Is it plain snoring or sleep apnea?

Most households have someone who snores at night. It is usually a joke, until the day a partner or roommate says, “In the middle of your snoring you stop breathing for a few moments.” That sentence is where the difference between plain snoring and sleep apnea begins.

Why does snoring happen?

The NHS writes that snoring happens when the tissues of the tongue, mouth, throat or nasal passages vibrate as you breathe. These tissues relax and narrow during sleep. Being overweight, smoking, drinking a lot of alcohol and sleeping on your back raise the risk. The NHS describes snoring as common and usually unimportant.

What is sleep apnea?

In obstructive sleep apnea, the airway narrows repeatedly during sleep, and breathing stops for a few moments and then returns. The ATS explains that the soft tissue at the back of the throat and the tongue usually collapses. The NHS says this condition needs treatment, because undiagnosed it can lead to more serious problems.

How can we tell them apart?

Based on the NHS and ATS, these signs make apnea more likely:

At night: loud, frequent snoring, pauses in breathing that someone else notices, choking or gasping sounds, repeated awakenings, sudden jerks and restlessness.

During the day: great tiredness despite long sleep, sleepiness, morning headache, dry mouth or sore throat in the morning, mood changes and trouble with concentration and memory.

The patient usually does not know about the night-time symptoms, and what another person observes is very valuable. If you only snore and your days are energetic, plain snoring is more likely, but you cannot be sure from reading one article.

Who is at higher risk?

The NHS and ATS name several factors: obesity, a large neck circumference, being male, older age (although young people and children also develop it), family history, alcohol and smoking, enlarged tonsils or adenoids, sleeping on the back, jaw structure and COPD. The NHLBI also names enlarged tonsils and hormonal changes.

If you don’t know anything yet, where do you start?

1. Have someone observe your night. The NHS says bringing along someone who has seen the snoring and the pauses in breathing helps the appointment.

2. What you can do yourself. For snoring, the NHS lists these: lose weight if you are overweight; sleep on your side (for example with a special pillow or wedge); give up smoking and heavy alcohol use, and take sleeping pills only on a doctor’s advice. The ATS says not to drink alcohol for at least four hours before bed. For a roommate who is woken up, earplugs are an NHS suggestion.

3. When to see a doctor. The NHS says to make an appointment if you have any of these:

• Lifestyle changes have not helped, or snoring is disrupting your life or your bed partner’s.
• You are sleepy during the day.
• Your breathing stops and starts in your sleep, or there are choking or gasping sounds.

How does the doctor assess it?

The NHS says the doctor looks inside the mouth and nose, and sometimes arranges blood tests or a referral. The NHLBI adds that the doctor asks about medicines (such as opioids, which affect breathing) and family history, and may ask for a sleep diary. Apnea is diagnosed with a sleep test. The ATS says it records breathing, heart rate and oxygen, and according to the ATS it can be done for a night at a sleep centre or, for some patients, at home. The NHS measures severity by the number of pauses per hour: 5 to 14 is mild, 15 to 30 is moderate and above 30 is severe.

What is the treatment?

Treatment depends on the cause and severity (ATS). Points the sources make:

• In mild apnea, lifestyle change alone, meaning losing weight, quitting smoking and drinking less alcohol, is sometimes enough (NHS).
• CPAP is a device that delivers gentle pressurised air through a mask and keeps the airway open. It is prescribed more than the others, and the ATS says that for the best result it should be used every time you sleep.
• An oral device that holds the jaw forward. The ATS says it works better for mild apnea in people who are not overweight.
• Surgery, such as removing the tonsils, or implanting a device that stimulates the tongue nerve, is usually for people who do not benefit from CPAP (ATS).
• For plain snoring without apnea there are also aids such as an oral device, nasal strips or a nasal spray (NHS). The NHS says snoring surgery does not always work and the snoring may come back.

The reason to take apnea seriously is that the NHS and ATS write that untreated apnea is linked to high blood pressure, stroke, type 2 diabetes, heart disease, depression and mood changes, accidents caused by sleepiness, and trouble concentrating.

Driving

If you are sleepy, do not drive. The ATS says sleep loss caused by apnea can lead to falling asleep at the wheel and to crashes. The NHS also says that if severe sleepiness caused by apnea is confirmed, you should not drive until the symptoms are under control. The law differs from country to country. Ask your doctor about this.

When is it urgent?

If you are gasping severely, asleep or awake, and cannot speak a sentence, your lips have turned blue or it is hard to wake someone, call 115 (Iran’s emergency number). Daytime sleepiness that creates a danger for driving or work is a “same day” matter. The full list is in the guide “When should I call urgently?”.