Loud snoring with pauses is a breathing problem.
Snoring is the sound of a narrow throat vibrating in sleep. On its own it is mostly a nuisance. When the throat closes completely, again and again, breathing stops for seconds at a time. That is sleep apnoea: common, easily missed, and treatable.
In plain words.
In sleep the muscles of the throat relax. If the airway is narrow, the soft tissues flutter as air rushes past: snoring. Extra weight around the neck, alcohol or sleeping pills at night, sleeping on the back and a blocked nose all make it worse.
In obstructive sleep apnoea, the throat closes completely or nearly, for ten seconds or more, many times an hour. Oxygen in the blood falls, and the brain wakes the body for a moment with a gasp or snort. The person rarely remembers it, but sleep is broken all night.
It matters because it causes sleepiness in the day, including at the wheel, and it adds to high blood pressure that is hard to control, an irregular heartbeat, heart failure, stroke and diabetes.
It is more common in men, after 40, with weight gain, and in women after the menopause. In children, large tonsils are the usual cause.
Treatment works. Losing weight, avoiding alcohol at night and sleeping on the side help. For moderate or severe apnoea, a CPAP machine blows gentle air through a mask to hold the throat open all night. A mouth guard made by a dentist suits some milder cases.
The throat at night
The throat relaxes and narrows. Air still gets through, but the soft palate and tongue flutter: the sound of snoring. Oxygen stays steady.
The throat closes completely. Breathing stops, oxygen in the blood falls, and the brain jolts the body half-awake with a gasp. This can happen dozens of times an hour.
A mask blows gentle air that holds the throat open like a splint. Breathing and oxygen stay steady all night, and daytime sleepiness lifts.
Go to hospital now if
- Someone asleep cannot be woken, or has stopped breathing or turned blue: call 112. If they are not breathing, start chest compressions.
- Chest pain, fainting, or a racing, irregular heartbeat: call 112.
- Sudden weakness of the face, arm or leg, or slurred speech: call 112. This may be a stroke.
- Very hard to keep awake and confused, especially with a lung condition or heavy weight: go to hospital now. Carbon dioxide may be building up in the blood.
- A child who struggles to breathe in sleep, with the chest sucking in or lips turning blue: go to hospital now.
Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).
See a doctor within a week or two if
- You doze off while driving, or have nearly had an accident; do not drive until you have been checked
- Someone has seen you stop breathing in your sleep
- Your blood pressure stays high despite medicines
- You wake with headaches, or feel sleepy most days
- A child snores most nights, with pauses, bedwetting, poor growth or trouble at school
- You have heart failure, an irregular heartbeat or have had a stroke, and you snore
Tests that help.
Not everyone needs every test. He decides which ones are worth doing for you.
| Test | What it tells |
|---|---|
| Sleep questionnaire | A few simple questions (such as STOP-BANG and the Epworth score) show how likely apnoea is and how sleepy you are. |
| Home sleep study | Small sensors worn for one night at home record breathing, oxygen and pulse. |
| Full sleep study (polysomnography) | A night in a sleep laboratory, when the home test is unclear or another sleep problem is suspected. |
| Blood pressure, sugar (HbA1c) and thyroid (TSH) | Look for the problems that often come with apnoea, and an underactive thyroid. |
| Weight, and neck size | A neck of more than 40 cm raises the chance of apnoea. |
| Nose and throat check | Looks for a blocked nose, a bent septum or large tonsils. |
Have it ready.
Tick them off as you gather them. The ticks stay on this phone only.
Online, or in person?
Sleeping tablets and alcohol at night relax the throat further and can make apnoea more dangerous. Do not take them to “sleep better” if you snore loudly, until you have been checked. Anti-snoring sprays and strips do not treat apnoea.
A video call can
- Judge how likely apnoea is from your story and the questionnaire
- Arrange a home sleep study, and explain the report
- Start and fine-tune CPAP, and help with mask problems
- Treat the blood pressure, sugar and weight that go with it
Needs a visit in person
- The sleep study itself, at home or in a laboratory
- Fitting a CPAP mask for the first time
- A nose and throat examination, or a dental mouth guard
- Any sign in the red box: that is an emergency
Talk it through with Dr. Arya.
Bring your reports and medicines to a video consultation. He goes through them with you, in plain words, and says clearly if you need to be seen in person.
Book a video consultationDr. Prabhat Arya · MBBS, MD (Internal Medicine) · Delhi Medical Council Reg. No. DMC-83759