Treating Airflow Restrictions During Sleep

Ninety-five percent of people with fibromyalgia (FM) wake up feeling unrefreshed. But don’t expect a visit to a sleep lab to pinpoint your problem symptoms. Depending upon the research study you read, the prevalence of primary sleep disorders in FM and chronic fatigue syndrome (CFS) patients varies widely, but sometimes it may be as little as 18 percent.¹

Primary disorders identified by overnight sleep studies include obstructive sleep apnea, periodic limb movement sleep (PLMS), and narcolepsy. So the difficulties you face all night long are not usually caused by what scientists view as primary sleep disorders, but that does not make them any less real.

Speaking at the International Association for CFS, Charles Lapp, M.D., of Charlotte, NC, says, “We just are not doing the right studies to find the sleep disorders in FM and CFS patients.” In other words, the current technology is not capable of accurately detecting the sleep problems you face each night. In the July 2009 issue of the Fibromyalgia Network Journal you will read about the less researched yet very common sleep disorders that Lapp finds in his FM and CFS patients, as well as his recommendations for treating them. And although upper airway resistance syndrome (UARS) is a sleep disorder that can be identified during a sleep study, many centers tend to overlook it.

“The problem,” says Lapp, “is that UARS patients do not meet the criteria for apnea, in which the airway collapses and the breathing stops.” People with UARS struggle with breathing and this causes frequent arousals associated with daytime fatigue, headaches, and irritable bowel. However, the airways don’t collapse in UARS.

To better understand the difference between apnea and UARS, Lapps suggests that you consider the back of your throat to be like a tent. When you are upright, your throat is open and there is lots of air movement through the tent. If people with apnea lie down to sleep, the tent in the back of their throat collapses. They stop breathing for a moment and their oxygen levels drop, until they gasp for breath and become aroused. But, once placed on a continuous positive airway pressure (CPAP) machine, this blows up their tent so that they breathe easily and sleep throughout the night.

“UARS is not a tent disorder because the tent never collapses and the breathing is not obstructed,” says Lapp. “UARS is more like breathing through a straw or hose. These patients struggle to breathe through a partially deflated tent and because of this they do not get deep sleep.” One study has shown that almost all FM patients have UARS and placing them on CPAP does benefit them, but not to the extent that it works for apnea patients.² “I can tell you from clinical experience that CPAP is not the answer,” says Lapp. “It helps patients sleep better, but it doesn’t cure their pain or fatigue.”

Being able to tolerate or afford CPAP is another issue for people with UARS. Health insurance companies often will restrict CPAP coverage to obstructive sleep apnea patients who are able to consistently demonstrate a 3 to 4 percent drop in blood oxygenation levels (something that doesn’t occur with UARS). Lapp says that some of his patients sleep in a recliner to keep the airways open. Aggressive treatment of acid reflux and nasal allergies, including irrigation of the sinuses with saline sprays or the use of a neti pot, is helpful. Sleeping on one’s side will also improve airflow, and you can either use a pillow wedge or arrange various sized pillows to create a ramp that props up the head if CPAP is not an option.

Although CPAP and other approaches will not cure your FM or CFS, Lapp emphasizes that it is a sleep disorder that should be addressed because patients do sleep better. In addition, he says CPAP does prevent hypertension and stroke, and reduces metabolic diseases that can lead to weight gain and diabetes. In other words, every little bit counts!

1. Reeves WC, et al. BMC Neurol 6:41, 2006.
2. Gold AR, et al. Sleep 27:459-66, 2004.

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