Snoring and Sleep Apnoea Explained

In our latest consultant FAQ, Mr Vik Veer, Consultant Ear, Nose and Throat Surgeon talks about two common problems that keep many of us awake at night; snoring and sleep apnoea.

So what do we mean when we talk about snoring and sleep apnoea?
Snoring is a rather irritating noise generated by vibrating tissue at the level of palate (the dangly thing at the back of throat) or from the area behind the tongue during sleep.

Sleep apnoea is when there are repeated obstructions of the throat leading to choking or gasping episodes during sleep.

Did you know?

• Snoring affects mainly men (up to 45%), but after menopause women tend to snore as much as men.
• Sleep apnoea affects about 4% of middle aged men, but over 80% of people are unaware of the diagnosis.
• Sleep apnoea costs the NHS about £432 million pounds a year as it causes obesity (or inability to lose weight), heart attacks, strokes, diabetes and high blood pressure.

It’s pretty easy to know if someone is snoring but how can you tell if a person has sleep apnoea?
The STOPBANG questions are a quick way of working out if you might have sleep apnoea.

If the answer is YES to two or more of these question you may have sleep apnoea. To get a more accurate result visit http://stopbang.ca/osa/screening.php”‹
Is there anything I can do myself to stop snoring or reduce the risk of sleep apnoea?
There are a number of simple ways of reducing snoring or reducing the risk of obstructive sleep apnoea:

1. Lose weight 
If you have a high BMI losing 10% of body weight reduces snoring and sleep apnoea by about 30%. Ideally you should aim for a BMI below 25. If you have lost weight but notice no improvement in your breathing or snoring, there might be another structural problem (e.g. tonsils, bulky tongue, floppy voice box etc.).

2. Sleep on your side
When some people sleep on their back it can lead to the back of the tongue collapsing and partly obstructing the breathing pathway. Moving on to your side could improve this. There are new devices available that ‘train’ you to sleep on your side. These are position sensitive gadgets that vibrate when you lie on your back. Research suggests wearing these devices for four to six weeks is sometimes enough to develop a habit of sleeping on the side.

3. Stop smoking
One cigarette affects the nasal passages for up to three months and can cause congestion and catarrh. Being unable to breathe through your nose forces you to open your mouth, generally resulting in in louder snoring. Stopping smoking can sometimes reduce the volume of snoring.

4. Avoid alcohol at bedtime
Alcohol reduces the tone in muscles holding the airway open. If the muscles become too relaxed, snoring and sleep apnoea normally become worse. Avoiding alcohol before bedtime can sometimes make a big difference to snoring and your ability to breathe.

5. Make sure you can breathe well through your nose
Allergies and nasal congestion can make snoring worse so using remedies to treat this can be very useful. If you can breathe your through nose normally, but still seem to breathe through your mouth at night, you could try a chin splint (which closes the mouth at night). With time you can train yourself to sleep without opening your mouth at night, after which you can discard the chin splint.

When should I see a specialist about my snoring or sleep apnoea?

There are theories that suggest that loud snoring leads to sleep apnoea. The repeated vibration of the throat leads to damage to the nerves, which leads to reduced muscle tone. This cycle continues until someone gets sleep apnoea.

Sleep apnoea leads to:
•    premature heart disease
•    strokes
•    diabetes
•    depression
•    and a much higher risk of having a traffic accident.

If you think you have sleep apnoea, ask your doctor for advice about a Sleep Study (polysomnography). This is a machine that you wear for one night at home, which monitors your breathing. This will show if you have a sleep related breathing disorder or not.

What will happen during a consultation?
The consultation involves discussing your particular problem and any symptoms suggestive of sleep apnoea. There are many different causes for breathing problems at night and your specialist will examine your nose, throat, tongue and voice box. Everyone will need a Sleep Study to investigate the severity of the problem and this will be explained in a clear and unrushed manner.

Our specialists will inform you about the range of treatments available from the conservative measures mentioned above, to the latest medical devices and surgical options.

As each patient is individual we will develop a treatment plan to suit your individual needs.
What treatments are available and what is the outcome?
Mr Vik Veer, is an ENT Surgeon who works at the award-winning Royal National Throat Nose & Ear Hospital Sleep Surgery department in Central London. He is one of only two surgeons in the country who are fully funded by the NHS to provide the entire range of surgical treatments for Sleep Apnoea.

• Those patients who have mild obstructive sleep apnoea or Upper Airways Resistance Syndrome are offered a Mandibular Advancement Splint. This is like a gum shield that lifts the tongue forward during sleep, so the patient can breathe better at night.
• For patients who have moderate or severe obstructive sleep apnoea the guidance is to offer a CPAP mask at night. This is a device that delivers air into the body and prevents the throat from collapsing.
• If patients are unable to tolerate these options, then there are surgical options that either help the patient use their device more comfortably, or open up the airway enough so that they no longer need to wear a device at night.

There are over 30 different operations available, but each person is different and this requires an individual careful plan.  Depending on the cause and severity of the obstruction, the results can be quite different. For example a patient with large tonsils nearly always does very well in terms of breathing after the operation. Patients with a large tongue however are harder to treat, but recently there are new treatments available for the tongue.  At one end of the spectrum there are very gentle techniques to reduce the bulk of the tongue, but some patients may need more advanced therapy such as robotic surgery or even an implant. This tiny implant is placed under the tongue and stimulates the tongue preventing it from collapsing back.  Mr Vik Veer and the team at the Royal National Throat Nose and Ear hospital are leading a global trial into a new implant that helps patients who have this particular problem.  This will be the first time implants will be available in this country.

An initial private consultation with Mr Veer costs £225 

To book a consultation, call our friendly appointments team on 020 8936 1201.

For more information on self-pay pricing just call our friendly Self-Pay Team on 020 8936 1157 or email info@theholly.com