Snoring: causes, treatment and when it points to sleep apnoea

The NHS says treatment depends on the cause. If the tongue partly blocks the back of the throat, a mandibular advancement device worn in the mouth brings the tongue forward. If the mouth falls open during sleep, a chin strap or a vestibular shield, a device that encourages nose breathing, may be used. If nasal airways are blocked or narrow, nasal dilators or strips can hold the nose open, and decongestants or nasal sprays can reduce swelling inside the nose.

Guy's and St Thomas' describes a mandibular repositioning appliance as a dental device similar to a gum shield that holds the lower jaw and tongue forward to clear the airway and usually reduces breathing noises and snoring. It advises wearing it for as long as possible at night, ideally 5 to 6 hours, and getting used to it gradually. Some people have slight gum discomfort or jaw ache at first, and an appliance should last about 2 years with regular use. It is not suitable for everyone and a dentist with training in sleep medicine should supply it.

Surgery is sometimes used if other treatments do not help, but the NHS says it is not widely available on the NHS, does not always work, and snoring can come back afterwards.

The NHS explains that snoring happens when the tongue, mouth, throat or the airways in your nose vibrate as you breathe. This occurs because those structures relax and narrow during sleep. Several things make it more likely: being overweight, smoking, drinking too much alcohol and sleeping on your back. Sometimes it is caused by a condition such as sleep apnoea, in which the airways become temporarily blocked during sleep.

Guy's and St Thomas' NHS Foundation Trust describes dental devices that hold the lower jaw and tongue forward to clear the airway, which fits with the tongue falling back towards the throat as one common mechanism. The NHS also lists blocked or narrow nasal airways as a cause, so more than one factor is often involved.

The NHS suggests trying to lose weight if you are overweight, sleeping on your side, and asking your partner to use earplugs if your snoring affects their sleep. To keep to your side it suggests taping or stitching a tennis ball to the back of your sleepwear, or buying a special pillow or bed wedge. It also advises not smoking, not drinking too much alcohol, and not taking sleeping pills, which can sometimes cause snoring.

These measures help many people, and are worth trying for several weeks before seeking more complex treatment. A sleep diary or recording of the snoring pattern can help a GP.

• Weight loss if overweight.

• Side-sleeping aids rather than lying on your back.

• Cutting back on alcohol, particularly in the evening.

• Stopping smoking.

• Avoiding sleeping pills unless prescribed for a reason.

The NHS says you might be snoring more in the second trimester, and that snoring is very common in pregnancy as your nasal passages are more likely to become swollen and blocked. For most people this is a temporary change.

The NHS general advice about snoring still applies: see a GP if you feel sleepy during the day, your breathing stops and starts while you sleep, or you make gasping or choking noises, as you may have sleep apnoea. In pregnancy, mention it to your midwife at your next appointment so it can be assessed.

Great Ormond Street Hospital says obstructive sleep apnoea (OSA) can occur in adults and children, and that the most common cause in children is enlarged tonsils or adenoids, which can partially block the airway. It is reported in 1 to 3 percent of children and is more common in children with conditions such as obesity, sickle cell disease and Down's syndrome.

Signs it lists include snoring, sleeping in an unusual position, briefly waking through the night, feeling sleepy or finding it hard to concentrate by day, waking up tired and unhappy, poor growth and weight gain, and hyperactivity or aggression in younger children. An overnight sleep study is the main way to investigate, and surgery to remove the adenoids and/or tonsils is the most common treatment, with CPAP or BiPAP as an alternative. A child who snores loudly with restless sleep or daytime tiredness should be seen by a GP.

The NHS says to see a GP if lifestyle changes are not helping, if the snoring is having a big impact on your or your partner's life, or if you feel sleepy during the day, your breathing stops and starts while you sleep, or you make gasping or choking noises: you may have sleep apnoea, which can be serious if not treated. At the appointment the GP will look inside your mouth and nose to check for problems that might be causing it. It helps to bring someone who can describe the snoring, such as a partner. The GP may do a blood test or refer you to a specialist for treatment or further tests if unsure of the cause.

Loud snoring in a child who also has restless sleep, mouth-breathing or daytime tiredness should be discussed with a GP too, as enlarged tonsils or adenoids can be responsible.

Sleep apnoea is a different problem, in which breathing stops and starts during sleep. NHS inform describes obstructive sleep apnoea as a condition where the walls of the throat relax and narrow or close during sleep, interrupting breathing, with symptoms including being very sleepy during the day, breathing pauses noticed by a partner, loud snoring, and noisy or laboured breathing with gasping or snorting. Not every snorer has sleep apnoea, and not every person with sleep apnoea snores loudly, but the combination of loud snoring and daytime sleepiness warrants assessment.

The NHS says a sleep study is used to check, often at home with portable equipment worn overnight. The Epworth Sleepiness Scale questionnaire is also used, and is useful to complete before the appointment. See the sleep apnoea page for tests and treatment.

On the NHS, a GP assessment comes first, then ENT or a sleep clinic if there are features of apnoea or a structural problem. Dental sleep services within hospitals fit appliances in some areas, but availability varies.

Privately, ENT surgeons, sleep physicians and dentists with sleep training can assess snoring and supply devices. A bespoke device made by a trained dentist differs from over-the-counter products, and surgery for simple snoring is a decision to take carefully given the NHS caution that benefits may not last. Ask what evidence supports any proposed procedure.