The Missed and the Misdiagnosed
Upper Airway Resistance Syndrome (UARS), a sleep
disorder characterized by airway resistance to breathing
during sleep, often goes undiagnosed or masquerades
as another problem. Headaches, myalgia, sleep onset
insomnia, sleep maintenance insomnia,1 bruxism, anxiety
and depression are all symptoms of chronic stress
which can be related back to respiratory effort related
arousals and (UARS). According to Christian
Guilleminault, the researcher credited with naming this
disorder, “Partial obstruction of the airway is hard to
quantify. Research and clinical diagnosis and treatment
have not been integrated. The medical community is
slow to recognize the problem.”2
Because the medical profession does not fully recognize
the problem, many doctors are ignoring a condition
that could be affecting as much as 15% of our population.
3 This is great for Starbucks, but quite the opposite
for many people. Dentists do not need an M.D. to diagnosis
Upper Airway Resistance Syndrome. With a
strong background in craniofacial pain, we can recognize
the symptoms in our patients and provide effective
treatment protocols. Patients that exhibit symptoms of
chronic stress can be tested with ambulatory polysomnography
to determine if there is a pattern of arousal
and light sleep all night long. If we can break the pattern
of chronic stress and lower cortisol levels, it will take
our patients out of sympathetic mode and slow down
their pulse rate and give them a more restorative night’s
sleep. This can be done with appliance therapy treatment,
myofunctional therapy, and breathing exercises.
Small changes in the airway at night during sleep can
be interpreted by the body’s defense mechanism as a
threat. This is an ancient and highly integrated reflex
pattern, known as the hypothalamic-pituitary-adrenal
axis, starts with the hypothalamus and results with cortisol
in the blood.
Cortisol is the enemy. Cortisol is synonymous with
stress. We now know that chronic cortisol, can activate
tens or even hundreds of unexpressed genes in our
body,4 that produces a variety of hormonal changes with
a plethora of symptoms.5 Among these symptoms are a
reduction in leukocyte production and interleukin. Both
make us more susceptible to infection. The dentist is
possibly the best positioned medical practitioner to provide
a special service and to educate their patients in
relation to a sleep and breathing disorder.
Orofacial pain and breathing problems reduce the
quality of life of so many of our patients. Be sure to
make an effort to educate the community where you
live. We can make a difference.
Theodore R. Belfor, D.D.S.
New York, New York
1. Sleep improvement in an insomniac patient with global pituitary insufficiency
after change from triple to quadruple cortisol replacement therapy.
Sleep Med 2007; 8(5):517-519. Epub 2007 May 18.
2. Interview with Christian Guilleminault, Tuesday July 26th; Dr. Steven Park,
3. Ogunrinde O, .Yue HJ, Guilleminault C: Upper airway resistance syndrome.
PCCSU 2011; July, Vol. 25. http://www.chestnet.org/accp/pccsu/upperairway-
4. Ridley M: Genome; Harper Perrenial Edition published 2006
5. Wust S, Federenko I, Hellhammer D: Genetic factors, perceived chronic
stress, and the free cortisol response to awakening. Psychoneuroendocrinology
2000; 25:707-720. www.elsevier.com/locate/psyneuen.