Snoring and sleep Apnoea
Mr Ali Qureishi regularly sees patients with snoring and sleep apnoea and is familiar
with surgical and non surgical treatment strategies.
More information about snoring and sleep apnoea can be seen below.
What is snoring?
Why it happens
Snoring is the sound made when soft tissues in the upper airway vibrate as air passes through during sleep.
It can come from the soft palate, the tongue or other tissues in the throat. Relaxation of these tissues
during sleep makes the airway narrower.
Common contributing factors
Snoring may be worse when you sleep on your back, drink alcohol or have a blocked nose. Excess weight, enlarged tonsils and the shape of the jaw or airway can also contribute. Snoring can affect both your sleep and your partner’s wellbeing.
When to seek advice
Arrange an assessment if snoring is persistent or disruptive, or if simple changes have not helped. Breathing pauses, gasping or choking during sleep, and daytime sleepiness suggest possible obstructive
sleep apnoea and need medical assessment. A partner’s observations can be useful at your appointment.
What may help
Sleeping on your side, reducing alcohol and losing weight if appropriate may help. Treatment of nasal blockage can improve breathing. The best treatment depends on the cause; surgery for snoring is not suitable for everyone and snoring can return.
Breathing interruptions during sleep
Sleep apnoea means repeated interruptions to breathing during sleep. In obstructive sleep apnoea (OSA), the upper airway narrows or closes despite continued effort to breathe. This can lower oxygen levels and repeatedly disturb sleep. Central sleep apnoea has a different mechanism and needs a different assessment; this leaflet focuses on adult OSA.
Symptoms and why they matter
Symptoms include loud snoring, witnessed breathing pauses, choking, restless sleep and waking unrefreshed. You may notice morning headaches, poor concentration or daytime tiredness. Untreated OSA is associated with high blood pressure, cardiovascular problems and accidents caused by sleepiness.
How it is diagnosed?
A sleep service usually arranges an overnight recording at home, with sensors monitoring breathing and oxygen levels. Sometimes testing in a sleep laboratory is needed. Results show whether OSA is present and help assess its severity. A normal initial test may need further investigation if symptoms continue.
Driving and daytime sleepiness
Do not drive if excessive sleepiness affects your ability to drive safely. Ask your clinician when driving can resume. In Great Britain, confirmed moderate or severe OSA syndrome with excessive sleepiness must be reported to the DVLA. Other sleep conditions causing excessive sleepiness for at least three months, iincluding suspected or confirmed mild OSA syndrome, also require notification. Check the current GOV.UK rules.
What is sleep apnoea?
Non-surgical management of sleep apnoea
Lifestyle and sleep habits
Regular activity, weight management where appropriate, less alcohol and stopping smoking can help. Keep regular sleep times. Avoid sleeping tablets unless your doctor recommends them; do not stop prescribed medicines without advice.
Continuous positive airway pressure
CPAP supplies pressurised air through a mask to keep the airway open while you sleep. It is usually the main treatment for moderate or severe OSA, and may also help symptomatic mild OSA. Use it throughout sleep, including naps. Getting used to a mask can take time. Leaks, dryness or discomfort often improve with a different mask, humidification or treatment of nasal blockage. Ask your sleep team for support before giving up.
Mandibular advancement devices
A fitted oral appliance holds the lower jaw forward during sleep. It may be considered when CPAP is declined or cannot be tolerated. Dental and gum health must be assessed, and the device needs adjustment and follow-up.
Positional treatment and nasal care
Devices that discourage sleeping on your back can help selected people with positional mild or moderate OSA. They are unlikely to be sufficient for severe OSA. Treating rhinitis with appropriate nasal medication may make breathing and CPAP use easier.
Checking that treatment works
Follow-up assesses symptoms, device use and, where needed, sleep measurements. Tell your team if sleepiness persists. Do not stop treatment simply because snoring has reduced or your weight has changed; arrange reassessment first.
Who may benefit?
Surgery is tailored to the site of airway obstruction and your overall health. It may help selected patients, particularly when suitable non-surgical treatment has not been successful. Assessment may include examination of the nose and throat and airway endoscopy.
Types of Surgery
Tonsil and throat surgery
Removing large obstructive tonsils may be appropriate; NICE highlights adults with a body mass index below 35. Specialist assessment for throat surgery may be considered in severe OSA when supervised attempts with CPAP and a customised oral appliance have not been tolerated.
Palate or throat procedures aim to widen and stabilise the airway.
Nasal and jaw surgery
Septal or turbinate surgery may relieve a structurally blocked nose and improve tolerance of CPAP. It is not usually a stand-alone cure for OSA. Jaw advancement surgery moves the upper and lower jaws forward to enlarge the airway and is reserved for carefully selected patients.
Hypoglossal nerve stimulation
An implanted device stimulates the nerve that controls tongue movement, helping maintain an open airway during sleep. It is an option for selected patients after specialist assessment. NICE requires special arrangements for governance, consent and audit or research because evidence is limited. Availability varies.
Benefits and risks
Surgery may reduce OSA severity, but a cure is not guaranteed and CPAP may still be needed. Risks vary by operation and include pain, bleeding, swallowing difficulty and anaesthetic complications. Discuss likely benefit, recovery and alternatives with your surgeon. Follow-up sleep testing is needed to assess the result.
