I've Tried Everything..Why Am I So Tired All The Time?

I've Tried Everything..Why Am I So Tired All The Time?

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Hello everyone, and welcome to another episode. I'm Dr. Michael Bennett. For those of you just joining us, this podcast explores how vital sleep and breathing are to healing, longevity, and quality of life.

My background began in general dentistry, but I sold my dental practice 10 years ago to specialize in treating breathing disorders like snoring, sleep apnea, and especially upper airway resistance syndrome (UARS)—a lesser-known but highly impactful condition. What inspired this journey was the truth that healing only happens when we sleep well. If we can’t sleep, our bodies can’t heal. If we do sleep—deeply and uninterrupted—our bodies are capable of healing almost anything.

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A Real-World Case: A 13-Year-Old with Chronic Pain and Fatigue

Recently, I met a 13-year-old girl who came into my office with her mother. She suffered from chronic headaches, facial pain, jaw discomfort, neck and shoulder issues, and frequent daytime fatigue. These symptoms were unusual for someone her age. She had already undergone a sleep test called a polysomnogram (PSG). "Poly" means many, "somno" means sleep, and "gram" is the recorded data. Her PSG showed no signs of obstructive sleep apnea (OSA). According to standard medical definitions, she was sleeping fine.

Yet her symptoms told another story.

She had also been diagnosed with postural orthostatic tachycardia syndrome (POTS)—a form of dysautonomia characterized by lightheadedness or dizziness upon standing. Treatment advice included increasing her salt intake, eating smaller meals more frequently, avoiding long periods of standing, and staying hydrated. But even with these strategies, she wasn’t improving. Her life was being consumed by pain and fatigue.

Physically, she had severely underdeveloped facial structures, especially in the maxilla and mandible. Her lower jaw was positioned far back—a condition known as retrognathia—and this anatomical setup meant that her tongue was likely falling backward into her throat and airway during sleep. In my experience, that’s often a strong signal of a more subtle sleep breathing disorder: upper airway resistance syndrome.

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What Is Upper Airway Resistance Syndrome (UARS)?

UARS is considered a variant of obstructive sleep apnea. While OSA involves complete or partial collapse of the upper airway causing noticeable pauses in breathing (apneas), UARS involves smaller, subtler airflow disruptions that don’t qualify as apneas by diagnostic standards.

The upper airway includes everything from the nostrils to the vocal cords. Above the vocal cords, it’s a soft, collapsible tube composed of the nose, soft palate, tongue, and throat—quite different from the rigid trachea below. This soft section collapses easily during sleep, particularly when the bones surrounding the airway are underdeveloped or narrow.

When the nasal passages are small or inflamed—due to allergies, processed foods, environmental toxins, or genetics—they provide resistance to airflow. If the brain detects that the body is working too hard to breathe, it responds just like an EMT would: it tilts the head back, pushes the jaw forward, or triggers a reflexive movement to open the airway. This happens repeatedly throughout the night, and each movement causes a shift in the sleep cycle.

In healthy sleep, about 20% of our time is spent in REM (rapid eye movement) and another 10–20% in deep, non-REM delta wave sleep. These two stages are critical for tissue repair, hormone production, and emotional regulation. When your body has to keep adjusting to resist airway collapse, it disrupts these stages, robbing you of the restorative value of sleep.

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Why Conventional Sleep Studies Often Miss UARS

In adults, sleep apnea is defined as five or more events per hour where breathing stops for at least 10 seconds and oxygen saturation drops by at least 3%. If you don’t meet that threshold, you may be told your sleep is “normal”—even if you feel terrible during the day.

That’s where UARS comes in. It doesn’t cause a full oxygen desaturation, but it does fragment sleep in a major way. The brain detects the resistance and reacts—even if you stay technically asleep. The result is a night full of micro-arousals, never reaching those deep sleep stages. Unfortunately, there’s no universally accepted diagnostic criteria for UARS, although some researchers suggest less than five events per hour plus excessive daytime sleepiness could qualify.

Symptoms of UARS are surprisingly similar to OSA: chronic fatigue, poor concentration, frequent headaches, anxiety, insomnia, digestive issues like acid reflux or irritable bowel syndrome (IBS), and in women, even infertility.

Insomnia is particularly interesting. Patients often say they feel wired right before bed—like their brain doesn't want them to fall asleep. This may be the body’s way of avoiding a situation it knows is unsafe: a narrow airway that collapses when they’re unconscious. REM sleep—which becomes more prominent in the second half of the night—is when the body is most relaxed and airway collapse is most likely. Many UARS sufferers wake up at 3:00 AM and can't fall back asleep. This is likely their body’s panic system kicking in, releasing cortisol and adrenaline in response to airway stress.

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Diagnosing UARS: Tools and Clinical Clues

In clinical practice, many of the people who report fatigue, headaches, insomnia, anxiety, digestive problems, or even hormonal issues often show no signs of sleep apnea on a traditional polysomnogram. However, when we dig deeper—looking at their anatomy, symptoms, and sleep architecture—we often find patterns consistent with Upper Airway Resistance Syndrome (UARS).

One tool that can help identify potential sleep disorders is the Epworth Sleepiness Scale. This brief questionnaire scores how likely you are to doze off in eight different scenarios—from sitting quietly to riding in a car for an hour. Each item is scored from 0 to 3, and a total score above 10 suggests excessive daytime sleepiness and the need for further evaluation.

However, the Epworth doesn’t detect micro-arousals or fragmentation during sleep. In patients with UARS, we look for high arousal indices on a sleep test—how frequently the brain moves from deeper to lighter sleep, even if breathing technically never “stops.” These arousals, caused by subtle airway resistance, prevent you from reaching and staying in deep, restorative sleep.

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UARS Symptoms and Associated Conditions

People with UARS may present with a wide array of daytime symptoms that don't immediately appear to be related to breathing:

• Chronic headaches
• Facial and jaw pain
• Gastroesophageal reflux (GERD)
• Irritable Bowel Syndrome (IBS)
• Anxiety and depression
• Frequent awakenings or insomnia
• Hormonal imbalance and fertility issues
• Skin conditions such as psoriasis or eczema

The key to understanding UARS is recognizing how chronic airway resistance during sleep keeps the body in a low-level “fight or flight” state all night. This state—called sympathetic dominance—alters blood flow away from the digestive and reproductive systems, weakens the immune system, and reduces tissue repair.

In fact, neuroscientist Matthew Walker, author of Why We Sleep, highlights how even modest sleep loss in men causes a measurable drop in testosterone and testicle volume. Similar hormonal disruption occurs in women, impacting fertility and menstrual regularity. The reproductive and digestive systems cannot function properly without sufficient REM and deep non-REM sleep.

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Treatment Options for UARS

If you've been diagnosed with UARS—or you suspect you may have it based on symptoms—the good news is that there are effective treatment paths. Though CPAP therapy (Continuous Positive Airway Pressure) remains the most studied treatment for sleep-disordered breathing, it's not always well-tolerated—especially in UARS patients whose obstruction is not as severe.

Alternative options include:

1. Oral Appliance Therapy – These devices reposition the jaw forward to open the airway. While they don’t resolve the root cause (underdeveloped bone structures), they can offer symptomatic relief. Custom-fit appliances from a qualified sleep-trained dentist are preferred.
2. Anatomical Airway Expansion – Through systems like the Vivos Method, we use appliances that stimulate bone remodeling of the maxilla (upper jaw), nasal cavity, and mandible (lower jaw). Over time, this widens the airway and provides long-term correction—not just symptom management.
3. Surgical Interventions – For patients with anatomical obstructions such as deviated septums, enlarged turbinates, or nasal valve collapse, collaborating with an ENT specialist may be essential. Functional nasal breathing is a key part of resolving UARS.
4. Allergy Management – Allergic inflammation from food or environment can cause nasal congestion and airway swelling. Treating allergies, using air purifiers, nasal sprays like Xlear saline with xylitol, or even simple environmental changes (like showering before bed) can help.
5. Sleep Hygiene and Nutritional Support – Avoid inflammatory foods, especially late in the day. Support your body’s parasympathetic system by staying hydrated, exercising during the day, and reducing evening screen exposure.

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Treating the Root, Not Just the Symptoms

As we saw in the 13-year-old girl I mentioned earlier, her sleep test may have shown "normal" results by standard scoring. But her jaw anatomy, fatigue, headaches, and other signs pointed clearly to disrupted sleep and breathing. With careful assessment and targeted intervention—such as oral appliance therapy and nasal breathing retraining—there's every reason to expect significant improvement in her health and quality of life.

When we only treat symptoms (headaches, GI issues, anxiety, etc.) without considering how sleep fragmentation and poor breathing may be causing them, we risk cycling through medications and interventions without ever solving the underlying problem.

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Final Thoughts: Unleashing the Healing Power of Sleep

Whether you're a parent of a tired teen, a person struggling with unexplained chronic fatigue, or a clinician wanting to help patients who don’t "fit the mold," understanding Upper Airway Resistance Syndrome is key. UARS is more common than previously thought, especially among women and children. It’s often missed because standard tests focus solely on oxygen drops, not subtle arousals and movement patterns.

Sleep isn’t just a time to rest—it’s a time to heal. And when healing is disrupted by airway resistance, the consequences ripple through every system in the body.

So, if you or someone you know is tired, in pain, or just not thriving, ask the deeper questions:

• Could it be the airway?
• Could it be the sleep?
• Could it be UARS?

Work with a qualified provider, explore testing, and consider treatments like oral appliance therapy or orthopedic airway expansion. Your body wants to heal—it just needs the conditions to do so.

Until next time, breathe well, sleep deeply, and pursue the full potential of your body’s natural healing power.

Resources Mentioned:

• Vivos Therapeutics – Airway Health Solutions
• Xlear Nasal Spray with Xylitol
• Epworth Sleepiness Scale
• Why We Sleep by Matthew Walker

Stay tuned for future episodes, and feel free to share this blog with anyone seeking answers about chronic fatigue, jaw pain, or disrupted sleep.

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