Snoring or sleep apnoea? How to tell the difference

It is rarely you who raises it. It is somebody else.

Somebody who has lain awake next to you, who has heard the sound stop and then restart with a jolt. Somebody who jokes about it in the morning, because joking is easier than saying it was unsettling to listen to.

Snoring is one of the few health signals you cannot observe yourself. That makes it easy to wave away. It does not hurt, it does not show up in the mirror, it is not in any app. And as long as you are the only person who cannot hear it, it is easy to never find out what it means.

For most people it means nothing at all. For a sizeable minority it means something worth catching. This is about telling those two cases apart.

What snoring actually is

Snoring happens because the upper airway is narrow while you sleep, usually in the throat or the nose. Air has a harder time getting through. The soft parts of the palate and the throat start to vibrate, and those vibrations are the sound.

It is not a fault in the lungs. It is a narrow tube.

The muscles that hold your airway open while you are awake relax when you fall asleep. That happens to everyone. The difference between someone who snores and someone who does not comes down to how much clearance there was in the tube to begin with.

Snoring itself is not dangerous. It can disturb your sleep quality, which is why it gets linked to poor concentration and dozing off during the day. It can certainly disturb whoever sleeps beside you. But the sound on its own is not a sign of disease.

Where snoring ends and sleep apnoea begins

With obstructive sleep apnoea, the airway is no longer merely narrow. It is blocked, fully or partly. Often the tongue falls back into the throat. Airflow to and from the lungs is interrupted.

To count as an apnoea, a pause has to last at least ten seconds. Swedish health guidance from 1177 notes that pauses in obstructive sleep apnoea usually run 20 to 30 seconds, and can sometimes last a minute or longer.

The word obstructive means blocking. That is exactly what separates sleep apnoea from snoring: the airway is closed off, not merely narrowed. You will see it spelled apnea in American sources and apnoea in British ones. They are the same condition.

What your body does during a pause

The chain of events runs like this. Adrenaline rises. Heart rate rises. Blood pressure climbs. Oxygen levels fall. Eventually you wake up, usually so briefly that you remember nothing about it in the morning.

That detail explains why sleep apnoea feels like something other than plain sleep deprivation. You were in bed for eight hours. You were not awake. And yet the night was interrupted again and again, with a stress response each time. The quantity was there. The quality was not.

The number that decides: AHI

A sleep study calculates an apnoea-hypopnoea index, or AHI. It is the number of breathing pauses plus periods of reduced breathing, averaged per hour of sleep. These are the NHS thresholds.

It is worth translating an AHI of 20 into a real night. Twenty times an hour. Across seven hours of sleep that is roughly 140 occasions when breathing stops or drops sharply, oxygen dips, and the body fires off a stress signal to get you going again.

How common is it at your age?

This is where being past forty becomes relevant. The Wisconsin Sleep Cohort, one of the most cited population studies in the field, published updated estimates in 2013 for moderate to severe sleep-disordered breathing, meaning an AHI of 15 or higher. That is a broader measure than a diagnosis of sleep apnoea syndrome, which also requires symptoms.

Two things jump out of that table.

The first is that the share among men rises by 70 percent between the younger and the older age band. Around one in six men aged 50 to 70 fell into this category.

The second is that the risk for women triples across the same age span. Sleep apnoea is thought of as a male condition, which in relative terms it is, but nine percent is not a marginal group. Women of that age who see a doctor about fatigue are not always asked whether they snore.

Globally, a 2019 review in The Lancet Respiratory Medicine estimated that 936 million adults aged 30 to 69 have mild to severe obstructive sleep apnoea, of whom 425 million have the moderate to severe form. That study was funded by ResMed, a manufacturer of CPAP equipment, which is worth knowing as you read it. It also rests on reliable prevalence data from only 16 countries, with the rest matched to comparable ones.

The signs you cannot see yourself

The central problem with sleep apnoea is built into the name. It happens while you are asleep.

Swedish health guidance puts it plainly: you may struggle to spot the pauses yourself, because you are asleep, and usually it is somebody close to you who notices them. Some people register that they keep half-waking and that their sleep is restless.

But there are traces that survive until morning. These are the symptoms listed alongside the pauses themselves:

• You are especially tired when you wake up.
• You wake with a lump in your throat.
• You are tired during the day.
• You wake several times a night.
• You need to urinate several times a night.

In some cases the pauses also leave you gasping for air and sweating heavily during the night. They can also lead to morning headaches, trouble concentrating, a shorter fuse and reduced sex drive. The NHS adds gasping, snorting or choking noises to the list of things a partner may hear.

The point about night-time urination is the one most often misread. Plenty of people over forty put nocturnal bathroom trips down to age, or to the prostate. Sometimes that is right. But it also sits on the symptom list for sleep apnoea. It is one of the few items you can observe entirely on your own.

If you sleep alone

The usual route to discovery assumes somebody is lying next to you. Sleep alone and that witness is missing. Then you work with the traces that remain:

• The morning is the verdict. Waking tired after enough hours is the strongest signal you can read on your own. Count the hours for a week first, so you know you actually gave your body the chance.
• Waking up choking. Coming awake with a jolt, gasping for air or with a racing heart is not the same as an ordinary night-time waking.
• Throat and head. A lump in the throat or a headache immediately on waking, especially several days a week.
• Sleepiness is not tiredness. Being tired is common. Nodding off in a meeting, in front of the television or behind the wheel is something else. The distinction between being tired and falling asleep unintentionally is the one that matters clinically.

If you want an indication before booking, there are apps that record sound overnight. Treat them as a note to bring to the appointment, not as a test result. They hear snoring. Breathing pauses are harder. No app makes a diagnosis.

What makes snoring worse

There are several reasons the nose and throat get narrower. The table below sorts them by how much you can influence them, which is the only sorting that helps when you are the one with the problem.

The last two rows matter for a reason that rarely gets said out loud. Sleep apnoea is often framed as a lifestyle problem. Sometimes it is anatomy. A small lower jaw is not a choice. An underactive thyroid can contribute too, and sleep apnoea is common alongside diabetes.

Alcohol deserves its own sentence, because it is the most misunderstood item on the list. Alcohol can make the pauses both longer and more frequent, particularly when you sleep on your back. We have written more about the distinctive kind of waking it produces, in the guide on waking at three in the morning.

What you can do yourself

These are measures both the NHS and Swedish health guidance recommend. They are reasonable to try while you wait for an appointment. For mild cases they are often all that is needed. They do not replace testing if you have symptoms of sleep apnoea.

• Sleep on your side. For many people the problem peaks on their back. Side, front, or a pillow behind your back all work. The NHS suggests taping a tennis ball to the back of your nightwear, which sounds like a joke but is an established trick.
• Raise the head of the bed. Breathing can improve with the head end lifted, for instance with an extra pillow under the mattress topper.
• Avoid alcohol close to bedtime. This applies even to people who do not otherwise snore. Most people snore more after drinking.
• Do not smoke. The lining of your nose and throat is affected both by your own smoking and by second-hand smoke, and that includes e-cigarettes and waterpipes.
• Get enough sleep. Sleep deprivation can make you snore more and make the pauses worse. It turns into a loop: poor sleep worsens breathing, which in turn worsens sleep.
• Move regularly. Regular physical activity is listed as something that can reduce symptoms.
• Do not take sleeping pills unless a doctor has recommended them. The NHS is explicit that they can make sleep apnoea worse. Talk to your doctor if you use sedatives or strong painkillers.

About weight, said straight

Excess weight is the single strongest modifiable cause in the research. It is also the piece of advice most often delivered in a way that makes people stop listening. Here is what the evidence actually shows.

The Sleep AHEAD trial from 2009 randomised 264 people with obesity and type 2 diabetes to either an intensive lifestyle programme or to three group sessions about diabetes. After a year the lifestyle group had lost 10.8 kg against 0.6 kg in the control group. Adjusted, that produced a drop in AHI of 9.7 events per hour relative to the control group. More than three times as many in the lifestyle group reached full remission of their sleep apnoea. The share with severe sleep apnoea was half that of the control group. The largest effects were in those who lost 10 kg or more.

That is a real effect, measured in a randomised trial. But read it with its limits in mind. Every participant had both obesity and type 2 diabetes, the mean age was 61, and mean AHI at the start was 23. Those numbers describe that group, not everyone.

Driving: the rule that makes people delay

This is a common unspoken reason people avoid getting checked, particularly those who drive for a living. So let us read what the rule actually says.

In the UK, you must tell the DVLA if you have confirmed moderate or severe obstructive sleep apnoea syndrome with excessive sleepiness. The same duty covers any other sleep condition that has caused excessive sleepiness for at least three months, a category GOV.UK says includes suspected or confirmed mild obstructive sleep apnoea syndrome. The instruction that follows is the part that matters:

"You must not drive until you're free from excessive sleepiness or until your symptoms are under control and you're strictly following any necessary treatment."

Read the second half of that sentence again. The condition is not what stops you driving. Uncontrolled sleepiness is. Failing to declare a condition that affects your driving can bring a fine of up to 1,000 pounds, and prosecution if you are involved in an accident as a result.

Sweden words it differently but lands in the same place. The Swedish transport agency's medical regulations state that obstructive sleep apnoea syndrome and habitual snoring are obstacles to holding a licence if the circumstances are judged to constitute a road safety risk, and the medical examination has to assess the severity of daytime sleepiness along with whether treatment is being followed and is working.

What testing and treatment involve

You start by describing the problem to a doctor. If they suspect sleep apnoea, you may be referred to a sleep clinic for testing.

The study is usually done at home with borrowed equipment. Over one night it records airflow through your nose and mouth, your breathing movements, the oxygen level in your blood, the position you sleep in and how many pauses you have. It is a night in your own bed, not a hospital admission.

CPAP

CPAP is the most effective treatment for sleep apnoea. The machine pushes a gentle stream of air through a mask, which holds the airway open. Many people feel more rested after the very first night, though it can take a few weeks for the full effect to show.

The drawbacks are worth stating honestly. It can feel uncomfortable at first, produce mild pressure over the nose or a dry throat, and it can feel intrusive to be attached to a machine by a hose. It works best when used every night, so tell your clinic rather than quietly giving up if you are struggling with it.

Mandibular advancement device

The other effective option is a device resembling a gum shield that holds the lower jaw forward so the tongue cannot fall back. It is used for mild to moderate sleep apnoea.

One detail here is worth money: the device should be fitted by a dentist from an impression of your teeth. An individually made device improves the odds of a good result without side effects, unlike the ready-made ones sold over the counter.

What treatment does, and what it has not been shown to do

Here is a nuance that usually gets lost. You deserve to have it.

Untreated sleep apnoea is linked to high blood pressure, stroke, type 2 diabetes and heart disease. That much is well established. But the conclusion that treatment therefore prevents cardiovascular events has proved harder to demonstrate than expected.

The SAVE trial, published in the New England Journal of Medicine in 2016, randomised 2,717 adults aged 45 to 75 with moderate to severe sleep apnoea plus established cardiovascular disease, to CPAP alongside usual care or to usual care alone. After a mean of 3.7 years, 17.0% in the CPAP group had experienced a primary endpoint event against 15.4% in the usual-care group. No benefit was demonstrated.

The same trial did show that CPAP clearly reduced snoring and daytime sleepiness. It also improved quality of life and mood. Two important caveats. Participants had minimal sleepiness to begin with. Mean use was 3.3 hours a night, which is low.

When to see a doctor

Book an appointment if any of the following applies to you.

• You snore and feel tired during the day. Those two on their own are enough.
• Someone has told you that you stop breathing while you sleep.
• You make gasping, snorting or choking noises while you sleep.
• You wake with a choking sensation or gasping for air.
• You are often sleepy, tired or irritable and suspect the snoring is behind it.
• You keep snoring despite having tried the self-help measures.
• You fall asleep unintentionally during the day, especially if it has happened while driving.

Tell the doctor if you have high blood pressure, headaches without a known cause, cardiovascular disease such as stroke or heart attack, or diabetes. Those are explicitly worth mentioning when you present with snoring. If it helps, bring the person who has heard you sleep.

This article provides general health information. It does not replace assessment by a healthcare professional. It does not diagnose anything, and neither does any app or recording.

Frequently asked questions

How do I know if I have sleep apnoea or if I just snore?

You cannot work it out on your own, because you are asleep when it happens. The difference is not in the sound but in whether the airway closes. What points towards sleep apnoea is someone witnessing breathing pauses, waking up gasping or choking, being tired during the day despite enough hours in bed, morning headaches, a lump in the throat on waking, and needing to urinate several times a night. The only thing that gives you an answer is a sleep study, which is usually done at home with equipment you borrow.

Is snoring dangerous?

Snoring on its own is not dangerous. It can disturb your sleep quality and it can certainly disturb whoever sleeps next to you, but the sound itself is not a sign of disease. What makes snoring medically interesting is that it can be a symptom of obstructive sleep apnoea, which the NHS links to high blood pressure, stroke, type 2 diabetes and heart disease when left untreated. Snoring plus daytime tiredness is the combination worth an appointment.

How many breathing pauses per hour is normal?

The measure is the apnoea-hypopnoea index, or AHI. It counts breathing pauses and periods of reduced breathing per hour of sleep. The NHS grades an AHI of 5 to 14 as mild, 15 to 30 as moderate and over 30 as severe. To count as an apnoea at all, a pause has to last at least ten seconds. Occasional events are normal and almost everyone has some.

Does sleeping on your side help?

For many people it makes a clear difference. Both the NHS and Swedish health guidance single out back sleeping as a worsening factor, because the tongue falls back into the throat more easily when you lie on your back. The NHS suggests taping a tennis ball to the back of your nightwear or using a wedge pillow. It is a sensible first step, but it does not replace testing if you have symptoms of sleep apnoea.

Will I lose my driving licence if I am diagnosed with sleep apnoea?

The diagnosis itself is not the obstacle, the untreated sleepiness is. In the UK you must tell the DVLA if you have confirmed moderate or severe obstructive sleep apnoea syndrome with excessive sleepiness, and you must not drive until you are free from excessive sleepiness or your symptoms are under control and you are following treatment. You can be fined up to 1,000 pounds for not declaring a condition that affects your driving. Rules differ by country, but the logic is the same everywhere: treated apnoea with controlled sleepiness is a different situation from untreated apnoea.

Will losing weight improve sleep apnoea?

For many people carrying extra weight, it does. In the randomised Sleep AHEAD trial the lifestyle group lost 10.8 kg over a year against 0.6 kg in the control group, which corresponded to an adjusted drop in AHI of 9.7 events per hour. More than three times as many reached full remission. But every participant had obesity and type 2 diabetes, so the numbers do not transfer directly to everyone. People at a normal weight get sleep apnoea too, because the cause can lie in the shape of the jaw or throat.

Sources: the NHS page on sleep apnoea, Swedish health guidance from 1177 on obstructive sleep apnoea and on snoring, GOV.UK guidance on excessive sleepiness and driving, the Swedish Transport Agency's medical regulations for driving licences (TSFS 2010:125, chapter on sleep and wakefulness disorders), Peppard et al. in the American Journal of Epidemiology 2013 on prevalence in the Wisconsin Sleep Cohort (PMID 23589584), Benjafield et al. in The Lancet Respiratory Medicine 2019 on global prevalence (PMID 31300334), Foster et al. in the Archives of Internal Medicine 2009, the Sleep AHEAD trial (PMID 19786682), and McEvoy et al. in the New England Journal of Medicine 2016, the SAVE trial (PMID 27571048).