Natalie
@nataliezzz.bsky.social
Sharing info on the connection between sleep-disordered breathing/upper airway resistance syndrome (UARS) & ME/CFS & related disorders. Mostly following art accounts here to have a chill feed; don’t be offended if I don’t follow you. On Xitter @nataliezzz3
PSG findings suggested UARS. Upon treatment with CPAP, "his complaints resolved dramatically." The authors concluded: "This case seemed interesting in showing that UARS may clinically present as symptoms of chronic fatigue, anxiety and depression in young, non-obese people." 60/n
October 15, 2025 at 9:28 PM
PSG findings suggested UARS. Upon treatment with CPAP, "his complaints resolved dramatically." The authors concluded: "This case seemed interesting in showing that UARS may clinically present as symptoms of chronic fatigue, anxiety and depression in young, non-obese people." 60/n
Case report: 17-year old male with complaints of chronic fatigue, insomnia, social and academic problems was unsuccessfully treated for anxiety, depression and insomnia with hypnotics, sedatives and antidepressants. He was referred for PSG for insomnia eval; 59/n
www.researchgate.net/publication/...
www.researchgate.net/publication/...
October 15, 2025 at 9:28 PM
Case report: 17-year old male with complaints of chronic fatigue, insomnia, social and academic problems was unsuccessfully treated for anxiety, depression and insomnia with hypnotics, sedatives and antidepressants. He was referred for PSG for insomnia eval; 59/n
www.researchgate.net/publication/...
www.researchgate.net/publication/...
While the diagnosis of UARS has been absorbed under OSA in the International Classification of Sleep Disorders – Third Edition (ICSD-3), it has been debated from the beginning (continuing to today) whether or not UARS & OSAS are distinct disorders (links to follow). 7/n
September 22, 2025 at 8:25 PM
While the diagnosis of UARS has been absorbed under OSA in the International Classification of Sleep Disorders – Third Edition (ICSD-3), it has been debated from the beginning (continuing to today) whether or not UARS & OSAS are distinct disorders (links to follow). 7/n
They chose a cutoff of ≥ 10 arousals/hour based on a small previous study 🔽, tho later data has shown that healthy ppl w/out OSA (RERAs weren't scored/taken into account in this study) or PLMD can have arousal indexes well over 10 (esp. with advancing age). 6/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
September 22, 2025 at 8:25 PM
They chose a cutoff of ≥ 10 arousals/hour based on a small previous study 🔽, tho later data has shown that healthy ppl w/out OSA (RERAs weren't scored/taken into account in this study) or PLMD can have arousal indexes well over 10 (esp. with advancing age). 6/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
UARS was first formally described in '93 by Dr. Christian Guilleminault et al. They ID'd a group of hypersomnolent pts w/ mild SDB who didn't meet OSA criteria whose hypersomnolence was alleviated by CPAP (snoring wasn't actually required; 2/15 didn't snore). 5/n
journal.chestnet.org/article/S001...
journal.chestnet.org/article/S001...
September 22, 2025 at 8:25 PM
UARS was first formally described in '93 by Dr. Christian Guilleminault et al. They ID'd a group of hypersomnolent pts w/ mild SDB who didn't meet OSA criteria whose hypersomnolence was alleviated by CPAP (snoring wasn't actually required; 2/15 didn't snore). 5/n
journal.chestnet.org/article/S001...
journal.chestnet.org/article/S001...
Here are OSA severity levels (unless otherwise specified, I will be using these cutoffs when referring to mild/moderate/severe OSA). However, I forgot to specify for the study below that UARS was considered AHI <10 (mild/mod OSA: AHI 10-39; mod/severe OSA: AHI ≥ 40). 4/n
bsky.app/profile/nata...
bsky.app/profile/nata...
September 22, 2025 at 8:25 PM
Here are OSA severity levels (unless otherwise specified, I will be using these cutoffs when referring to mild/moderate/severe OSA). However, I forgot to specify for the study below that UARS was considered AHI <10 (mild/mod OSA: AHI 10-39; mod/severe OSA: AHI ≥ 40). 4/n
bsky.app/profile/nata...
bsky.app/profile/nata...
Guidelines for scoring apneas & hypopneas as obstructive vs. central. Diagnosis of central sleep apnea (CSA): central AHI ≥5 with >50% of all events being central. CSA is much less common than OSA (& typically a complication of conditions like heart failure/stroke or use of certain meds/drugs). 3/n
September 22, 2025 at 8:25 PM
Guidelines for scoring apneas & hypopneas as obstructive vs. central. Diagnosis of central sleep apnea (CSA): central AHI ≥5 with >50% of all events being central. CSA is much less common than OSA (& typically a complication of conditions like heart failure/stroke or use of certain meds/drugs). 3/n
Apnea-hypopnea index (AHI) = mean # of apneas & hypopneas per hour of sleep. Respiratory disturbance index (RDI) = AHI + RERA index (mean # of RERAs per hour). Here are AASM scoring guidelines for apneas, hypopneas & RERAs (scoring RERAs is optional and most sleep clinics don't). 2/n
September 22, 2025 at 8:25 PM
Apnea-hypopnea index (AHI) = mean # of apneas & hypopneas per hour of sleep. Respiratory disturbance index (RDI) = AHI + RERA index (mean # of RERAs per hour). Here are AASM scoring guidelines for apneas, hypopneas & RERAs (scoring RERAs is optional and most sleep clinics don't). 2/n
The CPAP group (group 1) experienced greater improvement in symptoms compared to the control group (group 2) based on a 6-min walking test as well as Symptom Severity Scale (SS) & Short Form Health Survey (SF-36) Physical Component Summary (PCS) scores. 22/n
September 19, 2025 at 6:13 PM
The CPAP group (group 1) experienced greater improvement in symptoms compared to the control group (group 2) based on a 6-min walking test as well as Symptom Severity Scale (SS) & Short Form Health Survey (SF-36) Physical Component Summary (PCS) scores. 22/n
100 of the OSA patients with fibro were treated with CPAP and compared to a control group of 50 fibro patients treated with conventional therapy. It was noted that the control group was not adequately matched for sex/BMI. 21/n
September 19, 2025 at 6:13 PM
100 of the OSA patients with fibro were treated with CPAP and compared to a control group of 50 fibro patients treated with conventional therapy. It was noted that the control group was not adequately matched for sex/BMI. 21/n
In this study (a letter to the editor) of 900 consecutive OSA pts at a sleep clinic, 135 (15%) met ACR criteria for FM. Interestingly, 100 (74%) were men, perhaps bc men were more likely to be referred for suspected OSA (it was unstated what % of the 900 were men) 20/n
www.ejinme.com/article/S095...
www.ejinme.com/article/S095...
September 19, 2025 at 6:13 PM
In this study (a letter to the editor) of 900 consecutive OSA pts at a sleep clinic, 135 (15%) met ACR criteria for FM. Interestingly, 100 (74%) were men, perhaps bc men were more likely to be referred for suspected OSA (it was unstated what % of the 900 were men) 20/n
www.ejinme.com/article/S095...
www.ejinme.com/article/S095...
Here is a follow-up study of 94 UARS patients 4.5 years after they were diagnosed with UARS. Insurance refused to provide CPAP for 90/94 patients. When will doctors help fix this disaster? (I don't blame any individual dr. btw, but individual drs. can help!) 58/n
sciencedirect.com/science/arti...
sciencedirect.com/science/arti...
September 8, 2025 at 11:32 PM
Here is a follow-up study of 94 UARS patients 4.5 years after they were diagnosed with UARS. Insurance refused to provide CPAP for 90/94 patients. When will doctors help fix this disaster? (I don't blame any individual dr. btw, but individual drs. can help!) 58/n
sciencedirect.com/science/arti...
sciencedirect.com/science/arti...
Here is a study that found that UARS pts had "more neurotic & sensitive personalities" as well as greater depression, anxiety & obsessive-compulsiveness than OSAS pts. UARS was AHI <10 so included some mild OSAS pts; of course I don't think UARS & OSAS are 54/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
September 8, 2025 at 11:32 PM
Here is a study that found that UARS pts had "more neurotic & sensitive personalities" as well as greater depression, anxiety & obsessive-compulsiveness than OSAS pts. UARS was AHI <10 so included some mild OSAS pts; of course I don't think UARS & OSAS are 54/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
BiPAP was more comfortable, I couldn't sleep w/ either for more than 2-3 hours. I underwent nasomaxillary expansion (EASE w/ Dr. Kasey Li) & tolerated BiPAP & slept through the night w/ it following the surgery. 7/n
weblync.blob.core.windows.net/orthoquo/201...
sleepapneasurgery.com/wp-content/u...
weblync.blob.core.windows.net/orthoquo/201...
sleepapneasurgery.com/wp-content/u...
September 8, 2025 at 7:18 PM
BiPAP was more comfortable, I couldn't sleep w/ either for more than 2-3 hours. I underwent nasomaxillary expansion (EASE w/ Dr. Kasey Li) & tolerated BiPAP & slept through the night w/ it following the surgery. 7/n
weblync.blob.core.windows.net/orthoquo/201...
sleepapneasurgery.com/wp-content/u...
weblync.blob.core.windows.net/orthoquo/201...
sleepapneasurgery.com/wp-content/u...
UARS: A snippet of my breathing from my in-lab PSG 🔽 Flattening on top of airflow curves of nasal signal = inspiratory flow limitation (IFL). From what I reviewed, close to 100% of my breaths were flow limited. I also met UARS criteria based on RDI (AHI + RERA index), but this is not a reliable 5/n
September 8, 2025 at 5:28 PM
UARS: A snippet of my breathing from my in-lab PSG 🔽 Flattening on top of airflow curves of nasal signal = inspiratory flow limitation (IFL). From what I reviewed, close to 100% of my breaths were flow limited. I also met UARS criteria based on RDI (AHI + RERA index), but this is not a reliable 5/n
I developed PEM, OI & pain later on (I likely had some degree of dysautonomia prior to onset as I often had cold hands/feet, esp. during sleep). I was mild for the first 3 years & then declined w/ a Chikungunya infection, then remained moderate for 10 years. My diagnoses (from my ME/CFS doctor): 4/n
September 8, 2025 at 5:28 PM
I developed PEM, OI & pain later on (I likely had some degree of dysautonomia prior to onset as I often had cold hands/feet, esp. during sleep). I was mild for the first 3 years & then declined w/ a Chikungunya infection, then remained moderate for 10 years. My diagnoses (from my ME/CFS doctor): 4/n
Two factors likely determine UARS severity: 1) % IFL 2) how sensitized one is to IFL. So is there a % IFL threshold below which one is not at risk for UARS? This study attempted to provide an answer, but we don't actually know. Here's Dr. Gold's take on it 🔽 20/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
September 8, 2025 at 3:01 PM
Two factors likely determine UARS severity: 1) % IFL 2) how sensitized one is to IFL. So is there a % IFL threshold below which one is not at risk for UARS? This study attempted to provide an answer, but we don't actually know. Here's Dr. Gold's take on it 🔽 20/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
So how exactly is UARS causing PEM? Well, Dr. Renz-Polster explained in detail in his hypothesis piece how a dysfunctional CNS stress response leads to PEM; the only piece he was missing was what is actually causing the dysfunctional CNS stress response - UARS! 26/n
bsky.app/profile/nata...
bsky.app/profile/nata...
September 7, 2025 at 8:50 PM
So how exactly is UARS causing PEM? Well, Dr. Renz-Polster explained in detail in his hypothesis piece how a dysfunctional CNS stress response leads to PEM; the only piece he was missing was what is actually causing the dysfunctional CNS stress response - UARS! 26/n
bsky.app/profile/nata...
bsky.app/profile/nata...
Orthostatic intolerance (OI): started with orthostatic hypotension (OH) type symptoms (sx): lightheadedness/losing vision on standing, & later developed hyperadrenergic sx too. Fluctuated significantly; I've had both OH & hyperPOTS on NASA lean tests. Tilt table test: positive for (hyper) POTS. 2/n
September 7, 2025 at 8:27 PM
Orthostatic intolerance (OI): started with orthostatic hypotension (OH) type symptoms (sx): lightheadedness/losing vision on standing, & later developed hyperadrenergic sx too. Fluctuated significantly; I've had both OH & hyperPOTS on NASA lean tests. Tilt table test: positive for (hyper) POTS. 2/n
I'm confident I meet criteria for ME/CFS (& that I have UARS). I've been diagnosed w/ ME/CFS by 3 ME/CFS specialists & 2-day CPET (my results 🔽), tho I don't think 2-day CPET is a reliable diagnostic test after reading this article by @mecfsskeptic.bsky.social: 🧵 1/n
mecfsscience.org/the-biggest-...
mecfsscience.org/the-biggest-...
September 7, 2025 at 8:27 PM
I'm confident I meet criteria for ME/CFS (& that I have UARS). I've been diagnosed w/ ME/CFS by 3 ME/CFS specialists & 2-day CPET (my results 🔽), tho I don't think 2-day CPET is a reliable diagnostic test after reading this article by @mecfsskeptic.bsky.social: 🧵 1/n
mecfsscience.org/the-biggest-...
mecfsscience.org/the-biggest-...
For those skeptical that CCI can cause PEM, read Jen Brea's & Jeff Wood's accounts of their sx (incl. PEM) being fully & quickly cured by CCI surgery (same for Jeff being put in a halo brace 🔽). PEM can be caused by CCI & thus 20/n
www.mechanicalbasis.org/mystory
jenbrea.medium.com/health-updat...
www.mechanicalbasis.org/mystory
jenbrea.medium.com/health-updat...
September 6, 2025 at 9:26 PM
For those skeptical that CCI can cause PEM, read Jen Brea's & Jeff Wood's accounts of their sx (incl. PEM) being fully & quickly cured by CCI surgery (same for Jeff being put in a halo brace 🔽). PEM can be caused by CCI & thus 20/n
www.mechanicalbasis.org/mystory
jenbrea.medium.com/health-updat...
www.mechanicalbasis.org/mystory
jenbrea.medium.com/health-updat...
of w/ delayed-onset PEM associated w/ enduring declines are ME/CFS & CCI/brainstem compression, which both involve a major perturbation to the brain/CNS. There may be different features of PEM in ME/CFS vs. CCI tho (e.g. "tired but wired" seems like an almost universal feature of PEM in ME/CFS) 19/n
September 6, 2025 at 9:26 PM
of w/ delayed-onset PEM associated w/ enduring declines are ME/CFS & CCI/brainstem compression, which both involve a major perturbation to the brain/CNS. There may be different features of PEM in ME/CFS vs. CCI tho (e.g. "tired but wired" seems like an almost universal feature of PEM in ME/CFS) 19/n
to be a flavor of PEM in some Sjogren's pts (Sjogren's can affect the CNS & PNS), tho it may have different features in terms of lacking the delayed onset & possibility of leading to enduring declines in baseline seen in ME/CFS. The only disorders I'm aware 18/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
September 6, 2025 at 9:26 PM
to be a flavor of PEM in some Sjogren's pts (Sjogren's can affect the CNS & PNS), tho it may have different features in terms of lacking the delayed onset & possibility of leading to enduring declines in baseline seen in ME/CFS. The only disorders I'm aware 18/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
of ME/CFS in general (most dramatically in severe ME/CFS, but pts across severity levels report feeling better on benzos even when not in PEM). A striking report from @whitneydafoe.bsky.social re: dramatic/rapid-onset effects of Ativan. In the blog post, Whitney 14/n
whitneydafoe.com/mecfs/?post=...
whitneydafoe.com/mecfs/?post=...
September 6, 2025 at 9:26 PM
of ME/CFS in general (most dramatically in severe ME/CFS, but pts across severity levels report feeling better on benzos even when not in PEM). A striking report from @whitneydafoe.bsky.social re: dramatic/rapid-onset effects of Ativan. In the blog post, Whitney 14/n
whitneydafoe.com/mecfs/?post=...
whitneydafoe.com/mecfs/?post=...
to be aware of benzo-induced neurological dysfunction (BIND): a group of neurological symptoms (sx) (physical & psych.) that are the consequence of neuroadaptation &/or neurotoxicity from benzo exposure, & how the sx of BIND & ME/CFS almost entirely overlap. 11/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...
September 6, 2025 at 9:26 PM
to be aware of benzo-induced neurological dysfunction (BIND): a group of neurological symptoms (sx) (physical & psych.) that are the consequence of neuroadaptation &/or neurotoxicity from benzo exposure, & how the sx of BIND & ME/CFS almost entirely overlap. 11/n
pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov/articles/PMC...