Snoring and obstructive sleep apnea

What it is

During sleep the muscles of the tongue and throat relax. In a narrow or collapsible airway that relaxation is enough to obstruct airflow - partially, producing snoring, or completely, producing an apnoea that ends with a brief arousal to restore the muscle tone.

The consequence is not just tiredness. Repeated overnight drops in oxygen and repeated arousals drive up blood pressure, worsen insulin resistance and raise cardiovascular risk substantially. Obstructive sleep apnoea is a common and frequently missed cause of blood pressure that will not come down.

What it feels like

• Loud snoring, usually reported by someone else
• Witnessed pauses in breathing, gasping or choking during sleep
• Waking unrefreshed regardless of how many hours were spent in bed
• Daytime sleepiness, sometimes dozing off while sitting still
• Morning headache, dry mouth and irritability

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Loss of muscle tone in the tongue and throat

The genioglossus and pharyngeal muscles hold the airway open. Their tone falls during sleep and further in deeper stages, which is why obstruction is worst in REM sleep.

A narrow or crowded airway

Large tonsils, a large tongue, a small or set-back jaw and a long soft palate all reduce the space available. Craniofacial structure explains why some slim people have significant apnoea.

Excess weight, particularly around the neck

Fat deposition in the tissues around the airway narrows it, and abdominal fat reduces lung volume which in turn reduces the tension holding the airway open. Neck circumference is a better predictor than BMI.

Sleeping on the back

Gravity pulls the tongue and soft palate backward. Position-dependent apnoea is common and often substantially better on the side.

Alcohol and sedatives

Both reduce the tone of the airway muscles directly and blunt the arousal response that ends an apnoea, making events longer and oxygen drops deeper.

Nasal obstruction

A blocked nose forces mouth breathing, which drops the jaw back and narrows the airway. Allergy, a deviated septum and chronic congestion all contribute.

Age

Airway muscle tone and tissue elasticity both decline with age, which is why prevalence rises steadily through middle and later life.

Sex and hormones

It is more common in men, and in women it rises sharply after menopause as the protective effect of progesterone on airway tone is lost. It is substantially under-diagnosed in women for this reason.

Smoking

Smoking causes airway inflammation and swelling, which narrows an already tight space.

Fluid shifting overnight

In people with heart or kidney problems, fluid that has pooled in the legs during the day redistributes to the neck when lying down, narrowing the airway. This is why apnoea and heart failure so often travel together.

Who tends to get it

• Anyone who snores loudly and wakes unrefreshed
• People with a large neck circumference or central weight gain
• Men, and postmenopausal women
• Anyone with high blood pressure that will not come down despite treatment
• People with atrial fibrillation, type 2 diabetes or heart failure

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineSleep & Wind-Down

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Witnessed apneas, choking arousals, or falling asleep while driving - needs a sleep study now; do not self-treat moderate-severe OSA

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Tongue and throat muscle training reduces apnoea severity by around fifty per cent in mild to moderate cases in trials, which is a meaningful effect for something with no side effects - but it is not a substitute for CPAP in moderate to severe disease. This is a condition worth diagnosing properly rather than managing on assumption: the cardiovascular consequences of untreated moderate or severe apnoea are substantial, and treatment transforms daytime function for most people. Falling asleep while driving is an urgent situation, not a nuisance.

Prevalence basis: Population polysomnography studies

Others the same routine covers

These share the Sleep & Wind-Down routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.