Instant Genius - Better Sleep: How snoring affects our health

Episode Date: June 15, 2025

More than four in ten of us in the UK are snorers. Far from being a trivial condition, snoring can have a significant impact on our ability to sleep, our partners’ ability to sleep and our health in general. In this episode, part of our four-part Better Sleep miniseries, we speak to Ryan Chin Taw Cheong, a consultant ear, nose and throat and sleep surgeon based at University College London Hospitals and the Cleveland Clinic London. He tells us about the many factors that can lead to us snoring, the difference between regular snoring and obstructive sleep apnoea, and why we shouldn’t be embarrassed to seek medical help if breathing problems during sleep are affecting our lives. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Visit name audio.com to learn more. Hello and welcome to Instant Genius, a bite-sized masterclass in podcast form. Every Monday and Friday, you'll hear a world-leading scientists and experts talking about the most fascinating ideas in science and technology today. I'm Jason Goodyear, commissioning editor of BBC Science Focus. More than four in ten of us in the UK are snores. Far from being a trivial condition, snoring can have. have a significant impact on our ability to sleep, our partner's ability to sleep, and our health

in general. In this episode, we speak to Ryan Chin Tauchong, a consultant, ear, nose and throat and sleep surgeon based at University College London Hospitals and the Cleveland Clinic London. He tells us about the many factors that can lead to us snoring, the difference between regular snoring and obstructive sleep apnea, and why we shouldn't be embarrassed to seek medical help if breathing problems during sleep are affecting our lives. So welcome to the podcast. Thanks very much for joining us. It's a pleasure to be here, Jason. So today we're talking about sleep and specifically problems that we may have without breathing when we do fall asleep. So I think the first one that most people will think of is snoring. So what exactly is going on physiologically when we snore?

So that's a very good question, Jason. Snoring is an incredibly prevalent symptom in the British population. The British snoring and sleep apnea association estimates approximately 41.5% of the UK population experience this symptom. And as you alluded to, there is a physiological element to the symptom of snoring, but also there are range of different factors that can contribute to it. But in essence, it's basically an increasing resistance or turbulence of airflow when we sleep at night that produces that sound, that usually disrupts not just your own sleep, but potentially your bed partner's sleep as well, that is basically classified as snoring. So we tend to say that snoring is both a multi-level

and multifactorial symptom. Multi-level in a sense that if you imagine the air flowing, beginning from the tip of your nose, then entering to the back of your palate, down into the sidewalls of your throat, to the back of your tongue, reaching the epiglottis, which is the trap door that protects your windpipe or the trachea and then finally goes into your lungs. Now, if you have a resistance or turbulence of airflow at any of these points from the tip of your nose to the nasal cavity to the soft palate, the back of your throat, back of your tongue, to the epic lotus, that can produce sounds and symptoms of snoring. So what are some specific examples of the way in, there's a lot going on there and the way

that that can occur, you know, in the nose and the soft part? palates, etc. Absolutely, and I see a range of different patients in my practice as an E&T, a consultant surgeon who subspecializes in snoring and obstructive sleep apnea. For example, if you have symptoms of hay fever or allergic rhinitis, particularly around this time of the year, and your nasal lining becomes particularly congested or inflamed, that can increase the resistance of airflow in the nose itself. If you have particularly large tonsils that can narrow, the space we classify as the oral pharynx or the area that you can see through the mirror at the back of your throat. If you tend to mouth breathe at night, that can also predispose to snoring.

So when you mouth breathe, the number of things happen. The first is that the airflow that passes through the mouth is more turbulent. For example, when you breathe through the nose, air is flowing through a fixed and rigid structure of bone and cartilage. But when it flows through your mouth, it's passing through lids. lips, palate, soft tissue of the tongue, so everything becomes more turbulent. When you mouth breathe, you also tend to drop your jaw down. And when the jaw drops down, it brings the back of the tongue with it, further narrowing and compounding the issue.

And there are a number of different physiological benefits of nasal breathing both day and night. For example, when we breathe through our noses, there is an increased release of nitric oxide, which is a vasodilator that helps with oxygenation, and you don't get this particular physiological benefit if you mouth breathe particularly at night. And the third interesting thing is that there are nerves in the nasal cavity that communicate with the nerve of the tongue and the upper airway. So the trigeminal nerve, which is a nerve that sits within the nasal cavity itself,

communicates with the hypoglossal nerve, which is a nerve that controls tongue movement and tone in a trigeminal haplosal reflex that is triggered when you breathe through your nose at night and you don't get to take advantage of this when you mouth breathe. And all of these things can contribute to worsening of quality of sleep, quality of breathing and potentially increase the prevalence of snoring. Yeah, so you mentioned their hay fever and various nasal allergies. But what about other risk factors?

You know, for example, age and lifestyle factors such as perhaps weight, alcohol use, smoking, does that all play a role? Absolutely, Jason, and it's an absolutely critical part of the patient's history when they come and see me in my clinics. For example, if a patient is a smoker that will increase the likelihood of nasal congestion with all the different risk of mouth breathing that we talked about associated with it, with regards to the anatomy of a patient, for example, if they have a deviated nasal septum, they will find it more difficult to draw breath, increasing the resistance because of less physical space. If they are particularly overweight,

and we tend to measure someone's weight in terms of a metric known at the body mass index, if the body mass index is particularly high, we tend to say if it's 35 and above, they're particularly prone to symptoms of snoring and also more sinister sleep disorders, such as obstructive sleep apnea. So absolutely things like weight

can put you at an increased risk of symptoms of snoring. Alcohol, as you've alluded to, can also do this in a way that alcohol is a depressant of the upper airway muscles. So if you do have a heavy night of consuming alcohol, that can also put you at higher risk of snoring that particular night. So I tend to advise my patients to have their last drink at least three, four hours before going to bed to allow their body time to digest the alcohol. So let's stick with this sort of personal effects then. So how significantly can these sort of things affect someone getting a decent night's sleep. So snoring on its own can be loud enough to disrupt and arouse a patient

during sleep, and that can be particularly disruptive. So we tend to measure snoring in terms of decibels or loudness. And the decibels of a patient snoring, if it reaches a particular threshold, it can disrupt and wake the individual patient themselves. However, it can also, as you can imagine, disrupt your bid partner and frequently the main presenting complaint or main reason that the patient seeks my advice or consultation with me is via their bit partner who then brings them to the clinic because they've been struggling to get a decent night's restful sleep because of the disruption from their bit partner snoring. So how do you measure these decibels?

Do you give them a device that they can put in their bedrooms and then it collects the data? Absolutely. So from my perspective as a consultant E&T and sleep surgeon, one of the other things that I'm looking out for is a condition known as obstructive sleep apnea. So whilst snoring on its own and we term this primary snoring without any obstruction or apneas or pauses of breath is disruptive and can be a social nuisance, obstructive sleep apnea is a more serious and sinister condition that carries with it. risks of cardiovascular morbidity and mortality amongst a range of other health consequences, such as increased risk of hypertension, type 2 diabetes, neurocognitive conditions. So we tend to investigate a patient's sleep quality with what is known as a sleep study. So this, in my practice, can be a medical grade device that is sent to a patient's home, where they wear on their bodies, typically their wrist, finger and chest, and this tracks.

They are breathing, their oxygen levels, they are snoring decibels, and then it's able to produce raw data in graphical form that I'm able to report on to determine if indeed their symptoms are due to primary snoring, so just snoring on its own in isolation, or whether they have the co-existing, more sinister sleep disorder known as obstructive sleep apnea. and then we can then customize and personalize our treatment options based on the findings of the sleep study. Yeah, so what is the difference between, you know, primary snoring and obstructive sleep apnea? That's a very good question, Jason. So the symptom of snoring can frequently coexist with obstructive sleep apnea.

And in fact, one of the main presenting complaints or symptoms that the patients seek help for is because they have very troublesome snoring. and then upon further investigation or screening, I then am able to determine that they don't just have primary snoring, they also have this more serious, coexisting sleep disorder known as obstructive sleep apnea. But the main difference between the two, we essentially measure somebody's sleep and breathing at night with a metric known as the AHAI, the apnea hypopnia-hypnea index.

Now, this is a number that measures the number of times a patient pauses breath or breathing for 10 seconds or more per hour. The higher the number, the more severe the category of sleep apnea. Now, in medical terms, if the AHA is 5 or more, a patient is classified to have a diagnosis of sleep apnea. If the number is less than 5, then they don't have a formal diagnosis of obstructive sleep apnea. and if they also have coexisting snoring symptoms with an AHA of below five, we would then say this patient is a primary snorer.

So there are other sleep disorders that can coexist and can exist on a spectrum between the two, but by and large, these are the two main differentiating types of sleep breathing disorders. We gather here tonight to bring women back to their rightful place. The Testaments, a new Hulu original series, from the executive producers of the Handmaid's Tale. It's easier to accept a story than believe that the people around you are monsters. The battle isn't over.

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So let's stick with primary snoring for a moment then. Say that perhaps my, as you say, bed partner has said to me, sorry, Jason, your snoring's waking me up. at night, I'm finding it difficult to sleep. What are the sort of first steps that I can try to treat myself, to stop myself snoring? So the first thing that I tend to advise patients or patients in the general population can attempt is basic lifestyle modification. So things like making sure that your alcohol intake is within the recommended limits to ensure that you consume it in a reasonable time to allow it to be able to be digested before you go to bed. Things like

making sure that you engage in a healthy lifestyle. So making sure that your weight is particularly under control, although there is a bidirectional relationship between sleep disorders, like obstructive sleep apnea, and weight gain, increasing weight. So it's not just that overweight patients tend to snore more. Having sleep apnea can also contribute to weight gain. So it's a two-way effect. But things like optimizing your diet, your lifestyle,

body position and sleeping position can also play a factor. So a lot of patients tend to snore when they're on their backs. Trying to side sleep can also be a first-line way of trying to deal with snoring. There are a range of over-the-counter remedies as well. However, I would caution against pursuing them without first seeking medical attention if there is a genuine concern about your breathing and sleep at night. For example, there's been a reason. recent social media trend about mouth taping, you might have heard and come across this.

Now, there is anecdotal evidence to why mouth taping can improve symptoms of snoring in a sense that it reestablishes nasal breathing and allows you to engage with all the benefits of that that we talked about earlier on. However, if you have, for example, a deviated septum or a particularly blocked nose and you tape your mouth. You will essentially be at risk of suffocation because you're not able to breathe through your nose and your mouth. So my advice is tend to be cautious about engaging in over-the-counter remedies without first seeking expert medical advice. This might be a naive question, but sort of during my waking hours, can I train myself to nasal breathe more? Particularly yes. However, when we tend to sleep at night, we tend to fall into different

phases of stages of sleep if you like. But yes, you can try and train yourself to breathe yourself more during the day. However, when you do go to sleep, you enter a subconscious and altered conscious state, basically, when you sleep at night. And there tends to be four stages of sleep, broadly divided into non-repid eye movement sleep and rapid eye movement sleep, or REM sleep for short. and within the non-REM sleep there are three stages, N1 and 2 and 3. Now in the N3 stage, you tend to have increased muscle relaxation, as well as in the REM stage sleep. So even if you're able to train yourself to breathe consciously during the day through your nose, when you do enter these altered conscious states of sleep at night,

you may tend to revert to the path of least resistance and then mouth breathe if you have a baseline obstruction of your nose. So say that I've decided to go to see a professional about this, you know, what would happen? So the first thing that I would provide my patients is a comprehensive assessment of their medical history to basically gather as much information that's specific to them and trying to elucidate what is the specific reason they are experiencing the symptoms? Because as we talked about, there is a range of different factors that can contribute to symptoms of snoring and disrupted breathing at night, as well as different anatomical levels that can contribute to the worsening symptoms of snoring.

So a thorough medical history would be taken, a thorough social history would be taken as well to identify if there are any particular risk factors, such as smoking or excessive alcohol consumption, any previous history of hay fever or nasal obstruction, any previous surgical intervention that they might have had in the ear, nose, and throat region, and any previous treatments that they might have tried, then we can then try to adjust other optimize or provide alternate more effective solutions for. They would then go on to have a detail examination of their nose and throat, frequently with a fibro optic nasal laryngoscopic camera,

to assess in detail the actual anatomy of the nasal cavity, the post-nasal space, that's the back of the nose, down into the upper airways, into the region of the larynx, where we can visually see if there's any obvious narrowing anatomically of the patient's upper airway that could be causing their symptoms. We also measure their body mass index to assess and also conduct a range of different patient questionnaires that are able to subjectively determine how clinically sleepy they are. Yeah, so say I've been to a consultation, I don't have hay fever or rhinitis, I don't smoke,

I don't drink very much, my weights within the healthy boundaries, but I'm still snoring. What happens then? So that's a very good point you raised, Jason. So it's a myth that only overweight patients get symptoms of snoring or obstructive sleep apnea. You can be a slim patient with none of the lifestyle risk factors and still be a heavy snorer and be prone to severe obstructive sleep apnea. Now there are two reasons for this. Number one is that your native anatomy, what I mean by that is that the structure, shape, and size

of your jaws, your upper airway, your tongue, your palate, can be in a way that is more predisposed to these symptoms. So for example, if you have a baseline, smaller jaw than average, or a bigger tongue than average, or a narrow space at the back of your throat, which some patients do, even if you're not overweight or consume a lot of alcohol, you can still be a heavy snorer. So anatomy, shape of the back of the throat, upper airways,

a deviated septum can also cause this. Now, the second reason is that, as we've talked about, your body enters an altered state of physiology when you sleep. So the way your body works changes during sleep, particularly the upper airway muscles, relaxation, and the tone of these muscles. Now, we know that in some patients who are slim within normal weight limits, without any lifestyle risk factors who have severe obstructive sleep apnea, sometimes this is due to the physiology of their sleep. So they have an increased relaxation of their upper airway muscles and tone that increases the prevalence and frequency of collapse when they sleep at night. So both anatomy, so that's the structure and shape of their upper airway,

as well as physiology, so that's the way their body is behaving at night, can predispose even slim patients without lifestyle risk factors to symptoms of snoring and obstructive sleep apnea. So I've heard of these sort of breathing machines that some people use. I think they're called CPAPs, is that correct? That's right. So how does that work? And when would a specialist say,

I think you'd benefit from using this machine? So it's exactly like you've alluded to. So CPAP is a continuous positive airway pressure machine. And the way it works is that it's a pressurized mask that sits over your face or over your nose and it blows pressurized air into your nose and throat to act almost like an air splint, if you like. So if you think about it, snoring and obstructive sleep apnea is a condition where your upper airway is narrowing down and blocking off multiple times per hour. So CPAP is a form of medical treatment to prevent or minimize that process by blowing pressurized air into the nose and throat to keep the upper airway as patent as,

possible during sleep. We wouldn't advocate this for snoring primary snoring patients. It's primarily reserved for obstructive sleep apnea patients once a diagnosis has been established through a formal sleep study. So does it ever reach the point where you'd advise a surgical procedure, for example? Yeah, absolutely. So whilst we know that approximately 8 million adults in the United Kingdom, mass per the Lancet respiratory medicine experience or have the condition of obstructive sleep apnea. And the first line medical treatment option after lifestyle modification is with a CPAP machine. We do know that across the board, the medical literature suggests that the non-compliance rate for patients who need CPAP treatment with obstructive sleep apnea is at a minimum 34% over a 20-year period.

So at least one in three patients with obstructive sleep apnea, this serious, potentially life-threatening disease, can't tolerate the first-line treatment option with this mask. And that's really where someone like myself intervenes and is able to provide an alternate solution for patients who've tried things like the CPAP mask for sleep surgical interventions and solutions. Now, prior to this, I would essentially counsel or advise my patients to attempt more conservative, lower risk options, at least have an attempt at CPAP in the first instance. Once they've tried their best and is unable to tolerate it, then we can open that conversation with myself to consider sleep surgical interventions as an E&T consultant surgeon. So what that tends to look like is that after a thorough examination and a history that I've taken in the clinic, I will be able to be.

able to almost instantly within the first clinic consultation identify if there are any obvious points of physical obstruction that could be addressed. For example, if they have very large tonsils that can narrow the space of the back of their throat, if they have a very deviated nasal septum or very enlarged turbinates, so these are structures that sit inside the nasal cavity that can engorge and enlarge in patients with allergic type symptoms. So these areas, these anatomical areas can be targeted and addressed to, number one, either improve the space in their nose in the back of the throat to allow them to be more compliant with CPAP, to allow CPAP used to be more comfortable, or to try to essentially improve the patency of the upper airway so they can come

off CPAP as an alternative. Now, the next step, if there was no obvious anatomical cause in clinic if they were considering sleep surgical intervention would be for me to perform a procedure known as a drug-induced sleep endoscopy. So this procedure was first pioneered in my base hospital at the Royal National E&T Hospital at University College London Hospitals in 1991. And the essence of it is that snoring in obstructive sleep apnea is a state-dependent condition, meaning that the problems only occur when you sleep at night. You don't snore or obstruct when you're awake during the day. So if you wanted to offer a surgical solution in terms of an operation, you need to be able to assess the patient's anatomy whilst they're in that state

so that you can then accurately target and customize your treatment options based on the patient's specific way that they are obstructing, that they are snoring. Every single, every single. snoring and obstructive sleep apnea patient is unique. So the way that their upper airway narrows down and blocks off is almost like a fingerprint or unique to their specific anatomy. So some patients, they have a concentric collapse at the level of their palate. Some patients, they have a narrowing at the back of their throat, the oral pharynx. Some patients, they narrow at the back of their tongues. And some patients, it's their epiglottis. That's the trap door. And in some patient is a combination of these levels or all of these levels. And based on the findings

that I can then identify after performing a drug-induced sleep endoscopy, I will be able to then pinpoint the specific level of obstruction and narrowing to that specific snoring and obstructive sleep apnea patient. So there is no one-size-fits-all when it comes to E&T sleep surgical intervention. Everything is bespoke and personalized to that specific patient. So sort of one final question then. I think some people might be, I mean wrongly in my opinion, be a bit embarrassed to get help about this sort of thing. So as a specialist, you know, what would you say to anyone listening? Who is feeling like that? I think it's an absolutely understandable symptom or emotional feeling, Jason, to feel embarrassed

because sleep is a very intimate and it's a very social function. And frequently this can be a source of embarrassment, for example, when you go out with a group of friends on holiday, when you share a particular space or hotel room, or with your bid partner and you then have feedback in the morning that your bit partner was struggling to sleep. It's not the best feeling in the world, but it's very important that to go beyond that embarrassment, to seek medical attention, because this can particularly have a huge knock on effect, not just immediately in the form of daytime sleepiness and fatigue, but also long-term health consequences in terms of increasing risks of things like strokes and heart attacks. And we again know that the risk of things like strokes and

heart attacks in severe untreated obstructive sleep apnea can be as high as one in three patients. So it's not just about the quality of sleep or the social setting. It's also about the health consequences and the cardiovascular risks. And this is really why myself and my team have been pioneering newer forms of surgical intervention in the form of the hypoglossal nerve implants, which is an implant that can either sit underneath your chin or in the chest that is an alternate source of treatment for patients who are unable to tolerate the CPAP machine. So either the inspire hypoglarsal nerve implant or the genionic-SOA hyperglossol nerve implants. And I currently am able to offer both, depending on which one is most suitable for.

my patients as an alternative option for patients with obstructive sleep apnea who are unable to tolerate the CPAP mask. So really then the sort of final takeaway message is there's help out there? Absolutely. There is help out there and it's important to understand it from a place of importance in terms of the impact of health, not just on your own health, but on your bed partner's sleep quality, the longevity of the potential cardiovascular risks need to be taken into play as well, and also to know that there's a range of different treatment options, and by seeking an expert in sleep and snoring and sleep apnea, they will be able to help you navigate the range of different options available

to arrive at one that's personalized and bespoke to you. Thank you for listening to this episode of Instant Genius, brought you from the team behind BBC Science Focus. That was Ryan Chintal Chiong. If you liked what you just heard, then please do consider subscribing to Instant Genius on your preferred podcast platform. If you'd like to see our guests and hosts in person, then please also check out our YouTube channel

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