About snoring and sleep apnoea
What causes sleep apnoea?
Who gets sleep apnoea?
Symptoms of sleep apnoea
Diagnossis of sleep apnoea
Treatment
Snoring and the disturbance it causes used to be seen as a joke - something that not much could be done about. However, we now know that snoring can indicate problems with nighttime breathing that may harm the snorer. And there are things that can be done to reduce snoring.
During sleep all of the body's muscles relax. In most parts of the body this does not matter and helps you to sleep comfortably.
However, the muscles that help hold open the throat behind the tongue relax too. This leads to a partial collapse and narrowing in this area. Even in normal people this makes it harder to breathe in, but it usually doesn't matter.
When this narrowing is more than normal, the airway behind the tongue collapses much more. To start with, this causes snoring and then, when the collapse is complete, it causes apnoea (or apnea), which means "without breath" - you actually stop breathing.
Fortunately, the body senses that your breathing is blocked, and arouses from sleep. You do not wake up, but you start to breathe again with a few deep breaths and your sleep pattern is lighter.
This often becomes a continuous cycle - stopping breathing and arousing from sleep. It can happen every minute or so and go on hundreds of times each night. This continuous rousing upsets the quality of sleep, meaning you feel very tired during the day. You may think you have slept all night, but the quality of sleep is poor.
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Sleep apnoea is caused by anything that increases the normal narrowing of the throat during sleep. For example:
- Being overweight with a large neck is probably the most important factor. Extra fat in the neck squashes the throat from outside - particularly when the throat muscles become floppier when you sleep.
- Anything that makes the throat narrower to start with (for example, enlarged tonsils or a set back lower jaw) means that it is easy for the throat to close off a bit more and block the airway.
- A partially blocked nose causes pressures lower down in the throat when you breathe in - this tends to suck the walls of the throat together.
The sort of person who most commonly suffers from heavy snoring and sleep apnoea is an overweight middle-aged man with a large neck, usually with a size 17 inch collar or more. However, there are many people with sleep apnoea who are not particularly overweight. The commonest cause in children is enlarged tonsils.
Nowadays sleep apnoea is a common reason for recommending that a young child has their tonsils out.
Sleep apnoea and heavy snoring, severe enough to affect the quality of your sleep, is more common than people think. At least three men in every thousand have severe sleep apnoea. Four per cent of men, and two per cent of women have it mildly.
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Severe daytime sleepiness is the main symptom. This is because you’re tired from waking up regularly throughout the night.
To start with, you only feel sleepy during activities like reading, watching television or driving on motorways. But when the sleepiness gets worse it begins to interfere with most activities, with people falling asleep while talking or eating.
Poor performance at work can mean people lose their jobs and, of course, sleepiness while driving can be fatal (sleep apnoea sufferers are about seven times more likely to have a car crash. And because sleepy people do not take evasive action, those crashes are more likely to be serious).
Snoring is usually something that’s been noticed by your family for many years and has gone well beyond a joke.
There are many other symptoms, as you'd expect in someone who sleeps very little (irritability for example). But the twin symptoms of snoring and daytime sleepiness are the best pointers.
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Your partner may notice that you stop breathing during the night, and give you a nudge. They may also notice that your sleep is restless. These symptoms could lead your partner to believe you have sleep apnoea, if they have heard about the condition.
If your doctor agrees, a sleep study is done to confirm the diagnosis. This is done, through referral, by a hospital lung specialist. They can make a variety of measurements during a sleep study (without discomfort to you):
- Oxygen levels in your blood can be measured continuously from a clip on your finger.
- Your breathing can be monitored from belts around your chest and tummy. They can estimate the quality of your sleep from wires stuck to your scalp or from the number of body movements you make during sleep.
- Video recordings with sound are often used so that the doctor can actually see how badly your breathing is obstructed and your sleep is disturbed.
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If your sleep apnoea and snoring are not severe then simple approaches can help:
- Try to lose weight
- Stop drinking alcohol after 6.00 pm (alcohol relaxes the upper airway muscles even more)
- Keep your nose as clear as possible and sleep on your side or half propped up. There are now simple dental devices, like sports-type gum shields, that you wear at night and that can greatly reduce snoring. You usually get these through a dentist.
The only really effective treatment currently used for bad sleep apnoea is called 'nasal continuous positive airway pressure' (or 'nasal CPAP'). Because the inside of the throat narrows, it can be held open by slightly pressurised air.
The air is delivered by a mask while you sleep. The mask fits just over your nose and connects to a small, quiet pump beside the bed. Your breathing can then return to normal during sleep, with the air gently blowing through the nose, holding the throat open.
The response is usually dramatic with greatly improved sleep and the end of day-time sleepiness. Although these devices can be awkward to wear and don't do anything for your appearance, the benefits far outweigh the disadvantages.
The vast majority of people find the machines effective and choose to use them every night.
When snoring is really unbearable, and you and your partner are desperate for a solution, then an operation on the back of the throat may help. But this is a last resort and should only be done when a sleep study has shown that you snore, but have very little, or no, sleep apnoea.
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Page last medically reviewed: June 2011
