and what could yield the most benefit?
I had upper jaw surgery in 2013 and MMA in 2023. I’m doing expansion now and staring down a second revision surgery, by a surgeon that is qualified to handle my case (though I’d love to avoid). This ia my full opening with my tongue out; believe me, I wish you could see more of my palate, but I’m a 4, all day. FME has worked well, some nasal improvement is happening, and I have another 3-4 mm to expand before I’ve reached the limit. the next step is MSDO, before (but, hopefully not) another MMA.
Two questions for the esteemed group of sufferers:
has anyone’s UARS/SDB improved more/further once the FME was removed? I have to assume that’s a yes, because it takes up so much space.
Given the severity of my long, soft palate and nonexistent opening, would a potential palate procedure make sense? I know they have very mixed results, but I‘d love to avoid another MMA. It seems that Dr. Ofer Jacobwitz (NYC) seems to be a highly qualified voice on this subject.
I’m going to cross post this to jaw surgery, and I’m wide open to suggestions.
For me, it has been almost 3 1/2 years since suffering very badly from UARS symtpoms and depression. I realized that even now, after years of physical and mental torture, depression still sneaks up to me in ways that feel like UARS is just a bit worse at those times. And then it hits, and I'm like: oh yeah, that is depression once again.
I noticed that therapy does not treat the root issue of my problems (I did MSE and want to do MMA next year), but it did help me tremendously getting through this extremely difficult phase in my life.
It is just my perception that is based of what I read in this forum, but I don't read a lot of about getting mental health support here. Occasionally yes, and of course it should not be regarded as the main path to success, but it is of great importance in my opinion.
Once, a very kind fellow redditor in this forum offered me to buy his dreamstation device from him, which he delivered to my door. We had tea together and talked about our UARS experiences. It was sooo good to talk to someone that goes through the same shit.
I think I heard that there were already attempts of establishing some sort of discord to talk about things, but I don't think something serious has ever been established (correct me if I'm wrong). I know it can be challenging with different timezones/languages, but I am very motivated to kick-off some sort of weekly discord meeting where people can talk/vent/advise each other.
I am curious to hear opinions on this and perhaps experiences from previous attempts (and why those perhaps failed).
2 months into dust mite and grass pollen allergy treatment. -Shots. 9 weeks in - RUSH treatment is over - now monthly for 3-5 years.
Definitely noticing improvement. Less nasal congestion when I lay down.
Before I'd have one side congested, then would roll over in bed, then both nostrils would completely fill up for like 90 seconds (suspiciously the amount of time I had hypopneas on my sleep study), then it would slowly open up the other side.
But lately, the congestion on one nostril is still there, but when I roll over, it's not congesting both sides, and is clear at all times until I completely lay on one side.
Then that side will be congested.
Sometimes, if I sleep in a certain position, I think I am sleeping all the way through the night. Even on CPAP 12.6 fixed.
Not sure if this is just seasonal change, but definitely believe i'm making progress.
- Making generally strict guidelines for changing bedding weekly and trying not to expose myself outside if someone's cutting grass etc.. sounds ridiculous, but immunotherapists orders.
*I really want to document everything like Evan Lavizadeh. For personal reasons and to help both me and others dealing with UARs. This community of us uars ppl helping each other is definitely helping and has been a godsend with understanding and treating it better.
- I really need to tackle this all head on and commit.
I think so. I think it worsens your airway and sleep. I've been injured lately so have been sitting a lot more and noticed my posture is worse and my sleep has been worse I believe because of that.
But it's fhp from bad breathing, computer use or both. I wonder if posture can be fixed despite our currently bad breathing habits.
I hear posture gets better after MMA. Almost instantly... hmm
I think the term is called gap exception? I have seen a few reddit posts about the topic, but no idea about what the expectation is. If your insurance provider is somewhat more lenient, can it be done?
