March is National Sleep Awareness Month, a time often focused on getting enough hours of sleep. Yet in dental practice, we frequently see patients who are not struggling with how long they sleep, but with how well they sleep—often without realizing it. While sleep-disordered breathing is commonly associated with loud snoring or older individuals, a lesser-known condition called Upper Airway Resistance Syndrome (UARS) is increasingly affecting a very different group: young, fit, and often female patients.
Beyond the Stereotype
Unlike classic sleep apnea, where breathing fully stops, UARS involves a partial narrowing of the airway. Breathing continues, but with increased effort throughout the night. Because oxygen levels often remain within normal ranges, standard sleep studies may come back “normal,” leaving patients with persistent fatigue, brain fog, irritability, and unrefreshing sleep—with no clear explanation.
The “Tired but Wired” State
UARS often stems from structural factors such as a narrow palate, small jaw, or limited tongue space. To keep the airway open, the body compensates by activating the sympathetic nervous system—the “fight or flight” response. This triggers the release of adrenaline and cortisol, allowing breathing to continue but preventing true rest.
As a result, patients may feel exhausted yet unable to fully relax or sleep deeply. Common accompanying symptoms include anxiety, cold hands and feet, digestive issues, and difficulty unwinding. In women, hormones such as progesterone can temporarily mask symptoms, which may worsen during hormonal shifts like menstrual cycles or menopause.
Dental Red Flags We Look For
Dentists are often uniquely positioned to detect signs of airway strain during routine exams. Common indicators include:
- Bruxism (teeth grinding): Often a reflexive attempt by the brain to move the jaw forward and reopen the airway.
- Scalloped tongue: Indentations along the tongue’s edges suggest it is crowded within a narrow dental arch.
- Narrow or high palate: Reduces nasal airflow and encourages mouth breathing.
- Tongue tie (ankyloglossia): Restricts tongue mobility, increasing the likelihood of airway obstruction during sleep.
- Enlarged tonsils: These can significantly narrow the airway, increasing breathing effort at night.
Why Sleep Stops Being Restorative
Sleep is an active, restorative process. We cycle through non-REM and REM sleep every 90 to 120 minutes. Deep sleep supports physical repair and immune function, while REM sleep is essential for emotional regulation and memory.
In UARS, the body repeatedly triggers brief, unremembered awakenings—called micro-arousals—to restore airflow. These interruptions fragment sleep, preventing the brain from reaching and sustaining its most restorative stages.
Breathing Better to Sleep Better
Restorative sleep is foundational to overall health. If you feel persistently exhausted despite sleeping through the night, or if your dentist has noted signs like teeth grinding or a narrow palate, it may be time to look beyond sleep duration and consider airway health. This March, focusing on breathing better may be the key to finally sleeping better.
