Sleep Apnoea: Why Loud Snoring Can Be a Warning Sign
Snoring is often treated as a joke or an annoyance. But when snoring is loud, interrupted by silent pauses and followed by exhausted days, it may be obstructive sleep apnoea, a common and serious condition that raises the risk of heart disease, stroke and accidents. The good news is that it is highly treatable.
What happens during sleep
In obstructive sleep apnoea (OSA), the muscles at the back of the throat relax too much during sleep, and the airway narrows or closes. Breathing stops for ten seconds or more, oxygen levels drop and the brain briefly wakes the body to restart breathing, usually without the person remembering. This can happen dozens or even hundreds of times a night, fragmenting sleep and putting repeated strain on the heart and blood vessels.
A less common form, central sleep apnoea, results from the brain failing to send proper breathing signals and is often linked to heart failure, stroke or opioid use.
Who is at risk
- Excess weight, especially fat around the neck
- Male sex, though risk in women rises after menopause
- Age over 40
- A naturally narrow airway, large tonsils or a small jaw
- Nasal obstruction
- Alcohol and sedatives taken near bedtime
- Smoking
- A family history
- Conditions such as hypothyroidism, acromegaly and polycystic ovary syndrome
Symptoms
At night
- Loud, habitual snoring
- Witnessed pauses in breathing, gasping or choking
- Restless sleep and frequent trips to the toilet
- Night sweats and waking with a dry mouth
By day
- Overwhelming sleepiness, even after a full night in bed
- Morning headaches
- Difficulty concentrating and poor memory
- Irritability or low mood
- Falling asleep while driving or at work
A bed partner’s description is often the best clue. The Epworth Sleepiness Scale is a quick questionnaire doctors use to rate daytime sleepiness.
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Why it matters
Untreated OSA is associated with:
- High blood pressure that is hard to control
- Atrial fibrillation and other arrhythmias
- Heart attack, heart failure and stroke
- Type 2 diabetes and insulin resistance
- Road traffic and workplace accidents
- Reduced quality of life and relationship strain
Diagnosis
A home sleep test, using a small device with a finger probe and chest belt, can confirm many cases. A full overnight sleep study (polysomnography) in a sleep lab is used for more complex cases. The result is reported as an apnoea-hypopnoea index (AHI), the number of breathing disruptions per hour: 5 to 14 is mild, 15 to 29 moderate and 30 or more severe.
Treatment options
Lifestyle. Weight loss is one of the most effective treatments, and even a moderate reduction lessens severity. Avoid alcohol and sedatives in the evening, stop smoking and try sleeping on your side rather than on your back.
CPAP. Continuous positive airway pressure remains the gold standard. A mask delivers gentle air pressure that keeps the airway open. Many people notice better energy and mood within days. Modern machines are quiet, with humidifiers and a variety of mask styles. Comfort problems are common at first, so stick with it and ask your sleep clinic to adjust the fit.
Mandibular advancement devices. A custom-fitted mouthpiece moves the lower jaw forward and is suitable for mild to moderate OSA or those who cannot tolerate CPAP.
Surgery and implants. Options include tonsil removal, jaw surgery and hypoglossal nerve stimulation in selected patients.
Medicines. Some newer weight-loss drugs have been approved for sleep apnoea in people with obesity.
Driving and safety
If you feel drowsy while driving, stop and rest. In many countries, a diagnosis of OSA must be reported to the licensing authority, and driving is allowed again once symptoms are controlled.
When to see a doctor
Seek an assessment if you snore loudly and feel unrefreshed, if anyone has seen you stop breathing during sleep, or if you struggle to stay awake in the day. Treating sleep apnoea often improves blood pressure, mood, concentration and energy at the same time.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.