- Someone has seen you stop breathing in your sleep
- You fall asleep while driving, or at a desk mid-task
- You wake gasping or choking at night
- Morning headaches with high blood pressure that will not come down
- Snoring in a child with restless sleep and daytime behaviour problems
Go to the nearest emergency department, or call 8563816000
Snoring on its own is common and usually harmless. Snoring plus being tired during the day is a different matter, and it is the combination that ought to be taken seriously. It is the commonest presentation of obstructive sleep apnea, a condition that is simple to diagnose, very treatable, and frequently left untreated for years because it is dismissed as a habit or a joke.
What is happening
During sleep the muscles of the throat relax. In some people the airway narrows so far that it closes completely, for ten seconds or longer, again and again. Each time, oxygen falls and the brain briefly wakes you — not enough to remember, but enough to stop the deep sleep you need. This can happen dozens of times an hour, every night, for years.
The result is sleep that does not restore you no matter how long you spend in bed.
Signs worth acting on
At night: loud snoring, often audible from another room; pauses in breathing noticed by a partner; waking with a gasp or choking sensation; getting up repeatedly to pass urine; restless, sweaty sleep; a dry mouth on waking.
During the day: waking unrefreshed; morning headache; falling asleep watching television, in meetings, or — most dangerously — while driving; poor concentration and short-term memory; irritability; low mood; reduced interest in sex.
On examination: high blood pressure that resists treatment, a large neck circumference, and often excess weight, although plenty of people with sleep apnea are not overweight.
Why it is more than tiredness
Untreated sleep apnea is not simply a quality-of-life problem. Every apnea causes a surge in blood pressure and a strain on the heart, repeated through the night, for years. It is associated with high blood pressure that will not respond to tablets, atrial fibrillation and other arrhythmias, heart failure, stroke, worsened control of type 2 diabetes, and a markedly increased risk of road accidents.
If you drive for a living, this is a matter of safety for you and for other people on the road, and that alone is reason to have it assessed.
How it is diagnosed
The history and the partner's account point to it. What confirms it is a sleep study, which records airflow, breathing effort, oxygen saturation, heart rate, snoring and body position through a night's sleep. It reports how many times an hour your breathing stops or becomes shallow — the AHI — and how far your oxygen falls, which is how the severity is graded.
A home sleep study is sufficient for most straightforward cases and is done in your own bed. A full in-laboratory study is used where the picture is complicated or other sleep disorders are suspected. Sleep study and CPAP setup describes what happens in practice.
Treatment
CPAP is the mainstay for moderate and severe disease. A small machine delivers gently pressurised air through a mask, which holds the airway open. Done properly it works from the first night: people describe the difference in daytime alertness within a week.
Two things decide whether CPAP succeeds, and neither is the machine. The pressure has to be titrated to the level that actually holds your airway open in every sleep stage and position, not left at a default. And the mask has to fit — the wrong mask is the single commonest reason people give up. Both are done in person, and follow-up reads the machine's own data on hours of use, residual events and leak, so the settings can be corrected.
Weight loss meaningfully reduces severity where weight is a factor. Position matters for some people, whose apnea occurs almost entirely on the back. A mandibular advancement device — a dental appliance that holds the jaw forward — suits selected people with milder disease. Surgery has a narrow role, mainly where there is a specific correctable obstruction. Alcohol and sedatives in the evening make everything worse.
Children
A snoring child with restless sleep, mouth breathing, bedwetting or daytime behaviour and attention problems should be assessed. In children the cause is often enlarged tonsils and adenoids, and treatment can transform both sleep and school performance.
Frequently asked questions
Which doctor treats snoring?
A pulmonologist or sleep medicine specialist diagnoses and treats sleep apnea. ENT surgeons are involved where there is a correctable obstruction, and dentists provide mandibular advancement devices. Start with the sleep assessment.
I snore but I feel fine. Do I need a sleep study?
Not necessarily. Snoring without daytime sleepiness, witnessed pauses or resistant high blood pressure can be simple snoring. The combination is what matters — and if a partner has seen you stop breathing, get tested regardless of how you feel.
Do I have to use CPAP forever?
While you have the condition, yes — it treats rather than cures. Substantial weight loss can reduce severity enough to change or stop treatment in some people, which is checked with a repeat study rather than assumed.
I tried CPAP before and could not tolerate it.
That is common and usually fixable. It is almost always the wrong mask or an untitrated pressure. A proper refitting and a pressure set from your own data make the difference, and it is worth a second attempt.
Will losing weight cure it?
It can substantially reduce severity, and in milder cases resolve it. But it takes time, apnea makes weight loss harder by disrupting appetite hormones, and the heart and blood pressure risk continues meanwhile — so treatment usually runs alongside, not instead.