Snoring & Sleep-Related Breathing Disorders

Air moving through a narrowed airway makes the soft tissue around it vibrate, and that vibration is the sound. During sleep the muscles holding the airway open relax, so a passage that is perfectly adequate awake can become narrow enough to buzz once you are unconscious.

The narrowing can be at several levels and often at more than one: the nasal airway, the soft palate and uvula, the tonsils and the base of the tongue. Which level is responsible is the single most useful thing to establish, because a treatment aimed at the wrong level does very little.

The important distinction is not how loud it is. Sound on its own, with breathing continuing normally, is a nuisance and a social problem. Sound with repeated interruptions to breathing is a different condition with cardiovascular consequences, and it is common enough that anyone being assessed is screened for it before anything else is discussed. Weight, alcohol in the evening, sedatives and sleeping on the back all make any version of it worse.

The assessment starts with the bed partner, who can usually describe the pattern more accurately than the person themselves. Questions cover position, alcohol, weight change, and whether breathing appears to stop.

The nose is examined with an endoscope and the throat assessed for the size of the tonsils, the length of the uvula, how low the palate hangs and how much of the throat can be seen with the tongue in place. Neck circumference and body weight are recorded because both correlate strongly.

A sleep study is arranged in most cases, either at home or in a laboratory. It records airflow, chest movement, oxygen levels and pulse through the night, and it is what separates simple vibration from repeated obstruction. Where surgery is being considered, a sleep endoscopy may be done, in which the airway is watched under light sedation to see precisely which level collapses.

The measures that work first ask for change instead of treatment. Losing weight has a larger effect than anything else available, alcohol within three hours of bed reliably worsens it, and sleeping on the side instead of the back helps a substantial proportion of people. Devices to discourage lying on the back are cheap and worth trying before anything invasive.

A dental device made by a dentist experienced in them holds the lower jaw slightly forward. It takes a few weeks to get used to, can make the jaw ache in the morning at first, and needs periodic adjustment.

Where a procedure is done in the nose, recovery is a week or two of congestion. Work on the palate is considerably more uncomfortable: swallowing hurts for about a fortnight, and it is one of the few areas where the pain is worse in adults than in children. Results are judged at about three months, once the tissues have finished contracting.