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Anyone who has been kept awake at night by their partner’s snoring may have strong views about the need to find better solutions for this common problem.
While snoring is bad enough for the listener, it can also be a sign of a potentially serious medical condition in the person doing the snoring, called obstructive sleep apnoea.
This is when the airways become blocked, making the person wake up many times a night. This raises blood pressure and the risk of heart attacks and strokes, not to mention making sufferers dangerously tired in the day time.
We have long needed better treatments for sleep apnoea, but in the past few years, several new approaches have made progress – including nerve implants that are switched on at night and, at an earlier stage, a pill that is taken at bedtime.
So, what causes this sleep disorder and what are the prospects for a cure?
Both snoring and sleep apnoea happen because during sleep we unconsciously relax tissues in the throat, tongue, and soft palate (the roof of the mouth towards the back). This can lead to narrowing of the passageway for air.
If the airway narrows a little it can make the tissues vibrate as the air passes through, leading to the unwelcome chainsaw-like noises of snoring.
If the airway is completely blocked the person may stop breathing for 10 seconds or more, and the resulting lack of oxygen can make them wake up.
Partners of those affected often say it sounds like the person is choking or gasping for breath in the night.
Anyone can have such a temporary pause in breathing a few times during the night, so do not panic if you notice your partner doing this occasionally. It is classed as obstructive sleep apnoea if the pauses or periods of shallow breathing happen five times an hour or more.
If they happen more than 30 times an hour, this is classed as severe apnoea, giving an alarming one in three chance of a stroke or heart attack in the next decade. This may be because whenever breathing pauses, the low oxygen causes a rise in blood pressure and heart rate as the person responds by waking up, causing stress to the heart over time.
It is estimated that up to a quarter of adults have sleep apnoea to some extent. “We should be more worried about sleep apnoea because it’s a major problem,” said Ryan Cheong, an ear nose and throat and sleep surgeon at Cleveland Clinic London.
A CPAP machine doesn’t suit everyone (Photo: Getty)How is sleep apnoea currently treated?
The current mainstay of treatment for bad sleep apnoea is to go to sleep every night using a CPAP machine with a mask that blows air into the lungs. This helps keep the airway open.
Some people report having a much better night’s sleep this way, but this set-up is obviously inconvenient, and some don’t like the feeling of wearing a mask over their face all night.
That shouldn’t stop people getting investigated, though, as there are other options, which may help with both sleep apnoea and snoring.
If someone is referred to a sleep clinic, they usually will first be given monitoring devices to track breathing and heart rate during sleep at home. These can show how often breathing is being interrupted per hour.
If diagnosed with sleep apnoea, people are advised on lifestyle changes like trying to lose weight, as fat tissue in the neck and throat can compress the airways.
Alcohol also worsens snoring and apnoea because it relaxes the airway tissues, makes the nose more blocked and causes a worse night’s sleep, said Dr Lucia Pinilla, a sleep researcher at Flinders University in Australia. “Alcohol has a big impact,” she said.
Another strategy is “positional therapy”, which means using various methods for helping someone to avoid sleeping on their back, as side sleeping helps to keep the airways open.
One old anti-snoring trick is to put a golf ball in the back pocket of your pyjamas. People can also try using pillows to keep them propped on their side or devices that detect when they have flopped onto their back and vibrate until they turn over, said Professor Derk-Jan Dijk, head of the Surrey Sleep Research Centre.
“In one way or another, you need to make sure you or your bed partner turns from the back to their side,” he said.
If measures like these fail, people may be offered a procedure where a camera is put into their throat while they are sedated to see how the anatomy of their throat makes it narrow.
“Every snoring and sleep apnoea patient is unique,” said Cheong. “Some patients, they narrow at the level of the palate, some it’s the back of the throat. Depending on how they narrow and collapse, we can customise operations to reshape their palate, or back of the throat, so that it minimises the snoring.”
A recent advance is the option of a small chip, implanted under the chin, which electrically stimulates the nerves to the tongue. This stops the tongue from falling back in the mouth and blocking the airway.
The patient turns it on every night using either a phone app or a remote control.
The operation began being offered on the NHS last year. At the moment it is only available for sleep apnoea, not just snoring.
How could medicines help?
Surgeries and implants might seem extreme measures, so a new pill treatment for sleep apnoea has caused great interest.
The pill, only known as AD109, is a combination of two drugs that help keep the nerves around the airways more active during sleep, which stops muscles from relaxing too much.
In a large trial, people taking the medicine had half the number of pauses in their breathing as people taking placebo tablets. And a fifth of the people taking the drug had fewer than five pauses per hour, meaning their apnoea was classed as under control.
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On the downside, the medicine seemed to cause insomnia in a small percentage of users, which is unhelpful in a medicine for a sleep disorder, said Cheong.
Manufacturer Apnimed has not yet released the full details of the study, including which people responded best. The medicine is unlikely to help everyone with sleep apnoea, but these results seem promising on the face of it, said Cheong.
If the medicine is approved in the UK – which might take a few years – it will not be the first for sleep apnoea.
The new weight-loss injections, Wegovy and Mounjaro, are also helping people’s efforts to solve their sleep problems by losing weight – which was previously more difficult. “Weight loss is always a good thing in sleep apnoea,” said Professor Dijk.
So, for snorers and their partners, the future is looking brighter. And, hopefully, quieter.
As the drink-drive limit looks set to be lowered in England and Wales, I explore how alcohol affects driving and if there is a safe amount to drink.
I’ve been reading
While on holiday, I stumbled across an old and battered copy of The Princess Diarist, a compilation of old diary entries and reminiscences from Carrie Fisher about her time acting as Princess Leia in the Star Wars films.
It is a fun gossipy read about her relationships with the other actors and crew, as well as what it was like to be plunged into instant global fame. I recommend it, not just to Star Wars fans but anyone interested in the workings of Hollywood.
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