Snoring and sleep apnoea: find the cause first

Snoring is the sound of soft tissue vibrating in a narrowed airway. It can be loud and still be nothing more than noise. Obstructive sleep apnoea is different: the airway closes repeatedly through the night, breathing pauses, and sleep is broken without you being aware of it.

The two often travel together, and volume does not separate them. Someone who snores quietly can have significant apnoea. Someone who snores loudly may have nothing more than a narrow nose.

Interrupted sleep does not restore you in the same way, and that shows up in the daytime rather than at night. A dry mouth, a morning headache, poor concentration and fighting sleep after lunch are often the first clues. The purpose of the assessment is to know which pattern applies to you rather than assume it.

The upper airway can narrow in three broad places, and each behaves differently. At the level of the nose, a bent septum, enlarged turbinates or allergic swelling restrict airflow before it ever reaches the throat. At the level of the palate and tonsils, soft tissue vibrates as air passes it. At the level of the tongue base and throat, the airway loses tone during sleep and falls back.

Many people narrow at more than one level. The pattern is individual, and it shifts with sleeping position, nasal congestion, alcohol, sedating medication and the stage of sleep.

A treatment works best when it targets the level that is actually narrowing. This is why a device, a spray or a procedure can make a real difference for one person and change nothing at all for another.

Sleep apnoea is difficult to observe from the inside. You do not remember the pauses, the gasps or the position changes, because they do not wake you fully. The partner in the room is usually the first person able to describe what is really happening.

Partners are welcome at the consultation, and what they report is genuinely useful clinical information. How loud, how often, whether the sound stops and restarts, and whether it changes when you turn onto your side all help direct the examination.

If you sleep alone, a phone recording of one ordinary night serves a similar purpose. Bring it with you.

The market is full of strips, sprays, pillows and mouthguards, and most of them address a single level of the airway. Used without knowing where your own narrowing sits, they become a sequence of experiments rather than a treatment. Some of them do help. Knowing which, before you buy the next one, is the useful part.

An ENT examination establishes the anatomy. A sleep study records what your breathing actually does across a night. The two together replace assumption with information, and the plan follows from there. Understand the cause, then treat the source.