Snoring, sleep apnea and sleep disorders
Snoring is harmless most of the time, but if it comes with pauses in breathing during sleep, sudden choking or daytime sleepiness, it may be sleep apnea. This page explains what sleep apnea is, how it is assessed with a sleep test, what the treatments are and when to get urgent help.
What are snoring and sleep apnea?
Snoring happens when the tongue, mouth, throat or nasal passage vibrates as you breathe. The NHS writes that these tissues relax and narrow in sleep. Excess weight, smoking, heavy alcohol use and sleeping on your back make snoring more likely. Snoring is common and usually not serious.
Obstructive sleep apnea (OSA) is the more common type of apnea. In it, the airway repeatedly narrows during sleep, breathing stops for a few moments and then returns. The ATS explains that usually the soft tissue at the back of the throat and the tongue collapse. These pauses sometimes wake you from sleep. The NHLBI also describes another type, central apnea, in which the brain does not send the signal needed for breathing.
The symptoms, according to the ATS and NHS:
- During sleep: loud, frequent snoring, choking or gasping sounds, pauses in breathing that others notice, repeated waking.
- During waking hours: feeling unrested despite long sleep, morning headache, sore or dry throat, daytime sleepiness and tiredness, mood changes, poor memory and concentration.
The patient usually does not know about the night-time symptoms, and a partner or someone in the household notices sooner.
The risk factors given by the ATS and NHS: obesity, being male, being after menopause or over 65 (it is also seen in children and young people), enlarged tonsils or adenoids, family history, jaw structure, alcohol, smoking and COPD. This page is about snoring and apnea; other sleep disorders are assessed separately by the doctor.
Who should be seen?
The NHS says to see a doctor if you have one of the main symptoms: pauses in breathing during sleep, choking or gasping during sleep, or constant tiredness during the day. It helps a great deal to bring someone who has watched you at night. For simple snoring too, make an appointment if lifestyle changes do not help or it has disrupted your life and your bed partner’s. The NHLBI writes that snoring or gasping during sleep and severe daytime sleepiness are reasons to ask a doctor.
How is it assessed?
The NHLBI says the doctor asks about symptoms, risk factors, family history and medicines. Some medicines, such as opioids, affect sleep and breathing. The doctor may ask for a sleep diary in which you note the length and quality of sleep and how sleepy you are in the day, and sometimes a blood test, for example for the thyroid.
Diagnosis is by a sleep test (polysomnography). The ATS and NHS write that the test records breathing, heart rate and oxygen during sleep. According to the ATS, this can be done for one night at a sleep centre or, for some patients, with a home device. The NHS measures severity with the AHI index (the number of breathing pauses per hour): 5 to 14 is mild, 15 to 30 is moderate and more than 30 is severe. More detail is in the “Lung tests” guide.
What does treatment look like overall?
Treatment depends on the cause and severity (ATS). The options, according to the ATS, NHS and NHLBI:
- Lifestyle changes: losing weight, quitting smoking, drinking less alcohol, physical activity and a regular sleep schedule. The ATS says to stop alcohol at least four hours before sleep, because it suppresses breathing. Sleeping on your side instead of your back also helps.
- CPAP: the most widely used treatment. The device delivers pressurised air through a nose mask or a nose-and-mouth mask, which keeps the airway open. It often reduces snoring too.
- An oral appliance: a custom mouthpiece that holds the jaw or tongue forward. The ATS says it works better for mild apnea in people without excess weight and should be fitted by a dentist or surgeon who specialises in it.
- Surgery: removal of the tonsils, jaw surgery, removal of throat tissue or implantation of a tongue-nerve stimulation device. The ATS says these are usually less effective than CPAP and are for people who do not benefit from CPAP.
Mild side effects of CPAP such as a blocked nose or dry mouth are common. The ATS describes ways to deal with them, such as a different mask, a humidifier and a slow pressure ramp.
What can you do yourself?
- If you snore or stop breathing at night, bring someone who has watched you at night to the visit, or ask them to write down what they saw.
- A healthy weight, exercise and a fixed sleep schedule in a dark, quiet room (NHS).
- Give up cigarettes and heavy alcohol use, especially at night, and take sleeping tablets only on a doctor’s advice. The NHS says these make snoring worse.
- If you have been given CPAP or an oral appliance, use it every time you sleep (ATS), and if it is uncomfortable tell your doctor rather than quietly giving it up.
- If you are sleepy, do not drive.
Discuss any supplement, herb or sleeping tablet you want to take with your doctor before starting.
When to get urgent help
Call 115 (Iran’s emergency number) right now or go to the emergency department if:
- You are gasping for breath, asleep or awake, and cannot say a sentence.
- Your lips or skin have turned blue.
- You have suddenly become confused or someone is difficult to wake.
If you are extremely sleepy at the wheel, pull over somewhere safe and do not drive on.
See a doctor the same day if your daytime sleepiness is bad enough to create danger at work or when driving, or you often have severe morning headaches. If you cannot reach a doctor, go to the nearest emergency department. The full list is in the “When should I call urgently?” guide.
Frequently asked questions
Is every snore sleep apnea?
No. The NHS writes that snoring is common and usually not serious. But if it comes with daytime sleepiness, breathing that stops and starts at night, or choking and gasping sounds during sleep, it may be a sign of sleep apnea, which can become serious if untreated. Diagnosis is made by a doctor, usually with a sleep test.
What is a sleep test, and do I have to sleep at a centre overnight?
A sleep test records breathing, heart rate and blood oxygen during a night's sleep (ATS, NHS). The ATS writes that the test can be one night at a sleep centre or, for some patients, with a home device. The NHS also says it is usually done at home and sometimes at a centre. Which suits you, and where it is done, is decided by the doctor.
Does CPAP become a habit, or will I be unable to sleep without it?
CPAP is a device that keeps the airway open during sleep with gentle air pressure (ATS). The sources we read say nothing about 'addiction'. The ATS says that for the best result it should be used every time you sleep, and if you are uncomfortable you can change the mask, use a humidifier or consult your doctor. See the 'Oxygen and CPAP at home' guide.
Will losing weight cure my apnea?
The ATS writes that if excess weight is the cause of apnea, losing weight can resolve it, and the NHS says that in mild apnea lifestyle changes (losing weight, quitting smoking, drinking less alcohol) are sometimes enough. But everyone's apnea has a different cause, and the ATS says to keep using CPAP until you reach your target weight. The doctor arranges the plan with you.
Can I drive with sleep apnea?
If you are sleepy, no. The ATS says sleep loss from apnea can lead to falling asleep at the wheel and crashes. The NHS also writes that if severe sleepiness from apnea has been confirmed, you should not drive until symptoms such as tiredness are under control. Driving law and conditions differ in each country; ask your doctor about this.