Sleep Apnoea & Snoring

Simple snoring without apnoea is a social problem rather than a medical one, and does not carry the same health risks. The difficulty is that you cannot reliably tell them apart from the inside, because the arousals that break up the night are usually not remembered. If your snoring is loud and habitual, and particularly if anyone has seen you stop breathing, it is worth establishing which you have. If it turns out to be simple snoring, that is a useful thing to know.

Most people are assessed with a home sleep study: portable equipment worn overnight in your own bed, recording airflow, breathing effort, oxygen levels, heart rate and body position. It is unobtrusive and you sleep normally. A full in-laboratory study, which also records brain activity, eye movements and limb movements, is reserved for cases where the picture is more complicated or another disorder is suspected alongside.

Not necessarily, and it depends on severity. CPAP is the most effective treatment for moderate to severe obstructive sleep apnoea and works by holding the airway open with gently pressurised air through a mask. For mild disease, or where CPAP cannot be tolerated, a mandibular advancement device that holds the lower jaw forward is a well-established alternative. Weight loss, sleeping off your back, treating nasal obstruction and reducing evening alcohol all contribute, and for some people are sufficient.

It can, and it should be taken seriously rather than avoided. DVLA rules require you to stop driving and notify them if you have excessive sleepiness that is likely to impair driving. Once the condition is being treated effectively and the sleepiness has resolved, driving can usually resume, with confirmation from your doctor. Rules differ for car and for bus and lorry licences. Being diagnosed and treated is what protects your licence; carrying on undiagnosed while sleepy at the wheel does not.

Yes. Excess weight is the strongest risk factor but a substantial proportion of people with obstructive sleep apnoea are of normal weight, where the cause is usually the anatomy of the upper airway or the jaw. It is also under-diagnosed in women, partly because the presentation is more often fatigue, insomnia or low mood than classic loud snoring, so it is not considered. Risk in women rises significantly after the menopause.

The arousals that end each apnoea are very brief and rarely reach conscious awareness, so they are not remembered. What you experience is simply waking up unrefreshed. This is why a witness account is so valuable, and why partners are often the ones who prompt an assessment. If you sleep alone, a phone recording of your breathing overnight can be surprisingly informative.

Certainly, and part of the point of a consultant assessment is to distinguish them. Narcolepsy and idiopathic hypersomnia, insufficient sleep, shift work, circadian rhythm disorders, restless legs, thyroid disease, anaemia, depression and medication side effects all cause daytime sleepiness. Because this clinic covers neurology as well as sleep medicine, these can be considered together rather than each requiring a separate referral.