Investigating the columella response

[Falcon1]

The following quote comes from:
viewtopic.php?f=1&t=36483&p=436051&hili ... da#p436051

Dr. Falcon,

Do you have any comments on Steve's post from another thread ( viewtopic.php?f=1&t=47962&p=436037#p436037 )?

When using any nasal mask that will touch the area of the nose, the columella, the columella-labial angle or junction and around alar-facial groove or junction, columellar artery...basically putting constant pressure on these areas during the night, you are signaling to the body that there is an invasion of some sort, especially in the respiratory system! The body fights back by releasing more histamines, an immune response. This is why many on this board suffer from constant sinus, mucus...hay fever type responses. Gerryk is the perfect example of this:
"I have been using the quattro full face mask and recently got a nasal mask to try. I go to bed and fall right to sleep. The first night I slept for about 4 and a half hours with the nasal mask until I woke up with a headache and my nose pretty much plugged up."
The full mask doesn't touch the nose areas we are talking about ( the bridge won't illicit an immune response). I started Cpap 2 years ago now. I started with the full face Quattro too. Got it working perfectly and very comfortably. Got tired of screwing up my face with the straps, gel pressure etc. There IS a definite reconfiguration going on when it comes to "beauty" with this mask I started looking into other alternatives and stumbled across the No Mask.

I immediatley noticed sinus problems, mucus build up, hay fever type reactions and snezzing after waking up...but hey, I looked purdy! So I started to really look into it because I NEVER have had sinus problems before (I'm 62) or such a reaction with the full face Quattro. Found out that over time the body CAN (not always) adjust to this histimine response from a nasal mask. I really like the No Mask but it requires a lot of maintenance. Again, looked into it and found the SleepWeaver cloth mask. LOVE it...BUT, there is still a response like we are talking about because there is real columella pressure with this particular mask. Looked into it again...found the answer. I trick my body by taking 1 Sudafed with 2 anti-histamines before bed. Have everyhting under control now. You can see the columella response by putting pressure on it with your finger for a good period of time!

Rooster asked me the above question several days ago, regarding a phenomena which Sagesteve had mentioned in a previous post. I apologize that I didn’t get a chance to reply to the question sooner. I thought I’d start a new post to discuss this.

This is a very interesting observation by sagesteve, regarding the idea of a ‘histamine release’ by the body in response to ‘pressure’ placed on certain parts of the nose (what he termed the ‘columella response’).

(Histamine is a substance released by certain cells in our body, typically as part of an immune response to pathogens (e.g., allergens). A histamine release by cells in the nose is associated with increased nasal discharge, as well as sneezing, and watery/itchy eyes.)

I have actually not heard of the phenomena which sagesteve mentioned. I’m curious to learn where he got this information….perhaps he’s an Otolaryngologist (ENT) or Allergist, or perhaps he heard it from one. I consulted my medical literature, but I didn’t see the phenomena mentioned there, nor on-line.

The “columella” is the area of the nose which sits between the nostrils. The columella-labia angle is the angle formed between the columella of the nose and the upper lip.

Here’s an illustration part way down on this website, which shows the location of the columella: http://www.wetcanvas.com/forums/showthread.php?t=249234

Here’s a website which has a diagram showing the columella-labia angle:
http://www.shahfacialplastics.com/Nasolabialangle.html (Plastic surgeons who perform rhinoplasties are concerned with achieving a cosmetically appealing columella-labia angle, in addition to other nose-shaping factors which they must consider for their patients.)

Sagesteve suggested “You can see the columella response by putting pressure on it with your finger for a good period of time.”

After reading sagesteve’s post, I went ahead and did this experiment with myself today, by placing pressure on my columella with a finger for a five minute period using a stop watch. After five minutes of pressure I noticed that some congestion (nasal discharge) seemed to build up in my nose over the course of the five minute period, which didn’t seem to be there previously. (I had no sneezing or watery/itchy eyes, however.)

Afterwards I took a tissue and blew my nose to remove the discharge which had built up. Right after I blew my nose, I noticed that I seemed to be able to breathe even more freely and easily than before I started the experiment, just five minutes or so earlier. This made me wonder if, rather than creating new discharge from a histamine response, that instead the columella pressure I gave myself may have just loosened up the nasal discharge that was already present higher up in my nose/sinuses, and allowed it to drain down into the lower part of my nose more easily, which I was then able to remove by blowing my nose with a tissue.

Later, I then tried the same experiment, but this time I put pressure on my columella-labia angle. I had no response (e.g., I had no feeling of a buildup of nasal discharge, like I experienced with pressure on my columella alone).

I no longer use cpap, but from what I recall, the cpap nasal mask that I used previously (Resmed Mirage Swift II) did not put much pressure directly on the columella, but rather on the upper lip, and maybe also a slight amount of pressure on the columella-labia angle.

(In visualizing it in my mind, I think that if a cpap nasal/face mask were to put much pressure directly on the columella itself, then this would also simultaneously block off both nostrils as well, since the nostrils are directly adjacent to the columella on either side. With both nostrils blocked off, then that would negate the functionality of the cpap nasal/face mask, unless it was strictly a mouth mask.)

For cpaptalk readers who are interested, they can try the experiment which sagesteve suggested on themselves, to see what kind of response they get by placing pressure on their columella and/or their columella-labia angle. (I picked five minutes as an arbitrary time period to carry out the experiments on myself.)

As I mentioned, five minutes was enough for me to elicit a response with pressure on my columella (although I don’t think I’d characterize my results as a classic ‘histamine release’ response, which would be more akin to an allergic rhinitis response).

Also, again, I wouldn’t think that cpap nasal masks would put much pressure directly on the columella itself (although cpap mouth masks might, if they are strictly mouth masks with no nasal stenting).

In regards to the columella-labia angle, perhaps there will be some readers who experiment and discover that by placing pressure on their columella-labia angles that they develop increased nasal discharge as a result, or some variation of a histamine response, as sagesteve described. (As I mentioned, this didn’t happen to me - I had no increased nasal discharge in response to columella-labia angle pressure, just columella pressure alone.)

If columella-labia angle pressure is a problem for some readers, and if they realize that their cpap nasal/face masks place pressure on their columella-labia angles, then perhaps they could consider finding a different style of mask…or else, keep their same masks, but just find a way to counteract the buildup of night-time nasal discharge. (Sagesteve mentioned that he gets relief by taking “1 Sudafed with 2 anti-histamines before bed.”)

I’d be curious to hear from others if they have any other insights, or further information, on this topic.

Best regards all,

Dr Falcon

[Muse-Inc]

Pressure against the angle = no change. Light squeeze of columella = more congestion, no discharge...now (about 20 mins later), still slightly more congested. Pressure lasted 5 mins.

[Babette]

Wow! Interesting stuff. Thanks for posting this. I definitely am putting pressure on that area with my cpap mask, but I also routinely take a Claritin and 2 Benadryls before bed. But then, I was doing that before CPAP, too. And I was far more runny-nosed then, than I am now.

Why aren't you using CPAP anymore? Don't tell me the famous "Falcon" position has cured you of apnea? I gotta give that a better try than I have in the past.

Many thanks!
Barbara

[OutaSync]

5 minutes of pressure on my coumella resulted in no change. Right nostril was completely stuffed before experiment and same after experiment. My Activa presses that area, so much so that I often have a sore there in various stages of healing.

[-SWS]

Thanks much, Dr Falcon. I'll DEFINITELY give that a try this evening.

Why aren't you using CPAP anymore? Don't tell me the famous "Falcon" position has cured you of apnea? I gotta give that a better try than I have in the past.

Many thanks!
Barbara

Undoubtedly because of the UARS techniques in Dr. Falcon's book, which I haven't read yet : http://www.uarsrelief.com/sales.html
If anyone with UARS or just high nasal/upper-airway resistance has already read that book, please share opinions. Thanks in advance if you do.

Also, here's the Falcom sleep position for newcomers who have not yet heard of it:
wiki/index.php/Sleep_Positions

Again, Dr. Falcon, thank you very much!

[carbonman]

...ah....roger that Houston....

...we're standing by for UT throttle up.....

....over......

[Falcon1]

Thanks much, Dr Falcon. I'll DEFINITELY give that a try this evening.

Why aren't you using CPAP anymore? Don't tell me the famous "Falcon" position has cured you of apnea? I gotta give that a better try than I have in the past.

Many thanks!
Barbara

Undoubtedly because of the UARS techniques in Dr. Falcon's book, which I haven't read yet : http://www.uarsrelief.com/sales.html
If anyone with UARS or just high nasal/upper-airway resistance has already read that book, please share opinions. Thanks in advance if you do.

Also, here's the Falcom sleep position for newcomers who have not yet heard of it:
wiki/index.php/Sleep_Positions

Again, Dr. Falcon, thank you very much!

-SWS and Barbara,

I'm glad to hear that you find my post interesting. I must also thank sagesteve for mentioning this phenomenon of the 'columella response', as well as thank rooster for bringing sagesteve's post to my attention.

Regarding the reason why I no longer need to rely on cpap therapy for my Upper Airway Resistance Syndrome (UARS), it has been the result of a progression of a few different remedies which I have come across over time. (UARS, by the way, is considered by sleep specialists to be akin to a mild version of obstructive sleep apnea.)

Initially, a few years back I discovered the benefit of regularly taking a non-sedating antihistamine, such as Claritin (Loratidine), at BEDTIME; and I found that it effectively reversed my nighttime nasal congestion and swelling (which I didn’t previously even know that I had)! This practice then eliminated my UARS symptoms and therefore my need for cpap, which I had been using for several years. I described this in an earlier post here: viewtopic/t36483/viewtopic.php?f=1&t=36 ... 15#p319026

(Barbara, It sounds like you already discovered the benefits of taking a Claritin at bedtime, as well, even before you began cpap for your sleep apnea; and you now still continue this practice to augment your cpap therapy.)

Subsequently, I experimented and found that I benefited greatly from several different natural, drug-free methods which can reverse nasal mucosal congestion and inflammation; namely, the use of probiotics and herbals, in addition to dietary factors. I discuss these in another previous post here:
viewtopic.php?f=1&t=43714&p=388456#p388456

Presently, I rely on these natural methods alone. And yes, I still sleep in the Falcon position to this day, which also helps alot.

Of course, I didn't invent this sleeping position, I merely described it previously on this forum and posted photos of it in order to illustrate what it looks like. I actually have to humbly credit san_fran_gal for giving it the nickname "Falcon position": viewtopic.php?f=1&t=36738&p=319598#p319364

I must also mention the use of periodic nasal sinus irrigation, which is another natural method I find to be of great benefit. I describe the method I use in this post here:
viewtopic.php?f=1&t=36738&st=0&sk=t&sd=a#p319080

Best regards,

Dr Falcon

[rested gal]

Just now, I tried pressing my finger firmly against the columella.

Before I started, right nostril was semi-stuffy (could still get air through it) and left nostril was clear.

About 3 minutes into my five minute experiment, the left nostril was still clear, but right nostril was completely blocked...too stuffy to get any air at all through it.

At 5 minutes, still the same. Left nostril still clear. Right nostril completely stuffed up.

I took my finger off the area. Within seconds, my right nostril (the now completely congested one) allowed enough air to be breathed through it as when I had started the experiment -- back when it was "semi-stuffy."

Left nostril was unchanged -- clear before, clear during, clear after.

I pressed my finger there again for one second against the columella. Instantly my right nostril closed up...was completely stuffy -- could not breathe in any air through it.

I took my finger away. Instantly my right nostril was just "semi-stuffy" again -- could breathe "some" air through it again.

I repeated the pressure/no pressure on the columella several times in quick succession.

Each time, during the one second while I put pressure on the columella, it immediately caused my right nostril to not allow any air through. Each time I removed my finger after a second, the nostril instantly became only "semi-stuffy."

All of that was immediately after finishing the 5 minute experiment of steady finger pressure on the columella.

A few minutes later, putting pressure on the columella for a few seconds did not elicit any change. I didn't try the five minute test again.

[-SWS]

I’d be curious to hear from others if they have any other insights, or further information, on this topic.

Well, Dr. Falcon, I tried it twice with pressure approximately equal to CPAP mask pressure on that spot (if I used something other than a Quattro FFM) . Both times I progressed quickly from a baseline of slightly swollen nasal passages to only slightly more rhinitis type swelling. Then I tried a third time with a LOT more pressure----certainly more than a CPAP mask would apply. That time I more quickly elicited a more drastic swelling response. I'm not sure if there was a change in mucous discharge, however. I don't think so.

I asked my wife to try the test. She applied a good amount of pressure and received absolutely no response of any kind. However, she does not have any symptoms whatsoever of SDB.

...ah....roger that Houston....

...we're standing by for UT throttle up.....

....over......

I think your CPAP treatment worked out faaaaar better than you and your doctor ever dreamed.

I’d be curious to hear from others if they have any other insights, or further information, on this topic.

If you don't mind, Dr. Falcon I'll stretch that invitation to comment on your book: I wonder if your book's title undershoots the scope of SDB patients who stand to benefit from the material inside.

When I repeatedly evaluated your book's UARS-related title, each time I came away with doubts about whether the book was applicable to me---since I don't have a UARS diagnosis. However, when I scan the chapter titles, it occurs to me that the information contained in the book is perhaps VERY important to SDB patient like me. That's the reason I was hoping to generate some informal reader reviews in my first post. I can clearly see that not everything in your book might suit my circumstances. But I also get the impression that there's actually quite a bit of information in that book that just might be not only relevant, but important to me.

Why might the work in your book be important to a patient like me---an OSA patient without a UARS diagnosis? Well, we know that there are plenty of non-UARS patients on all the message boards who find that nasal and sinus problems throw a wrench into their CPAP therapy in a big way. Some of them don't seem to tolerate CPAP therapy without addressing nasal problems. They might not be able to relinquish CPAP as you did, because of frank apneas and frank hypopneas. But they sometimes discover that addressing nasal and/or sinus problems is an absolutely necessary adjunct treatment in tandem with CPAP.

I most often need about 8 cm to address my usual abundant hypopneas sprinkled with fewer apneas. However, on rhinitis nights like tonight, my APAP will need to stent my airway open with 10cm instead. Neither pressure is problematic for me. However, lower CPAP pressures, complements of adjunct treatment methods, conceivably coverts some CPAP-intolerant patients into CPAP-tolerant patients thanks to those lower pressures. At progressively higher pressures CPAP patients seem to take on a variety of pressure-related challenges: aerophagia, puffing cheeks, mask leaks, disruptive pressure/flow stimuli on the face, airway receptor stretch, etc. If lowering airway resistance brings down required pressure, some of those CPAP-intolerant frank OSA patients presumably become tolerant to their lifesaving machine.

Then there's room for conjecture about heightened neuromuscular workload that high upper airway resistance might impose on non-UARS patients: some COPD researchers speculate that nothing more that COPD's extra neuromuscular WOB during sleep (irrespective of sleep architecture effects) brings on daytime fatigue. If that's true, then non-UARS patients with high airway resistance might owe some of their daytime fatigue to extra neuromuscular WOB from high yet non-occlusive airway resistance.

The long story short is that there just might be far more SDB patients without UARS diagnoses who stand to benefit from correcting upper airway resistance problems than UARS patients---considering respective patient population sizes.

______________________________________________________________________________________________________________________________


Thanks for the way you come here to engage us with helpful and interesting information, Dr. Falcon. Much appreciated.

[Muse-Inc]

No mask issues, my major CPAP therapy challenge has always been and remains congestion.

...heightened neuromuscular workload that high upper airway resistance might impose on non-UARS patients: some COPD researchers speculate that nothing more that COPD's extra neuromuscular WOB during sleep (irrespective of sleep architecture effects) brings on daytime fatigue. If that's true, then non-UARS patients with high airway resistance might owe some of their daytime fatigue to extra neuromuscular WOB from high yet non-occlusive airway resistance.

The long story short is that there just might be far more SDB patients without UARS diagnoses who stand to benefit from correcting upper airway resistance problems than UARS patients---considering respective patient population sizes...

I think this applies to me: as I sit here I'm aware of needing to use more ribcage effort to breathe in, the same effort that makes my APAP increase quickly in pressure. I can breathe thru my nose, it just takes more effort. Seems to me I have 2 airway areas that narrow, one is high up sorta behind nose and slightly below my eyes (sensitive to my variable congestion, I assume this was likely the cause of my high respiratory arousals) and the other when-if my jaw slips backwards towards throat; the first I can help with anti-congestion practices, the other by side-sleeping; both with CPAP airway stenting. Thanks for the headsup -SWS re Falcon's book, will ck it out. As I continue losing wt, my 'awake' breathing continues to improve (less effort) so I assume that's why my pressure requirements are decreasing; while I've had congestion at bedtime the past wk or so, the past 2 mornings, I've woken up with no congestion and pressure=6.9 on my APAP...pretty cool. Days when my pressure's been up with typically with higher numbers and almost always with more congestion, I am more tired than usual...never considered it might be because of arousals or just the NM workout...hmmmm, maybe that's why I became intolerant of exhaling against pressure on straight CPAP at a higher rate, I know my lower ribcage was staying sore for hours the next day.

...Thanks for the way you come here to engage us with helpful and interesting information, Dr. Falcon. Much appreciated.

Ditto!

[-SWS]

Days when my pressure's been up with typically with higher numbers and almost always with more congestion, I am more tired than usual...never considered it might be because of arousals or just the NM workout...hmmmm, maybe that's why I became intolerant of exhaling against pressure on straight CPAP at a higher rate, I know my lower ribcage was staying sore for hours the next day.

Since we both inhale and exhale, that positive CPAP pressure during both respiratory phases is akin to a double-edged knife so to speak: it can mechanically unload inspiration for us, but it also mechanically loads expiration. As a patient population, we tolerate that expiratory-phase mechanical loading imposed by CPAP to varying degrees. Some of us don't tolerate it so well...

Lower ribcage soreness is a sign that natural elastic recoil of the lungs during expiration was insufficient for you---again, because of CPAP's mechanical loading effect during expiration. More CPAP pressure during expiration amounts to more mechanical loading during exhalation. And anytime natural elastic recoil falls short during expiration, the accessory muscles tend to get involved with the neuromuscular work of exhalation. Hence the sore rib muscles. Naturally, lower CPAP or BiLevel pressures during exhalation impose less mechanical loading during exhalation. Then, as you pointed out, higher CPAP pressures have an increased tendency to produce a variety of stimuli-based arousals irrespective of also imposing expiratory WOB.

While we can't all get away from CPAP as Dr. Falcon did, adjunct treatment methods conceivably stand to help many of us in my opinion... A reminder that I am not a physician or health professional of any kind.

[Falcon1]

Thanks to everyone who has contributed to this informal investigation so far.

For anyone who's interested, here is a summary of findings of this forum's readers after the first few days of this post. So far, there's a total of six anecdotal reports, which include the report of the spouse of a reader (-SWS's spouse).

Regarding self-applied pressure on the columella (e.g., for at least five minutes), the findings are as follows:

1. Two persons w/a response of increased congestion (Falcon1, Muse-Inc)
2. One person w/a response of increased congestion, only in a single, pre-congested nostril (restedgal)
3. One person went from "a baseline of slightly swollen nasal passages to only slightly more rhinitis type swelling" (-SWS)
4. Two persons with no response (e.g., no increased congestion) (OutaSync, -SWS's spouse)

Regarding self-applied pressure on the columella-labia angle: There were two reports of no response (myself and Muse-Inc).


Compilation of Reports of findings for the columella response:
--------------------------------------------------------------------------
Falcon1 (myself) "After five minutes of [columella] pressure I noticed that some congestion (nasal discharge) seemed to build up in my nose over the course of the five minute period, which didn’t seem to be there previously....Afterwards I took a tissue and blew my nose to remove the discharge which had built up. Right after I blew my nose, I noticed that I seemed to be able to breathe even more freely and easily than before I started the experiment, just five minutes or so earlier.

"Later, I then tried the same experiment, but this time I put pressure on my columella-labia angle. I had no response (e.g., I had no feeling of a buildup of nasal discharge, like I experienced with pressure on my columella alone)."

--------------------------------------------------------------------------
Muse-Inc "Pressure against the angle = no change. Light squeeze of columella = more congestion, no discharge...now (about 20 mins later), still slightly more congested. Pressure lasted 5 mins."

--------------------------------------------------------------------------
OutaSync "5 minutes of pressure on my coumella [sic] resulted in no change. Right nostril was completely stuffed before experiment and same after experiment."

--------------------------------------------------------------------------
rested gal [With pressure against the columella] "Before I started, right nostril was semi-stuffy (could still get air through it) and left nostril was clear. About 3 minutes into my five minute experiment, the left nostril was still clear, but right nostril was completely blocked...too stuffy to get any air at all through it. At 5 minutes, still the same. Left nostril still clear. Right nostril completely stuffed up.

"I took my finger off the area. Within seconds, my right nostril (the now completely congested one) allowed enough air to be breathed through it as when I had started the experiment -- back when it was "semi-stuffy."

"Left nostril was unchanged -- clear before, clear during, clear after.

"I pressed my finger there again for one second against the columella. Instantly my right nostril closed up...was completely stuffy -- could not breathe in any air through it.

"I took my finger away. Instantly my right nostril was just "semi-stuffy" again -- could breathe "some" air through it again.

"I repeated the pressure/no pressure on the columella several times in quick succession.

"Each time, during the one second while I put pressure on the columella, it immediately caused my right nostril to not allow any air through. Each time I removed my finger after a second, the nostril instantly became only "semi-stuffy."

"All of that was immediately after finishing the 5 minute experiment of steady finger pressure on the columella.

"A few minutes later, putting pressure on the columella for a few seconds did not elicit any change. I didn't try the five minute test again."

--------------------------------------------------------------------------
-SWS "I tried it twice with pressure approximately equal to CPAP mask pressure on that spot...Both times I progressed quickly from a baseline of slightly swollen nasal passages to only slightly more rhinitis type swelling. Then I tried a third time with a LOT more pressure----certainly more than a CPAP mask would apply. That time I more quickly elicited a more drastic swelling response. I'm not sure if there was a change in mucous discharge, however. I don't think so.

"I asked my wife to try the test. She applied a good amount of pressure and received absolutely no response of any kind. However, she does not have any symptoms whatsoever of SDB."
--------------------------------------------------------------------------

The above findings obviously represent a limited, anecdotal, unscientific sampling. Numerous factors conceivably could potentially influence the type and degree of responses which a patient might experience, if any, in reaction to pressure on the columella, or the columella-labia angle. These factors could include such things as time-length of pressure, degree and angle of pressure, position of the patient (e.g., standing, sitting, lying down), underlying medical conditions, etc.

Yet, with experiments and observations involving any given size sampling of patients, a spectrum of reactions and responses is most often the typical finding. It's been wisely stated that grasping for certainties and insisting upon absolutes leads to futility, at least as far as it applies to human physiologic responses. The vast body of data in the medical sciences field does nothing but confirm this conclusion, as far as I can tell. I guess, more often than not, the aphorism 'nature loves variety' gets affirmed.

- Eric Falcon, MD

[Falcon1]

....The long story short is that there just might be far more SDB patients without UARS diagnoses who stand to benefit from correcting upper airway resistance problems than UARS patients---considering respective patient population sizes.

Thank you for the suggestion, -SWS, and I agree with you. I'll act on the idea of a broader title, or else a separate volume, as soon as I get the opportunity.

Even more importantly, I plan to continue spreading the word about the cpaptalk.com forum to others. I believe it's an invaluable resource for those with any sort of Sleep Disordered Breathing (SDB), whether using xpap or not.

In my opinion, the internet has afforded the fields of medicine and health a giant leap forward in their evolution, at least from the patient's standpoint, that is!

Sir (Dr) William Osler, one of the medical profession's most revered and legendary physician-teachers, taught that the most valuable medical skill which student doctors could develop was the skill of listening carefully to their patients.

I look forward to the day when it becomes a standard part of medical residency training for doctors to spend time weekly reading patient-centered, on-line forums, and learning more about patients' experiences, challenges, complaints, and successes.

It would also be beneficial and enlightening for doctors who have already graduated from residency to stay exposed to on-line patient forums related to their specialties. For example, sleep medicine and ENT specialists, allergists, internists, and family physicians all would benefit from exposure to this cpaptalk forum, at least on an intermittent basis.

The "taking care of our own" attitude that is displayed by so many of the cpaptalk forum regulars here, towards their fellow xpap users and xpap newbies, is remarkable. I find the sense of contribution and selflessness displayed here to be impressive.

Xpap users are incredibly fortunate, I believe, that the growth of the internet forum phenomena has occurred nearly simultaneously with the development of modern xpap technology itself.

In essence, this forum is participating in no less than the birth and creation of the science and art of xpap usage, with all of its intricacies, subtleties, and variations - at least as much, if not more so, than many medical scientists in the field, as well as many academic lecturers and aloof clinicians, who may have never even tried on a cpap mask.

The impressive body of knowledge that this forum has generated, comprised of numerous invaluable patient insights, anecdotes, and contributions over the years, may benefit generations of xpap newbies to come. The cpaptalk.com wiki which is under development is another brilliant resource.

Granted, the anonymity of the internet means that misinformation and disinformation may abound. Patients who consult on-line sources for health advice should exercise a healthy level of caution, and anything one comes across on the internet should of course be 'taken with a grain of salt', so to speak. I hope readers stay mindful of the importance of checking things out against multiple sources, and gaining exposure to a variety of different viewpoints and opinions, on matters of interest. Also, don't forget intuition and common sense, as well. Usage of any medication should always be done in consultation with a healthcare professional, of course.

However, there are plenty of suggestions and home-remedies that can be found on patient-centered forums like this, which are easy-to-try, inexpensive, and relatively harmless, which can make a huge difference in many patients' quality of life, health, and comfort.

Keep up the great work.

- Eric Falcon, MD

[GumbyCT]

The long story short is that there just might be far more SDB patients without UARS diagnoses who stand to benefit from correcting upper airway resistance problems than UARS patients---considering respective patient population sizes. ______________________________________________________________________________________________________________________________
Thanks for the way you come here to engage us with helpful and interesting information, Dr. Falcon. Much appreciated.

Was my sleep doctor not correct when she said that "anyone with OSA has UARS"?

Echoing the thanks above

[Falcon1]

Was my sleep doctor not correct when she said that "anyone with OSA has UARS"?

Echoing the thanks above

GumbyCT,

This might be a matter of how the term UARS is being used. As a general concept, 'upper airway resistance' is present in anyone with Obstructive Sleep Apnea, since the "obstructive" part of OSA entails some portion of the upper airway causing airway resistance (and periodically, complete obstruction). Typically, it's the tongue falling down into the back of the throat when asleep, but it may also include enlarged nasal turbinates, deviated nasal septum, nasal congestion and inflammation, etc, as well.

However, usually as a formal diagnosis, Upper Airway Resistance Syndrome (UARS) is a separate diagnosis from OSA. The diagnosis of UARS typically is applied to individuals who have undergone a sleep study and have not been found to have periods of actual 'apneas' (breathing cessation) during sleep, but rather who have the subjective symptoms of OSA, and who have subtle forms of nighttime breathing irregularities, associated with sleep fragmentation.

However, Dr Barry Krakow has an extensive entry in this forum's Wiki here wiki/index.php/UARS, and he mentions that UARS may not be mutually exclusive of apneas. Dr Krakow, a sleep specialist, states "You can have all three types of events [apneas, hypopneas, and UARS] when you are diagnosed with sleep-disordered breathing (SDB). In fact, the most common type of SDB shows all 3 components in varying proportions during the sleep study."

So, your sleep doctor may be referring to the same phenomenon that Dr Krakow is alluding to, in this Wiki entry.

Best regards.