I'd wake in the middle of the night, gasping for breath as though surfacing from a near drowning. My heart would be racing, my skin clammy, my organs suffused with grief and fear, like I'd been pickled in some bitter brine while I slept, and now, at 2 or 3 a.m., I was fighting my way out of the jar. I'd then proceed to lie awake for hours, my life flashing before my eyes—but only the sad, bad, mad parts. Even the happy scenes curdled in this film—I was screwing up my children, ruining my marriage, wasting my life. And my life! Was I dying? This gasping and sweating in the night—something was wrong with me.
The episodes started in my early thirties and went on for years, gradually progressing in severity and frequency until, according to my Fitbit, I was averaging only four hours of sleep a night. I'd always been an insomniac, but this was a new level of hell. In the past, I'd prided myself on being an efficient, hard worker. Now I could barely keep my mind on a task for 15 minutes. My body began to break down: My ankle gave out mysteriously, and I had to wear an orthopedic boot for months. I ached everywhere. I developed rosacea. It became hard to eat out because everything but the plainest food made me sick.
I am fortunate to have good health insurance, and I put it to use. I went to my gynecologist: Was it perimenopause? No, she said, just stress and postpartum hormones. (I gave birth to my fourth child during this period—another red herring that threw everyone off: "Of course you're tired! Of course you feel crazy! You are crazy.") I went to my general practitioner: Was it cancer, Lyme disease, hyperthyroidism, early-onset Alzheimer's? He tested me for all of them. Nope. I went to a gastroenterologist and a nutritionist, who failed to find anything wrong with my stomach or diet. I went to a psychiatrist, who diagnosed anxiety and prescribed sleeping pills, which did not help me get more sleep but did make me feel more cotton-headed the day after I took them.
I followed all the "sleep hygiene" advice: no naps, getting out of bed at the same time every day, no caffeine, no screens an hour before bed. I exercised daily. I took lavender baths, hung blackout curtains, wore a sleep mask and earplugs. I took a seminar on stress reduction. I meditated. I tried sleeping in a different room from my husband. I tried giving up wheat, dairy, sugar, and— finally, painfully—wine. Nothing worked.
And then I crunched through the night guard I wore to stop me from grinding my teeth at night. Oddly enough, it was my dentist, Michael Gelb, who diagnosed my problem when I went to get a new one. He peered down my throat and then motioned for his assistant to come over. "Look at that big tongue! No wonder!" he exclaimed. He turned to me. "This is easy. I know what you have. You're waking up in a panic? In a cold sweat? Like someone just threw a rock through your window?" he asked. Yes, yes, yes, I told him. "You have low blood pressure? Cold feet?" Uh, yeah. "You have anxiety?" Yes.… "You had your wisdom teeth out? Were you ever told you needed a palate expander as a kid?" Umm…yes? "You have UARS. It's the young, thin, beautiful women's sleep disorder. You should write about it!"
In the 15 years I've known Dr. Gelb, he has never steered me wrong—an expert in jaw pain and snoring, he's cured both my TMJ and my husband's log-sawing. And yet, he's such a smooth salesman, such an adept self-promoter, and so quick to diagnose problems that can only be resolved with $4,000 retainers, I'm sometimes inclined to disbelieve him. I couldn't hold my freakishly huge tongue in check: "Dr. Gelb, please. The 'beautiful women's sleep disorder?' " I laughed. "That's not a thing."
Gelb snap-snapped at his assistant, who printed out an inch-thick stack of research articles from reputable journals. Turns out, UARS is a thing. Upper airway resistance syndrome was identified in adults nearly 25 years ago by medical researchers at Stanford University. It's a form of sleep- disordered breathing in which people get slightly less air than they should because some part of their airway is too narrow and—though they're not actually in danger—their body perceives they're suffocating and wakes them up.
The American Academy of Sleep Medicine categorizes UARS as a form of obstructive sleep apnea syndrome (OSA)—but UARS's effects are subtler and its diagnosis trickier than the apnea most people are familiar with. Because the research on it is broad but rather shallow—and includes few randomized, controlled trials—sleep experts disagree about almost every aspect of the disorder, from whether it's distinct from OSA to the best therapies to ameliorate it. The exact prevalence of UARS isn't known—in part because it's thought to be so underdiagnosed—but the National Sleep Foundation estimates that 18 million Americans suffer from apnea overall, two or three men for every woman.
That said, there are some established facts about UARS: While OSA is associated with being older, heavier, and male, UARS sufferers are typically younger, leaner, and predominantly female, according to epidemiological data. A petite build may be a risk factor, because smaller bodies have smaller airways, which can be more easily crowded by adenoids, the tongue, and the uvula, as well as relaxation of the throat during sleep. (And while the literature is silent on the topic of beauty and UARS, one physician told me anecdotally that the facial structure that can put a woman at risk for UARS is sometimes linked with beauty in our culture: a small jaw and nose.) High blood pressure commonly occurs in tandem with OSA; the opposite is true for UARS, in which blood pressure can be so low that it leads to fainting and chronically cold extremities. UARS patients don't always snore or stop breathing—symptoms a bed partner would likely notice—but they tend to complain of greater fatigue than people with standard apnea do.
It sounded too good to be true: Curing my sleep disorder would cure my anxiety, stomach problems, everything.
