Snoring can wreck sleep, strain relationships and sometimes signal a health problem. Sleep expert Professor Joerg Steiert reveals what can help and when to see your GP.
Professor Joerg Steier Adjunct Professor of Respiratory and Sleep Medicine at Guy's & St Thomas' NHS Foundation Trust and King's College London. He specialises in snoring, sleep apnoea and respiratory health
Snoring is stealing our sleep. Adults lose about two hours of sleep on nights affected by snoring, according to recent research by Zeus, a sleep technology company. That might be because the noise keeps a partner awake or it wakes the snorer up. Each year, that adds up to more than a fortnight.
This can strain relationships, make people self-conscious about sharing a bed and, in some cases, point to something more serious.
Snoring happens when air moves turbulently through the upper airway. When you’re awake, your airway is open and airflow is smooth. As you fall asleep, your body relaxes, the airway narrows and soft tissue starts to flutter. That fluttering is the sound we call snoring.
Regular snoring doesn’t harm your health. It doesn’t give you high blood pressure or increase your risk of heart disease. But snoring sits on a spectrum. If the airway narrows further, breathing becomes harder. If it briefly closes, that’s obstructive sleep apnoea.
Sleep apnoea becomes more common with age because soft tissue loses elasticity. Some studies suggest more than 10% of people over 65 have it, though many cases go undiagnosed.
Sleep apnoea is a health risk because it can fragment your sleep, lower oxygen levels in the blood and leave you exhausted the next day. It is also linked to high blood pressure and cardiovascular disease. If you wake gasping, feel excessively tired all the time or your partner says you stop breathing at night, speak to your GP. They may refer you for a sleep study.
Whether you suffer from regular snoring or sleep apnoea, there are things that can help.
One of the most common contributors to snoring is obesity. In sleep medicine, what matters is the load on the upper airway.
For most adults in the UK, a BMI of 18.5 to 24.9 is considered healthy, 25 to 29.9 is overweight and 30 or above is obese. BMI isn’t perfect, but it is useful here.
The more weight you carry around your neck, the more pressure there is on the airway. Once the muscles relax at night, the airway is more likely to narrow or collapse.
Weight loss can improve both snoring and sleep apnoea. If you have sleep apnoea and lose more than 10% of your weight, you might cure it. Losing weight has certainly improved it in many cases.
Alcohol dampens alert signals in the brain and makes the body more relaxed. The problem is that it relaxes your upper airway, too.
The muscles become more collapsible, which can lead to snoring. Just one drink can cause snoring or worsen it, so if you don’t want to snore, you may need to avoid alcohol close to bedtime.
Smoking irritates the airway, causing swelling of the mucosa (the inner lining of the nose and airway) and sometimes contributing to polyps (soft, non-cancerous growths in the nose).
Both can block the nose. If you breathe through your mouth at night, the lower jaw and tongue can fall back, making the airway more likely to flutter.
If you smoke or inhale someone else’s smoke occasionally, a blocked nose may be temporary. If you’ve smoked for decades, it may be harder to reverse.
Certain medicines can have a similar relaxing effect to alcohol.
Some sleeping pills (including benzodiazepines), some antidepressants (such as amitriptyline), opioid painkillers (such as codeine) and nerve-pain medicines (including gabapentin and pregabalin) can have sedative effects.
That doesn’t mean you should stop medication if you snore. But it is worth discussing this with your doctor, especially if you feel sleepy during the day or your snoring has worsened.
Sleep posture is really important. When you lie on your back, gravity pulls the soft tissue attached to the lower jaw backwards. That tends to be the worst position if you snore or have sleep apnoea.
If you sleep on your side, gravity pulls the tongue base a little away from the airway. If you sleep on your front, the tongue base is pulled away even more.
The old trick to stop people sleeping on their back was to sew a tennis ball into the back of their pyjamas. A neater solution is to place sofa cushions or triangular cushions alongside them at night, so rolling onto their back becomes difficult.
You might only snore during hay fever season or when you have a cold. This is often because your nose is blocked, so you breathe through your mouth.
Decongestant sprays can help for a few days, but you shouldn’t use them for too long. When the spray wears off, the lining can swell again, often worse than before, leaving you more blocked.
If your nose is clear and you still snore, the blockage may be lower down, where the soft palate, tongue base or throat relaxes during sleep, narrows the airway and vibrates. In this case, you might have sleep apnoea.
In the Eighties and Nineties, it was popular to have an operation for snoring and sleep apnoea called uvulopalatopharyngoplasty or UPPP. Surgeons removed tissue from the soft palate and upper airway to make the space wider.
This helped some people, especially at first, but results were unpredictable and often faded. The problem is that snoring and sleep apnoea are not always caused by the airway being too narrow when you are awake. The airway relaxes and collapses during sleep. Even a wide airway narrows down at night.
For obstructive sleep apnoea, CPAP remains the standard treatment. CPAP stands for continuous positive airway pressure. You sleep wearing a mask and breathe pressurised air.
CPAP can reduce snoring when snoring is part of obstructive sleep apnoea because the pressurised air helps keep the airway open. But it is not usually used for simple snoring alone because it’s too sophisticated and forceful.
Although it can be effective, lots of people struggle with it. After three months, only 75% typically stay on the treatment. After a year, it is down to 50%. The mask can feel uncomfortable or claustrophobic and can irritate the skin.
I’ve been looking into another approach using electrical stimulation. Zeus is a small external device worn under the chin at night. It delivers gentle pulses intended to stimulate the hypoglossal nerve, which controls the tongue muscles, and help keep the airway open.
It is currently on the market for snoring. As a respiratory physician, I’m doing a trial to see whether it could be used as a licensed treatment for sleep apnoea.
Some extreme measures to treat snoring involve training the upper airway muscles.
In one study, published in the BMJ in 2006, people practised the didgeridoo six days a week, for 25 minutes a day, for four months. Their sleep apnoea scores improved and partners reported less disturbance from snoring.
It did work, but you would need to be a very committed didgeridoo player for it to have an effect.
You might be better off starting with more straightforward changes, whether it’s losing weight or sleeping on your side. And if snoring comes with gasping, pauses in breathing or daytime sleepiness, don’t ignore it. It could be sleep apnoea. It can be treated.
(As told to Laura Silverman)
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