Snoring vs Obstructive Sleep Apnoea
Snoring and sleep apnoea are very closely related, and the two often go hand in hand. I will try and explain the differences between them.

Snoring occurs when the tissues in your throat vibrate because of the passing of air (breath) through them during sleep. It often happens when the airway is slightly narrowed and there is loose tissue that can flap around as the air passes through it.

On the other hand, sleep apnoea is when the airway is so narrowed that it blocks off the air altogether. So, instead of vibrating the tissues in the throat, the tissue stops all airflow completely. In this situation, the person may start to lose oxygen and can't get rid of carbon dioxide quickly enough. The body cannot survive very long in this situation, and so after losing 3% or 4% of oxygen levels, most people partly wake up and take a deep breath to rectify the problem. Once the oxygen levels have returned to normal, the body relaxes back into deeper sleep. The trouble with deep sleeping, that the throat may close down again, blocking off the airway and repeating the whole process again.

In obstructive sleep apnoea people can stop breathing every 2 or 3 minutes whilst they are asleep. Each time they need to wake up partly, take a deep breath, and then drop back off to sleep again.

Most people are blissfully unaware of these events. They have no idea that they are losing oxygen every few minutes and disturbing their sleep. Some people can stop breathing every 30 seconds and dangerously drop their oxygen levels and still have no recollection of any of this happening.

The vast majority of people with obstructive sleep apnoea snore very loudly and there is evidence stating that 89.9% of patients with obstructive sleep apnoea report also snore. In those people who apparently do not snore with obstructive sleep apnoea, are probably not making the typical snoring noise, but are simply choking or going blue rather than making the characteristic sound we all are aware of.


How do I know if I have simple snoring or obstructive sleep apnoea?
This is harder than one might expect. Firstly, it is challenging to know if you have obstructive sleep apnoea because most people have no recollection of waking up at night with breathing problems. Secondly, sleep apnoea tends to creep up on us as the years pass by, and therefore, we do not realise how tired or unproductive we have become. Often, people blame just getting old or work stress rather than making the link between snoring and sleep apnoea. It is heartwarming to see patients who previously had no idea they had sleep apnoea or were run down, only to feel so much better after treatment. Often, people say “I completely forgot what normal was; I can't believe I was walking around so tired, for so long”.

Interestingly, even when bed partners watch people breathe at night, it is very difficult to pick up whether or not they have sleep apnoea. It is not always a very dramatic, deep breath or choking episode. Sometimes, it is simply a shallow breathing event where patients slowly go blue with lack of oxygen, and then they take a slightly deeper set of breaths before sinking back into shallow breathing again. So it is often surprising for bed partners to see how bad their partners are breathing when the sleep study results come out. Hearing interruptions in snoring is often a sign that they have obstructive sleep apnoea. Witnessing someone holding their breath is often a late and severe sign.


What is a Sleep Study?
A sleep study is a small machine that sits on your chest or on your hand and measures your oxygen level, your pulse rate, how deep you are breathing, how fast you are breathing and also what stage of sleep you're in. In this is the only true way of working out whether or not you have obstructive sleep apnoea or not. This is the definitive test, but it is difficult to come by, so there are other ways of identifying if you have high chance of having obstructive sleep apnoea.


The STOPBANG questionnaire
The STOPBANG questionnaire is the only validated questionnaire that can help you work out your risk of having obstructive sleep apnoea. It is known as a good 'screening tool', which means that it picks up lots of people with obstructive sleep apnoea, but unfortunately it may also pick up people who don't have this condition. This questionnaire aims to find all the people with the condition and then encourage them to have a sleep study test. Some people may end up not having sleep apnoea at all, but at least we are picking up the vast majority who do. There is a free website for this questionnaire which you can find online. If you are found to have an intermediate or high risk of obstructive sleep apnoea, the guidance is to see your GP and ask to be referred for a sleep study.

There are several symptoms and signs that point to having obstructive sleep apnoea:

• Snoring. If someone snores so loudly that they can be heard through a closed door, they likely have obstructive sleep apnoea.


• Tiredness and unrefreshing sleep. Feeling tired during the day and waking up unrefreshed after a night's rest is a common symptom of obstructive sleep apnoea. The Epworth score is often used to detect daytime tiredness. However, it should be stressed that many people have no symptoms of tiredness and only realise how tired they are after being treated.


• Waking up at night to urinate. This commonly affects people with quite severe sleep apnoea. A hormone released from the heart called atrial natriuretic peptide (ANP), generally helps stop us from filling up our bladders at night. In the morning, the kidneys start to clear themselves out, and your bladder fills up normally. The problem is that with obstructive sleep apnoea, The body is constantly thinking that it is morning as it is being woken up so often. It is tricked into filling up the bladder so that often people wake up multiple times at night with needing to pass water. This is often misdiagnosed as bladder problems or prostate problems, and again, people do not make the link between their severe snoring and possible obstructive sleep apnoea.


• Impaired ability to concentrate. Again, this is rather difficult to notice as it seems to creep up on people over the years. Being less productive at work and also not having the same reaction time is often difficult to quantify or be aware of in our busy daily lives. But this is also the reason why 40% of car accidents in this country are caused by someone with obstructive sleep apnoea.


• Waking up in the morning with a headache. This is a common symptom and is often associated with people with low oxygenation levels during sleep. Starving your brain of oxygen will lead to a headache in the morning. After an hour or so, things seem to settle down, and people just put this down to stress or other problems in their lives.


• Dry Mouth. Waking up with a dry mouth is not a specific symptom of obstructive sleep apnoea as almost anyone with a blocked nose will have this problem. Breathing through your mouth all night will lead to drying up your saliva and feeling parched in the morning. Many people with obstructive sleep apnoea have a blocked nose. I think it is helpful to think of this as the fact that we have an awful lot of redundancy in ensuring that we can continue breathing. For someone to have obstructive sleep apnoea, multiple problems and issues need to be compounding upon each other before you actually get obstructions and sleep apnoea. So although having a blocked nose does not itself cause obstructive sleep apnoea, but it's certainly one of the most common problems associated with people with this condition. Sleep apnoea patients often have a blocked nose as well as several other blockages in their airways. To be clear, A blocked nose does not cause sleep apnoea purely because if that were the case, then everyone with a cold or flu would have sleep apnoea for a few days. People with blocked noses sleep poorly, but it does not cause sleep apnoea by itself.


• Mood disturbances. There is a strong link between obstructive sleep apnoea (and any severe sleep deprivation actually), and mood disorders. Interestingly, sleep apnoea causes depression, and depression can cause sleep apnoea. This can be a difficult cycle to escape from. Patients are often more anxious and find it very difficult to cope in various stressful situations.


• Obstructive sleep apnoea also causes several medical conditions and has many severe long-term detrimental effects. Obstructive sleep apnoea causes:


• High blood pressure


• Diabetes


• Weight gain


• Strokes


• Irregular heart rate


• Heart attacks

Reduced Life Expectancy We believe the life expectancy of someone with obstructive sleep apnoea is reduced by approximately 20 years. This would mean that a man with obstructive sleep apnoea has an average life expectancy at the moment of roughly 58 years old. Untreated obstructive sleep apnoea patients have 26% chance of mortality at 5 years after diagnosis. Approximately 34% of untreated obstructive sleep apnoea patients are still alive after 20 years.

Conclusion
Although closely linked, snoring and obstructive sleep apnoea are very different in significance to our lives. They occupy the same spectrum of disorders (known as sleep breathing disorders), but they can be considered on opposite ends of this continuum. The only surefire way of knowing whether or not you have simple snoring or obstructive sleep apnoea is to perform a sleep study but as mentioned above there are ways of increasing your awareness of this condition and picking up some of the subtle signs that may may suggest a serious problem.

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