Snoring and obstructive sleep apnoea (OSA): what’s the difference, and how can you treat OSA?
Snoring is a very common symptom that affects over 40% of adults. It is twice as common in men and the likelihood of snoring increases with age. Reassuringly, in most cases it is not harmful to your health, although it may affect you or your partner’s quality of life.
However, in some rare instances (up to 4% of cases), snoring can be indicative of a potentially more serious underlying condition, called obstructive sleep apnoea (OSA).
In this article, Ear, Nose and Throat (ENT) consultant Mr Jahangir Ahmed explains what causes snoring, the link between snoring and OSA, how it’s diagnosed and how it can be treated.
What causes snoring?
You snore when air flows through your upper breathing passages: the nose, mouth, throat (including tonsils and soft palate), the back of the tongue and the voice box.
One or more of these areas narrows or becomes floppy and as air passes, their vibration causes the unpleasant sound of snoring.
7 causes of snoring
Depending on where your snoring originates from in your body, it could be caused by:
- Deviated septum / twist in the structure of your nose
- Rhinosinusitis (inflammation of the nose and sinus lining) – this can be caused by an allergy, response to irritant chemicals or infection. In some cases, this may develop into obstructive nasal polyps.Especially in those with allergies, the adenoids (glands in the upper throat, behind your nose and the top of the mouth) may also be enlarged, causing blockage and snoring.
- An enlarged elongated soft palate and / or uvula in the mouth (the uvula is the soft floppy tissue that resembles a punching bag).
- Enlarged tonsils and a bulky back of the tongue.Nasal blockage may indirectly worsen obstruction in this area too. For example: an open mouth whilst asleep leads to the tongue being pushed back, particularly while lying on your back.
- The muscles surrounding the throat collapsing when you breathe in, which narrows the throat passage.This can be exacerbated as you age and if you’re overweight, as fat deposits in the neck and tongue narrow the airway further.
- Your anatomy: a relatively small jawbone or a flattened mid-facial skeleton for example, causes a crowded throat and narrow nasal passages meaning you’re more likely to snore and suffer from OSA.
- Less commonly, masses or tumour growths in any of these areas or in the voice box may be a source of noisy breathing, particularly if you smoke or have a family history of cancer.
Snoring and other sleep-related symptoms may be indicative of a condition called obstructive sleep apnoea (OSA).
What is sleep apnoea?
Sleep apnoea is when your breathing is interrupted during your sleep. There are different forms of sleep apnoea that have different causes.
Obstructive sleep apnoea is the most common. This means your breathing is interrupted during sleep specifically by one or more areas in your air passages, and this subsequently triggers an often forceful or effortful breath.
During an apnoeic episode, your airflow is temporarily stopped or significantly reduced for at least 10 seconds at a time. Although an episode or two of sleep apnoea in every hour of sleep can be normal, if it happens more than 5 times in an hour, you have OSA.
In very severe cases, these obstructions in your breathing can occur more than once a minute and may be hazardous to your health.
A rarer form of sleep apnoea called central sleep apnoea is generally more dangerous, as it is caused by the brain not sending correct signals to your breathing muscles as you sleep. In this case there is no triggering of an effortful breath.
Symptoms of obstructive sleep apnoea
When you experience OSA, your brain lacks oxygen, so sends bursts of electrical activity to the muscles involved in breathing. Your chest and abdominal muscles move, causing you to gasp in your sleep.
Your partner or other people may be able to alert you to this behaviour.
Other potential symptoms while you sleep include:
- Snoring
- Stopping breathing
- Feeling that you’re choking
- Tossing and turning
- Waking up with sweats and a racing heart
You may wake up with a headache, not feeling rested after a night’s sleep, which can impair your ability to think and work.
Additional symptoms not obviously related to OSA include: night sweats, the sensation of a racing heart and the need to go to the toilet to pass urine multiple times. Reduced libido and sexual function have also been linked strongly to OSA.
Left untreated, OSA can develop into more serious, chronic conditions like diabetes, heart disease, high blood pressure and stroke.
How is obstructive sleep apnoea diagnosed?
If you think you have OSA, see your doctor. You may be asked to fill out one or more questionnaires, including the Epworth Sleepiness Scale, to help quantify the severity of your symptoms.
If you are referred to us, you will have a physical assessment, where your jaw size, mouth opening and position of the tongue and tonsils will be carefully examined. An internal examination of the nose, throat and voice box will be performed with a thin, flexible, high-definition camera called a nasendoscope. You may also be sent for blood and imaging tests.
How can obstructive sleep apnoea be treated?
To help determine whether you simply snore or have OSA, your doctor may suggest a non-invasive sleep study. You will be referred to a consultant specialising in respiratory medicine to facilitate this.
Sleep study
A sleep study can usually be done by taking a machine home and attaching it to your finger to measure your oxygen saturation levels while you are asleep. Modern devices may additionally measure nasal airflow and chest movement.
In most cases, this should be enough to make a diagnosis. However, if the results are inconclusive you may need to stay overnight at hospital for a more detailed sleep study.
Possible treatments include:
- A continuous positive airways pressure (CPAC) device – very effective for moderate to severe OSA, this is a machine that delivers pressurised air through a nasal or face mask to help open your upper airway while you are asleep. It needs to be used daily for at least 7 hours a night, for a prolonged period of time.
- Nasal steroids / decongestants / external valve strips (if your OSA is caused by an inflamed nasal lining)
- A splint for your jaw, which draws it and the attached tongue forward while you sleep.
If the above doesn’t work, you may be recommended surgery.
Surgical treatment options for obstructive sleep apnoea
Prior to surgery, some consultants might perform an endoscopic assessment of your airway under sedation and anaesthesia, which mimics sleep. They examine the upper airway to determine which anatomical area(s) may be responsible for the noise and obstruction causing your OSA. You may also require an MRI or CT of the sinuses and neck.
If you have a nasal deformity, such as a deviated nasal septum or enlarged turbinates’, you may be offered surgery to correct this (a septoplasty and turbinate reduction).
If your mouth / throat plays a part in your OSA, a palate shortening and / or stiffening procedure might be the surgery you need (for example, laser palatoplasty or expansion sphincter-pharyngoplasty), tonsillectomy or targeted surgery to the back of the tongue.
If your anatomy is responsible for your OSA, corrective surgery might be recommended e.g. jaw surgery if you have a small lower jaw.
There are also new, cutting-edge procedures available, such as transoral (meaning via the mouth) robotic surgery and hypoglossal nerve stimulation (under trial in the US and centres in mainland Europe, currently unavailable in the UK).
All these procedures require special expertise, experience and equipment to prevent serious complications.
Your doctor can advise you on what would be the best option for you.
More information
- If you’re worried about your snoring and think you may have OSA, speak to your GP about possible treatments. (Don’t have a GP?)
- King Edward VII’s ENT department is a fully equipped unit, staffed by experts with access to the most up to date tests and treatments.
- Mr Jahangir Ahmed works in one of the most experienced units in the UK managing snorers’ and OSA patients on CPAP with transoral robotic surgery and other advanced techniques, and can provide expert, advice, treatment and guidance. Make an enquiry.
- If you suffer with snoring, our Respiratory Medicine Unit can also help.
