Snoring
Roughly one adult man in two and one woman in three snores, and most of the time it really is a noise rather than a disease.
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Roughly one adult man in two and one woman in three snores, and most of the time it really is a noise rather than a disease. In some snorers, though, the noise sits on top of sleep apnoea: pauses in breathing that break the night dozens of times without the sleeper remembering any of it, while the heart and blood vessels work under strain for years. The difference between the two situations is not a matter of loudness but of a handful of signs, and those are what to talk about first.
Why snoring happens
During sleep the muscles of the throat, tongue and soft palate relax, the airway narrows, and moving air sets the soft tissue vibrating. That sound is the snore. It is louder when someone lies on their back, because the tongue and palate fall backwards under their own weight.
The narrowing is made worse by excess weight, especially fat around the neck; by alcohol and sleeping tablets, which relax the muscles further; by smoking, which swells the lining of the airway; by a blocked nose from a cold, allergy, a deviated septum or polyps; by large tonsils; and by a small or set-back lower jaw. Age plays its part too: throat muscle tone falls over the years, and in women snoring starts far more often after the menopause. Heavy, constant snoring can also be a sign of an underactive thyroid.
Simple snoring and snoring with pauses in breathing
Even, uninterrupted snoring is usually only an acoustic problem: it damages a partner's sleep rather than the snorer's health.
What should raise concern is different. Pauses in breathing that somebody in the household has witnessed; snorts with a sudden gasping breath, as though the person were suffocating or choking; waking with a feeling of not getting enough air; restless sleep with constant shifting about. The snorer almost never remembers any of this, because the arousals are too brief to register. That is why the most valuable account here comes not from the person who snores but from the person sleeping beside them.
This is what obstructive sleep apnoea looks like: for a few seconds the airway closes completely, the oxygen level in the blood falls, the brain has to wake briefly to restart breathing — and the cycle repeats dozens and sometimes hundreds of times a night.
How apnoea shows itself in the daytime
Night-time pauses are more often picked up from their daytime traces than from the snoring itself:
- daytime sleepiness — not simple tiredness but a pull towards dozing off in any quiet setting: in front of the television, on public transport, in a meeting;
- falling asleep at the wheel, or moments when the last few minutes of a journey cannot be recalled — the most dangerous sign of all;
- morning headaches and the feeling that sleep is not refreshing however long it lasts;
- a dry mouth and throat on waking;
- getting up to pass urine at night, two or three times or more, with no bladder problem to explain it;
- irritability, forgetfulness, trouble concentrating, low mood;
- high blood pressure that responds poorly to treatment, pressure rising overnight and in the early morning, disturbances of heart rhythm.
If sleepiness is interfering with work or with driving, see a doctor without delay, and until you have been assessed it is safer not to take on long drives.
Why this is not just a domestic nuisance
Pauses in breathing at night mean repeated dips in oxygen and repeated surges of nervous system activity. Carried for years, that load raises the risk of persistent high blood pressure, of heart rhythm disorders, of heart attack and stroke, and it worsens blood sugar control in diabetes. Daytime sleepiness is a separate danger: behind the wheel and at work it belongs in the same bracket as alcohol.
The good news is that sleep apnoea can be treated, and treatment changes how a person feels fairly quickly: the sense of being rested comes back, and blood pressure and mood become easier. So snoring with pauses is not something to write off as an unfixable family trait — what it needs is a diagnosis.
Snoring in a child
Children snore occasionally, and with a cold that is normal. Snoring every night, however, is already a reason to have the child looked at.
Especially if the child sleeps with their mouth open, struggles to breathe through the nose, has pauses in breathing, tosses about, sleeps in odd positions with the head thrown back, or sweats in their sleep. Most often the explanation is large tonsils and adenoids: in children these are the leading cause of night-time breathing pauses. In the daytime such a child is usually not sleepy but the opposite — restless, inattentive, irritable, doing less well at school; sometimes bedwetting returns, and growth and weight suffer. It is worth seeing a doctor and discussing an examination of the nose and throat: in childhood this is usually something that can be put right, and left alone it drags behind it both behaviour and the development of the face and teeth.
What you can do yourself
These measures reduce simple snoring and help in mild apnoea, but on their own they do not treat significant apnoea:
- sleep on your side rather than on your back — of the simple measures this is the most effective; a pillow, raising the head of the bed and the habit of falling asleep on your side all help;
- lose weight if you are carrying too much: even a modest loss noticeably reduces both the snoring and the number of pauses;
- avoid alcohol in the hours before bed, as it relaxes the throat muscles and lengthens the pauses;
- do not take sleeping tablets or sedatives without medical advice: they act in much the same way and additionally make it harder to wake when breathing stops;
- stop smoking;
- treat a blocked nose — seasonal allergy, a cold that drags on; if the nose is permanently blocked, discuss the septum and polyps with a doctor;
- keep regular bed and waking times: too little sleep intensifies snoring in its own right.
One thing to keep in mind: nasal strips, decongestant drops and sprays, and special pillows have no effect on apnoea. They may make breathing through the nose easier, but they do not remove pauses in breathing, and drops used continuously make congestion worse. Where there are signs of apnoea, buying an “anti-snoring” product simply postpones the diagnosis.
What happens at the appointment
The doctor will ask about the night and about the day — and it helps a great deal if the account is filled in by whoever hears the snoring from outside, or by a short recording made on a phone. It is useful to note beforehand how many hours you sleep, how many times you get up at night, whether sleepiness comes over you in the day, which medicines you take and how much alcohol you drink in the evening.
Then the nose, mouth and throat are examined, blood pressure and weight are measured and, where relevant, thyroid function is checked. Where there are signs of breathing pauses, a sleep study is arranged: an overnight recording of breathing and oxygen, either at home or in a sleep unit. That is what separates simple snoring from apnoea and shows how severe it is.
Treatment depends on the result. In simple snoring it stops at the measures above and at treating the nose. In apnoea there are effective options, from breathing support during sleep to intraoral devices made by a specialist and surgery on the upper airway; which of them fits a particular person is decided from the study findings rather than from a catalogue. Choosing yourself an “anti-snoring machine” is not a good idea.
Online consultation
Snoring is a convenient thing to start remotely: almost everything a doctor needs at the first step is a description of the night and the day. In a consultation you can go through the signs of breathing pauses, weigh up daytime sleepiness and the risk at the wheel, discuss weight, alcohol, the nose and medicines that may be making things worse, and decide whether a sleep study is needed and which specialist to see. A child's snoring can be discussed separately, including whether it is time to look at the tonsils and adenoids.
This material is for information only and does not replace medical advice.
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