Your partner nudges you at night: "You were snoring again." You laugh it off. But a quieter question may follow: is this just noise, or is something else going on?
Snoring is very common, and often it is only a nuisance. In some people, though, it goes with obstructive sleep apnoea, a condition in which the airway repeatedly narrows or closes during sleep. This article explains how to tell the two apart, and when to ask a doctor. It cannot diagnose you. Only a medical assessment can do that.
What is happening when we snore?
During sleep, the muscles in the throat relax. Air passing through a narrowed airway makes the tissues vibrate, and that sound is snoring. Narrowing can come from a blocked nose, extra tissue around the neck, the position of the jaw and tongue, alcohol, or sleeping on the back.
What is obstructive sleep apnoea?
In obstructive sleep apnoea, the airway narrows so much that breathing slows or stops for short periods, often many times in a night. The brain briefly wakes the body to reopen the airway, usually without the person remembering it. Sleep becomes fragmented, even if you spend enough hours in bed.
Simple snoring or something more?
A rough guide to what to look for:
| More likely simple snoring | Signs that should be checked |
|---|---|
| Noise without pauses in breathing | Pauses in breathing seen by someone else |
| Feels rested in the morning | Waking unrefreshed despite a full night |
| Snoring mainly with a cold, alcohol or on the back | Loud, frequent snoring most nights |
| No daytime sleepiness | Heavy sleepiness, falling asleep in meetings or while driving |
| Gasping, choking or waking short of breath | |
| Morning headaches, dry mouth or frequent night urination | |
| Difficulty concentrating or low mood |
If you recognise several signs in the right-hand column, book an appointment. Being tired at the wheel is a safety issue, not only a comfort issue.
Who is more likely to have sleep apnoea?
Risk factors include excess body weight, a larger neck size, increasing age, being male, menopause, smoking, alcohol before bed, nasal blockage and a family history. But sleep apnoea also affects people of normal weight, so do not rule it out because you are slim.
How is it diagnosed?
Start with your general practitioner or family doctor. They may ask about symptoms, use a screening questionnaire and refer you to a sleep specialist. Diagnosis is usually made with a sleep study, either in a clinic or with a home device that measures breathing, oxygen levels and sleep during the night.
What treatment can involve
Treatment depends on severity and on you. Options your doctor may discuss include:
- Lifestyle changes: weight loss if relevant, less alcohol in the evening, stopping smoking and sleeping on your side.
- CPAP: a machine that gently keeps the airway open with air pressure. It is widely used and well studied, though it takes some getting used to.
- Oral appliances: custom devices that move the lower jaw forward, made by a dentist trained in sleep medicine.
- Nasal treatment: for a blocked nose, depending on the cause.
- Surgery or other procedures: in selected cases, after specialist assessment.
Where traditional approaches fit
Traditional Chinese medicine offers ideas about breathing, diet and daily rhythm, and some people find practices such as gentle breathing exercises and a calm evening routine helpful. These are not proven treatments for sleep apnoea. If you have signs of sleep apnoea, a medical check should come first. Traditional practices can sit alongside medical care, but should not replace it.
What you can do tonight
- Try sleeping on your side. Some people tape a tennis ball to the back of a pyjama top to discourage turning over.
- Avoid alcohol close to bedtime.
- Keep a regular sleep schedule.
- If your nose is blocked, ask a pharmacist or doctor about safe options. Do not use decongestant sprays for more than the packet says.
- Ask your partner to note any pauses in your breathing.
Children and snoring
Regular loud snoring in a child, especially with pauses, restless sleep or daytime behaviour changes, is worth a medical check.
What this article does not say
It does not say that snoring will go away with a remedy, and it does not suggest you diagnose yourself. It says that persistent loud snoring with other symptoms deserves attention.
Questions readers ask
Does everyone who snores have sleep apnoea?
No. Many people snore without apnoea. A sleep study is the way to find out.
Can sleep apnoea be dangerous?
Untreated sleep apnoea is associated with daytime sleepiness and with higher risk of problems such as high blood pressure. That is why a medical assessment is worth having.
Do anti-snoring gadgets work?
Some help certain people, but they do not treat sleep apnoea. Do not rely on them if you have warning signs.
Evidence and limits
- Sleep apnoea is a recognised medical condition with established diagnosis and treatment.
- Evidence for herbal or traditional remedies for snoring and sleep apnoea is limited.
- This article is general information, not medical advice.
If you recognise two or more of the warning signs, make an appointment this week.