Restore Sleep
Upper Airway Resistance Syndrome (UARS)
Have you had a sleep study that came back saying you don't have obstructive sleep apnoea (OSA), yet you still feel like you've been hit by a bus come first light? Or perhaps you've never had a sleep study, but you wake with headaches, brain fog, anxiety or difficulty concentrating. Maybe you struggle to stay asleep, feel like your sleep is incredibly light, or simply wake feeling like you've barely slept.
Well, your breathing could be creating extra effort due to increased resistance when you're asleep, contributing to many of the symptoms you're experiencing. This is known as Upper Airway Resistance Syndrome (UARS).
When breathing takes more effort
UARS sits within the spectrum of sleep-disordered breathing, but rather than the airway repeatedly closing enough to create a full apnoea or hypopnoea, as is measured in obstructive sleep apnoea (OSA), the upper airway can still become narrower, resulting in you having to work harder to breathe. A similar process can happen with snoring. This increased effort can eventually trigger brief, often repetitive arousals from sleep. You may not fully wake up or remember them happening, but your sleep has been disrupted. These events are known as respiratory effort-related arousals (RERAs).
Because UARS can involve increased breathing effort and repeated arousals without the significant oxygen desaturation often associated with OSA, an AHI score on a sleep study may remain below the threshold used to diagnose OSA. So you can be told, ‘You don't have sleep apnoea' but you can still experience similar symptoms.
This fragmented sleep can make it harder to get the restorative sleep you need to feel replenished and ready to take on a new day. Your nervous system is responding to increased breathing effort during sleep, which can make it harder to settle into deeper, more restorative sleep. As a result, you may wake feeling like you've barely slept.
And UARS can be easy to miss
UARS has historically been difficult to identify because conventional sleep studies may not always capture the increased effort and airflow limitation involved. There is also still debate around its precise diagnostic criteria and how it should be considered within the broader OSA spectrum.
Interestingly, research comparing people with UARS to those with mild sleep apnoea has found that the UARS group had worse sleep quality and more fatigue. Interestingly, UARS appears to be more common in women than men, particularly during the premenopausal and perimenopausal years.
So, if you've been told your sleep study didn't show a positive result for OSA, or if the information here sounds all too familiar, we can explore how retraining your breathing may help address some of your concerns.
Where does breathing retraining fit?
This is where we need to establish healthy breathing habits during the day, as it’s possible that some of the additional breathing effort we experience at night may be influenced by dysfunctional breathing habits that can be retrained.
Carbon dioxide is an important part of what drives our breathing. In Buteyko, we work with your breathing response to CO₂, helping your body become more comfortable with changes in CO₂ while developing lighter, slower, lower, calmer and less effortful breathing habits.
And in time, you welcome this new breathing rhythm into the bedroom with you, helping you create the conditions for more restorative sleep.
Want to start learning? Breathing 101
Learn the foundations of functional breathing and discover the skills no-one ever taught you. A 75-minute introduction to the Buteyko Breathing Method, with practical exercises you can take into everyday life.
Or ready to explore your breathing?
Let’s talk about your story, what you’re experiencing, what you notice, and explore whether breathing retraining could benefit you.