Sleep apnoea: what it is, how it's diagnosed, and what you can do about it
Obstructive sleep apnoea is one of the most common chronic health conditions in the United Kingdom, yet it remains significantly underdiagnosed. Many people live with the condition for years — attributing their fatigue, poor concentration and low mood to work pressures or the demands of modern life — without realising that the root cause is a nightly disruption to their breathing.
This article aims to explain clearly what sleep apnoea is, how it is identified, and what treatment options exist for those affected.
What is obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is a condition in which the airway repeatedly collapses or becomes obstructed during sleep, causing breathing to pause temporarily. These pauses — known as apnoeas — typically last between ten seconds and a minute, and can occur dozens or even hundreds of times per night in severe cases.
Each apnoea triggers a brief arousal from sleep as the brain detects the drop in oxygen levels and signals the body to restore airflow. The sleeper rarely remembers these arousals, but they are sufficient to fragment sleep architecture, preventing the restorative deep sleep that the body requires. Over time, this cumulative deprivation takes a significant toll.
OSA is distinct from simple snoring, though the two often coexist. Snoring involves partial airway obstruction and vibration of soft tissues; apnoea involves complete or near-complete collapse. The distinction matters clinically because the health consequences of untreated OSA are considerably more serious.
What are the symptoms?
Because the most dramatic manifestation of sleep apnoea — stopping breathing — occurs during sleep, many people are unaware they have it. The condition is often first suspected by a bed partner who notices loud snoring punctuated by silence, followed by a gasp or choking sound as breathing resumes.
Common symptoms include:
Loud, persistent snoring, often described as irregular or punctuated by pauses.
Excessive daytime sleepiness — falling asleep during sedentary activities, or struggling to stay alert during the day despite adequate time in bed.
Waking unrefreshed, regardless of how long you have slept.
Morning headaches, thought to result from elevated carbon dioxide levels during the night.
Waking with a dry mouth or sore throat.
Poor concentration, memory difficulties or irritability.
Nocturia — waking frequently to urinate during the night.
Not everyone with OSA snores loudly, and not everyone who snores has OSA. The presence of daytime symptoms alongside snoring is particularly significant and warrants assessment.
Who is at risk?
OSA affects people of all body types and ages, but certain factors increase the risk considerably. Excess weight — particularly around the neck — is the single most modifiable risk factor, as fatty tissue compresses the airway during sleep. Anatomical features such as a narrow jaw, enlarged tonsils or a long soft palate also play a role, as does increasing age, which reduces the natural tone of the throat muscles.
Men are more commonly affected than women, though the gap narrows significantly after the menopause. Those with a family history of OSA, a large neck circumference, or conditions such as hypothyroidism or diabetes may also be at elevated risk.
Why does it matter?
Left untreated, obstructive sleep apnoea is associated with a range of serious health consequences. The repeated drops in oxygen saturation place sustained stress on the cardiovascular system, and OSA is recognised as an independent risk factor for hypertension, atrial fibrillation, coronary artery disease and stroke. It is also linked to impaired glucose regulation and type 2 diabetes, and is a significant contributing factor to road traffic accidents attributable to driver fatigue.
Beyond these physical risks, the impact on quality of life should not be underestimated. Chronic sleep deprivation affects mood, cognitive function, relationships and professional performance in ways that can be profound and progressive.
How is sleep apnoea diagnosed?
Diagnosis begins with a clinical consultation in which symptoms, sleep history and relevant medical background are reviewed. A physical examination, including flexible nasendoscopy, allows the clinician to assess the nasal passages, throat and airway anatomy directly.
The next step is typically a sleep study. At Hillser Clinic, we offer home-based sleep studies using a small, non-invasive monitoring device worn overnight. This records breathing patterns, oxygen saturation, heart rate and sleep stages, providing a detailed picture of what is happening during sleep. For patients whose results suggest more complex or positional obstruction, a drug-induced sleep endoscopy (DISE) may be recommended. This involves administering mild sedation to reproduce the sleep state, enabling direct visualisation of the sites of airway collapse — information that is invaluable in planning targeted surgical treatment.
What are the treatment options?
Treatment is tailored to the severity of the condition and the underlying causes identified during assessment.
For mild OSA, lifestyle measures can make a meaningful difference. Weight loss, reducing alcohol intake — particularly in the evening — improving sleep position, and addressing nasal congestion are all interventions with good evidence behind them.
CPAP (continuous positive airway pressure) therapy is the most widely used treatment for moderate to severe OSA. A CPAP machine delivers a gentle, continuous flow of pressurised air through a mask during sleep, acting as a pneumatic splint to keep the airway open. It is highly effective when used consistently, and most patients notice a dramatic improvement in their daytime symptoms within days of starting treatment. Hillser Clinic provides CPAP services from titration under DISE to ongoing adaptation support and compliance improvement as part of our sleep pathway.
Mandibular advancement devices — custom-fitted dental appliances that hold the lower jaw slightly forward during sleep — are an effective alternative for those with mild to moderate OSA or for whom CPAP is not tolerated.
Surgical options are considered where anatomy is a significant contributing factor. These range from nasal surgery to improve airflow, through to targeted procedures addressing the palate, tongue base or other sites of collapse identified during DISE. Modern surgical approaches are predominantly minimally invasive and precisely tailored to each patient's anatomy.