This month, GP Alice Fitzgibbon discussed a something commonly complained about by partners and families all over the world – snoring!
Specifically, this article will cover a condition called obstructive sleep apnoea (OSA), which can have a significant impact on overall health. So, firstly, what causes snoring? When we are asleep, the muscles and tissues of the upper airway relax. This relaxation can lead to mild narrowing of the airways and breathing can become noisier as the tissues vibrate with the passing air. Being overweight, consuming alcohol, smoking or sleeping on your back can all make snoring worse.
Most of the time, snoring is not a sign of anything serious although it can cause a lot of problems in a household! Changing sleeping positions, reducing alcohol, weight loss and stopping smoking can help reduce the severity of snoring. Using devices such as mandibular realignment splints can also help by ensuring your jaw is in a forward position and the tissues do not narrow the airway during sleep. Having a clear, uncongested nose can also help reduce snoring, so trials of nasal strips or nasal sprays may also be used.
So, when is snoring a sign of something more serious? Snoring, along with waking up during the night gasping for breath and/or having excessive daytime sleepiness can be signs of obstructive sleep apnoea (OSA). Having stop/start breathing overnight, frequent overnight waking, headaches and lack of concentration during the day can also be signs that something is not right. OSA happens when the airways are too narrow during sleep to the extent it affects breathing during sleep. It can lead to a drop in oxygen levels in the body.
Recognising OSA is important. If it goes undiagnosed or untreated it can cause high blood pressure, increase the risk of having a stroke, lead to reduced concentration, mood changes, and also increases the chances of having an accident due to tiredness – eg a car accident. The snoring with OSA is also generally severe. This can have a big impact on other household members and cause strain in relationships. Being excessively tired during the day is considered a big risk for activities such as driving. For your safety, if you have OSA the DVLA may need to be informed and you may need to stop driving until the symptoms are controlled.
So how is OSA diagnosed? A lot of the time a patient and their family can give a good history which explains the symptoms. A questionnaire called the Epworth Sleepiness Scale can be completed and the answers give a score which rates the severity of daytime sleepiness. Patients can be referred to specialist sleep clinics for further tests if required. These tests involve wearing monitors overnight that check heart rate and breathing during sleep. The results can identify how severe the OSA is.
Managing obstructive sleep apnoea will depend on the cause. Losing weight if overweight can help. Having surgery to reduce enlarged tonsils or adenoids can also help if these are contributing. Having a healthy lifestyle – reducing alcohol and stopping smoking – is recommended. Sometimes, in severe cases, people need to use a CPAP (continuous positive airway pressure) machine to help maintain their breathing overnight. This means wearing a mask to sleep which allows the machine to push air into the airways to keep them open and ensure regular breathing. Using a CPAP machine might take some getting used to, but it is important to use it every night if required.
Snoring is a very common issue, and the vast majority of people who snore do not have sleep apnoea. If you think you might have symptoms that do indicate sleep apnoea please contact your GP to discuss these in more detail.
For further information on obstructive sleep apnoea (OSA) from the NHS visit https://www.nhs.uk/conditions/sleep-apnoea/
