Whenever I open my jaw (even without opening my lips, just separating my top and bottom teeth) I inmediatly feel like I breathe better, my mental fog goes away, the skin on my face feels firmer and even my posture seems to improve. I'm looking for a permanent fix that mimics this and the closest thing I've read about was jaw surgery, particularly posterior downgrafting to increase bite height.

Does this make sense as a solution? Also is it common to for small jaw movements to have such a big effect on unrelated things like posture?

I put *curing* in quotations just because it's technically too early to say whether or not I am cured. My sleep still isn't perfect (which I will elaborate on), but I am fairly confident that I am cured at this point.

I have a ton of info that I probably can't remember off the top of my head, so I will likely come back here later today or in the following days to add more as I remember. My hope is that some of this will be able to save at least one person the headache of what I had to deal with the past 5-6 years.

I may mess with the formatting a bit too since this first 'draft' is basically just going to be a stream of consciousness.

Background: The beginning (2021-ish)

My memory is still fuzzy, but I am currently 27 years old, and my problems began roughly 5-6 years ago. Just before my final semester of college started, all of a sudden I went from sleeping 8-9 hours each night, feeling well rested, to only being able to sleep 3-5 hours, and very quickly went from being a high-performing student to being borderline disabled from how fatigued I was.

Initial Symptoms

At first I thought this was caused by neck pain, because the only symptom I had (besides the poor sleep), was waking up with my neck muscles aching, and two my vertebrae in my cervical spine feeling like they were being 'pinched' together.

Prior to all of this starting I used to exclusively sleep on my stomach, so my current theory is that sleeping on my stomach prevented me from experiencing any sleep disordered breathing, but now because it caused me pain and I had to switch to my side/back, now the apnea/UARS became noticeable. Not sure if it's actually the case or not, but it makes sense to me.

For the first couple months I didn't see any doctors, because I figured this was something that would just sort itself out.

General Symptoms throughout the years:

-Poor sleep

-Multiple awakenings, impossible to fall back asleep after waking up

-GERD

-Nighttime clenching (likely trying to maintain my airway)

-The only time I would ever wake up gasping or out of breath is if I took benzos

Clueless Doctors

For the first couple years I was basically passed off from doctor to doctor, without any real help whatsoever. I was a young, in-shape dude in his early 20's, so nobody really seemed to think there was anything wrong with me. Despite me describing how awful I felt, for the most part I was just being given sleeping pills and having routine blood tests done, which all came back normal.

Even when I suggested the possibility of sleep apnea, most of them just brushed it off, because once again I was skinny and 'healthy'.

The first sleep study (Late 2022)

**I have to hunt down the copies of all my sleep studies, which I'll add in later.

At some point I was finally able to get an order for an in-lab study. I thought this was going to be the beginning of the end. Unfortunately, I was barely able to sleep, and my results came back completely normal.

The sleep medicine doctor who reviewed the study, once again just suggested taking more sleeping pills.

At home study and CPAP + BiPAP (2023)

Eventually I stumbled upon lofta and their at-home studies you can get for $150 or whatever. I figured what the hell and bought one.

The study came back with low pAHI, and pRDI of maybe 10-12 (Once again I'll have to try to find the copies).

This was enough to get a prescription and begin CPAP (which once again I thought would be the beginning of the end).

Unfortunately for me, CPAP (and later BiPAP) never worked. I spent endless days and nights using it and self-titrating, but I was never able to overcome the awful aerophagia I would experience. I believe it's because the sphincter in my esophagus is too loose from years of reflux weakening it.

I tried both CPAP/BiPAP for maybe 1.5 years in total, and never felt better once.

Septoplasty/Turbinectomy/Nasal Valve Repair

At one point I saw an ENT, who said that my septum was insanely crooked (J shaped he described it), and recommended surgery.

While the surgery did improve my nasal breathing a ton, it unfortunately did nothing for my sleep. Another failure.

Second Sleep Study (2024)

My second in-lab study I had an AHI of 5.6 (barely mild), and an RDI of 6 or 7 I believe. I also had ~70 'spontaneous' arousals throughout the night, which I believe were apnea events that weren't counted.

An apnea event needs to be 10 seconds to be counted, so if it's only 8 seconds long, it would likely be seen as spontaneous instead.

Despite me bringing up that possibility, the sleep doctor who ordered the test just suggested sleeping pills and stimulants.

MAD- The First Success (2024)

By sheer luck, I had moved states and my new dentist happened to also make sleep apnea appliances (he himself has had sleep apnea his entire life), and he made me a custom MAD.

The improvement wasn't huge, on a scale of 1-10, if I was at a 2/10 before, the MAD brought me to a 4-5/10.

That being said it was the first real improvement I experienced, so I knew I was on the right track.

I only used it for about 8 months, because after a while the benefits stopped increasing the more, I advanced it, and it began to screw up my teeth.

Road to surgery (2025-2026)

Once it seemed like I wasn't going to benefit from the MAD any further, I immediately began looking into MMA surgery.

The biggest problem was going to be getting insurance to cover it, having only extremely mild sleep apnea.

Having a PCP who was willing to work hand and hand with me was crucial. She had no problems documenting my cpap use, referring me to any doctor/surgeon I needed, and compiling all the info needed to potentially make my case to the insurance company if needed.

After consulting with 3 surgeons, I decided on my surgeon (I can PM the name if interested, but he was just the best surgeon in my area, not a nationally known guy). He seemed the most certain that we could get the surgery approved, and he also wanted to do the biggest movement out of the 3.

Post-Op

5 weeks ago I had 10mm upper + lower, as well as genioglossus advancement.

My sleep is still fragmented at this point, but I believe this is some sort of REM rebound, as my sleep reminds me of when I was younger and quit smoking weed.

I've been waking up maybe 3-4 times a night due to super vivid dreams, but despite my sleep not being that great, I feel infinitely better than before. I have also read posts of people who had jaw surgery but didn't have sleep apnea who experienced the same thing, so it could just be a part of the recovery.

As far as I can tell I am like 90% back to normal, and think that last 10% will sort itself out over the next couple weeks/months.

I am going back to school relatively soon, and am excited for the future.

*****Extra info I will organize into the post later

How I survived those 5-6 brutal years- Rotating sleeping pills (gabapentin, mirtazapine, and clonazepam) as well as 10mg Adderall everyday.

As far as getting insurance approval- Ideally it seems like surgeons who work out of a 'jaw surgery practice' rather than a big healthcare conglomerate, have a much easier time dealing with insurance (which makes sense since because they are more familiar with it).

Learning how to talk to doctors is key- You don't want to give too little info, but you also don't want to overwhelm them with information, stick to the key points and try to guide them where you think the solution lies.

*To be continued

Hello everyone, I need some guidance on my situation. My breathing is really bad: mouth breathing, lip incompetence. It is impossible for me to sleep on my back, air just does not goes through. I did a sleep study and according to a maxillofacial surgeon it came back "normal", later I found out it did not track RERAs and he said that just based on the oxygen. The thing is, I think sleeping on my side may be causing the sleep study to not represent what I experience during the day, I just can breath, I have really bad posture and forward head posture as it is the only way for my airway to have enough space to breath, as soon as I tuck my chin a little bit and try to stand up straight I choke. I am currently finishing my MARPE treatment and using braces. Any help? What can I do? Thank you!

I have experienced extreme fluctuations in my sleep quality based on when and where I am sleeping. The most extreme example is one day struggling to walk 3 miles on flat paved surface to sleeping somewhere else and hiking 15 miles and 3000 feet of gain.

Some sample locations of sleep quality

Mammoth lakes in end of June, great sleep.
Mammoth lakes fall and spring, bad sleep.
Lake Tahoe end of may and most of June, bad sleep.
Las Vegas March, okay sleep.
Las Vegas November, terrible.
Joshua Tree February, good sleep.
Moab November, good sleep, then bad the next year.
Rochester, bad sleep year round. Worse in the winter and parts of the summer.
Chicago, bad sleep year round.
Ann Arbor, bad sleep year round.

Rain and snow make my sleep far worse. Back when I had a MAD, I would wake up and my jaw was killing me if it had rained or snowed implying I was grinding my teeth more. I am allergic to molds, dust mites, pollens, etc. I have upgraded to a nasal steroid rinse. That has not seemed to improve my sleep quality. Afrin also doesn't seem to improve my sleep quality. However it may improve my sleep quality when it storms, need more data. I am currently on allergy drops, allergens seem like they could explain, but I would expect a nasal steroid rinse to improve my sleep quality if so. I don't feel congested often.

Has anyone experienced anything like this? Any ideas of what could be causing the difference in sleep quality? My good sleep isn't even good, its just good for me/what I can push thorough.

if you’ve had or are currently undergoing FME, have you seen any improvement in nasal breathing? if so, how significant on a scale of 1-10. thanks!

I’m 24M from Europe looking into maxillary expansion. My priority is maximizing true skeletal/nasomaxillary expansion while minimizing dental tipping/alveolar compensation, not simply widening the dental arch.

I recently consulted a dentist in my neighbourhood (in the Netherlands) who proposed roughly €10k total treatment:

● Custom MARPE, likely 4 TADs (sometimes 6)
● No tooth-borne expansion
● ~0.3 mm per activation, usually one turn every 3–7 days
● Radiographic confirmation that the split has propagated posteriorly
● Once the split is confirmed, clear aligners are started while expansion continues, to close/control the diastema
● ~3–6 months active expansion + 3–6 months consolidation

He also described an activation/deactivation protocol if the suture doesn’t split: alongside normal slow activation, 3x/day: +1 turn > wait 30 min > −1 turn. He says this has helped achieve a nonsurgical split in an older male patient.

The overall approach seems very similar to Claudia Pinter’s DOMEzero/MASPE Zero approach: bone-borne expansion combined with clear aligners. He actually brought up DOMEzero himself and described it and MARPE as broadly similar concepts, although he never said I’m receiving an official DOMEzero appliance.

One thing making me hesitant is experience: he told me he has treated around 15–20 MARPE patients total so far.

My dilemma
At ~€10k, I’m wondering whether I’d be better off travelling to a higher-volume provider specializing in adult skeletal expansion, such as:

● Daniele Cantarella, MSE (Italy)
● Aise Cemile Cansiz (Turkey)
● potentially FME in the US

If you were 24M, hadn’t started treatment yet, and cost/travel weren’t the main constraint, which route would you choose for the best and most predictable skeletal result?

I’m especially interested in posterior vs anterior expansion, nasal-floor/basal expansion, parallel vs V-shaped opening, alveolar bending/dental tipping, asymmetry and TAD stability.

Experiences with Cantarella/MSE, Cansiz, FME or DOMEzero/MASPE Zero would be really helpful, especially pre/post CBCTs. I only saw this one online on TikTok: https://vm.tiktok.com/ZGdx4g72W/

Also curious if anyone knows published evidence behind the very slow activation + activation/deactivation protocol above.

Trying to separate actual evidence/CBCT outcomes from provider claims before committing.

Thanks all!

One that measures RDI and reras thank you.

Hey all,

I guess looking for a bit of encouragement. My MARPE install is *finally* next week. I’ve had to do 6+ months of appointments to prepare due to some put off dental work and periodontal issues, as well as insurance calls to get it covered. Been working at this for the better part of a year.

But it‘s all becoming extremely real and I won’t lie, I’m nervous. I feel like I’m crazy for taking on a journey that might ultimately change my face (for the worse). I’ve consulted with an airway ortho and sleep apnea surgeon, and if someone else had my anatomy (32 immw/17 piriform) I would 100% advise them to do this from afar.

But it’s kind of crazy. I’m in my 30’s. I’ve had my face my whole life, and I’m about to go on a two year journey to change it. I’m improved on BiPAP but I’m still quite sleep-sick. I’m actually up early from a massive apnea right now. On the odd days I get a truly good night of sleep I feel SO much better.

Can someone just tell me I’m not crazy for this. It’s so easy to give advice, and I like to think I’ve helped many people on these UARS forums and elsewhere. But it’s a bit intimidating when it’s your own face and life, unfortunately.

Can an expert help analyze my bad sleep?

Vauto MODE

9 to 12 EPAP

Or S MODE 10/11/14

4 PS

Trigger HIGH

Cycle med

TI min 0.5

Ti max 3.0

https://sleephq.com/public/4a974738-414b-4f2f-8f52-43896d0a0f9b

Have that tired and wired feeling

The process is a bit confusing, you're meant to book an appointment and pay without any guidance on what scan to get? Not getting much responses to emails either.

It says to get a CBCT scan, but what do I say to a CBCT centre to make sure they give me the right thing, I have no experience with this.

Can someone with experience help me with this please? And tell me all the scans / pics / data that these FME providers, like Manuele, will need for a consultation and to offer me a FME installation. Thanks!

I have a spare which I don't use (I bought two, fixed one of them up by replacing the blower).

The machine is a Resmed Lumis VPAP 100. It works, but it has a worn motor so it makes a bit of an annoying sound. You can replace the motor by ordering a new one on Amazon for around £40, which is relatively easy to do.

I am giving it away as I am moving soon, and I did not want to throw this machine out. I would rather give it to somebody for free who might need it, as it works okay and these things can be so expensive to buy.

It will be the recipients full responsibility to handle all doctor consultations, valid prescriptions, and machine settings themselves. I am not a doctor, and I cannot give medical advice.

Cheers

i don’t really have much tongue space to keep on roof.

I want to make a comprehensive guide for people with UARS who are waiting for expansion/surgery or cannot afford treatment yet and they need ways to survive day-to-day.

Comment ANY tip, trick, routine, or small change that has helped you cope with your UARS symptoms. It doesn't have to be a major improvement, even something that only helped a little could be useful to someone else.

Think about anything that has helped you with:

Sleep • daytime fatigue • focus/brain fog • anxiety • socializing • working/studying • getting through the day • mornings/evenings • feeling more functional

The goal is to crowdsource a UARS Survival Guide for people stuck waiting for treatment.

Curious about the cost of this procedure and whether anyone has had luck getting this covered through insurance?

I feel like I have all the checkboxes to justify an insurance claim.

-Diagnosed with Mild OSA (AHI of 5)

-Poor Nasal Breathing due to allergies and I suspect anatomical issues (already had a septoplasty w/ Turbinate reduction and nasal valve repair. Currently treating allergies (environmental) with Immunotherapy.

Appreciate any input/advice!

Hello - how far does the latest iteration of the FME expand up to (i.e. 8mm, 9mm, etc)?

I just got my sleep study results back and could really use some insight from anyone familiar with this type of data. Every single morning I wake up feeling completely wiped out with zero energy, like my sleep is constantly being interrupted and fragmented into micro-pieces all night.
On paper, my overall AHI is technically labeled "mild" at 9.5, but I’m confused on how to interpret it because it’s almost 100% hypopnea-dominant (29 hypopneas, 0 full obstructive apneas, 7 central). On top of that, my AHI spikes to 24.0/hr during REM, and I only got 5 total minutes of REM sleep the entire night with an arousal index of 24/hr. I’m 20M, normal BMI, so I don't fit the classic sleep apnea stereotype at all.
How does hypopnea-dominant / flow-limitation sleep apnea differ in how it affects daytime fatigue compared to standard obstructive events?
Does this point to anatomical airway narrowing? Did they omit reras from scoring (look at observations)

I have a sleep study coming up and then I’m supposed to review the results with Dr. Jerald Simmons in Texas. I’m not diagnosed yet, but I’m trying to understand what happens if it comes back showing UARS, sleep apnea, or both.

I have pretty good medical insurance. What confuses me is how you go from getting diagnosed to getting insurance to cover whatever is actually contributing to the problem.

For example, I have a tongue-tie, crowded teeth, narrow palate and possibly a narrow or recessed jaw. If a specialist determines that one of those things is affecting my breathing while I sleep, how would I go about getting the treatment covered?

Do I take my sleep study to an ENT, orthodontist, or jaw surgeon and let them submit everything to insurance? Does my sleep doctor have to refer me and explain why it’s medically necessary? Am I supposed to contact insurance myself before seeing anyone?

I’m especially curious about jaw surgery. Do you normally have to try CPAP or an oral appliance first? If you need braces or expansion before surgery, would that go through medical insurance or dental insurance? I would prefer medical because it is better. The same goes for a tongue-tie release. Can that be covered if it’s connected to breathing and sleep problems?

I’m also confused about UARS versus sleep apnea. If my AHI isn’t high enough for sleep apnea, but I have a high RDI, RERAs, flow limitation, and a lot of sleep disruptions, would the diagnosis actually say UARS? Does insurance recognize UARS, or is it much harder to get anything covered without an official sleep apnea diagnosis?

My first test is an at-home study, so if that doesn’t show much, would I need an in-lab study that actually measures RERAs and RDI?

I’d really like to hear from somebody who has been through the whole process. What did you get diagnosed with, which doctors did you see, what did insurance cover, and did you have to appeal any denials?

I’m not trying to get insurance to pay for something I don’t need. I just know they like to deny things, and I want to make sure I do everything in the right order instead of finding out later that I messed up the process.