Sleep Apnoea & Snoring: Diagnosis & Treatment by Dr CC Lau
Understand Snoring and Sleep Apnoea
A deep rumbling sound fills the room just as you are about to drift off to sleep. What should have been a restful night becomes another interrupted one. Although snoring might seem harmless, frequent or loud snoring can disrupt sleep for both the person snoring and their partner, affecting mood, focus and energy levels. It occurs when the throat muscles relax during sleep, narrowing the airway and causing surrounding tissues to vibrate as air passes through.
Sometimes, snoring is more than a noisy nuisance and may be a sign of sleep apnoea, a condition in which breathing repeatedly pauses during sleep. There are three recognised types, with obstructive sleep apnoea (OSA) being the most common. OSA occurs when the tongue or soft palate collapses during sleep, blocking the airway. The other two, central sleep apnoea and complex sleep apnoea, are less common and are usually linked to neurological or mixed causes. Regardless of the type, interrupted breathing reduces oxygen levels and prevents restorative sleep.
In Singapore, OSA remains a significant health concern. A 2012 Singapore Health Study found that nearly one-third of adults had moderate to severe OSA, and more recent national guidelines continue to recognise it as a growing public health issue. Each time the airway closes, breathing briefly stops until the brain signals the body to restore airflow. Although these awakenings often go unnoticed, they fragment sleep and leave the person feeling unrefreshed. Understanding how airway blockages occur is the first step towards recognising OSA and seeking appropriate treatment.
What Causes Snoring?
Snoring can have multiple causes, including structural issues in the nose or throat, body weight, sleep posture and natural differences in airway anatomy. ENT specialists classify snoring based on the site of airway narrowing. The three levels include:
Level 1 (Nasal Obstruction)
Restricted airflow through the nose increases pressure within the upper airway, causing nearby tissues to vibrate. Common causes include a deviated nasal septum, enlarged turbinates and nasal polyps.
Level 2 (Back of the Mouth)
The back of the mouth, or oropharynx, is one of the most common sites of snoring. An enlarged or relaxed soft palate, uvula or tonsils can narrow the airway and create vibration during breathing. This often worsens with weight gain or age-related muscle changes.
Level 3 (Throat Obstruction)
Snoring can also originate deeper in the throat when excess tissue or a large tongue narrows the airway. Excess body weight can further compress the airway, increasing the risk of louder snoring and obstructive sleep apnoea.
What Is OSA?
Obstructive sleep apnoea (OSA) is the most common type of sleep apnoea, causing breathing to repeatedly stop and start during sleep as the airway becomes too narrow or blocked. These interruptions reduce oxygen levels, disrupt normal sleep cycles and often leave the person feeling unrefreshed despite a full night’s sleep. Over time, the ongoing lack of oxygen and restorative rest can increase the risk of high blood pressure, heart disease and stroke.
OSA develops when the muscles and soft tissues of the throat relax during sleep, allowing the tongue or soft palate to block the airway, even as the chest and diaphragm continue trying to breathe. The brain briefly wakes the body to restore airflow before sleep resumes, a cycle that can repeat many times throughout the night without the person realising it.
The severity of OSA is classified using the Apnoea–Hypopnoea Index (AHI), which measures how often breathing disruptions occur during sleep.
| Severity | AHI (events/hour) | What This Means |
|---|---|---|
| Mild OSA | 5 – 14 | Symptoms present; lifestyle/device treatment often sufficient |
| Moderate OSA | 15 – 29 | Higher health risk; CPAP or oral appliance typically recommended |
| Severe OSA | 30 or more | Significant health risk; CPAP or surgery usually required |
Untreated obstructive sleep apnoea can affect more than just sleep. Book an assessment with our throat specialist to understand the cause and explore suitable treatment options.
What Are the Common Symptoms of OSA?
OSA symptoms can vary from person to person and often develop gradually, making them easy to overlook. While some people notice disrupted sleep, others may only recognise the effects during the day. Common signs and symptoms include:
- Abrupt or frequent awakenings during sleep
- Breathing pauses noticed by a partner
- Choking or gasping for air at night
- Difficulty concentrating or memory lapses
- Dry mouth or sore throat upon waking
- Excessive daytime fatigue or sleepiness
- Frequent urination at night (nocturia)
- Morning headaches
- Loud or habitual snoring
- Mood changes, such as irritability
- Decreased libido or sexual dysfunction
Because OSA develops gradually, many people mistake restless sleep or daytime fatigue as part of everyday life. Early assessment by an ENT specialist can help identify the underlying cause and recommend appropriate treatment before the condition progresses.
What Increases the Risk of OSA?
OSA can result from a combination of anatomical, physiological and lifestyle factors. While some risk factors cannot be changed, recognising them can help identify when to seek medical advice. These include:
- Ageing, which reduces muscle tone and increases tissue around the throat and tongue
- Excess body weight, which can narrow the airway
- Chronic heart or kidney disease, which may cause fluid build-up in the neck
- Differences in facial or jaw structure that predispose the airway to narrowing
- Endocrine or hormonal conditions, such as hypothyroidism or polycystic ovary syndrome (PCOS)
- Family history or genetic predisposition affecting skull and airway shape
- Gender, as men are more commonly affected, while women’s risk increases after menopause
- Smoking, which irritates and inflames the airway
Although factors such as age or genetics cannot be changed, others, including body weight and smoking, can often be managed. If multiple risk factors are present, an ENT assessment can help determine whether OSA is contributing to disrupted sleep and guide appropriate treatment.
What Are the Risks and Complications of Untreated OSA?
Left untreated, OSA does more than disrupt sleep. Each episode of airway obstruction causes a temporary drop in blood oxygen and places repeated strain on the cardiovascular system. Over time, untreated OSA is associated with:
- High blood pressure (hypertension)
- Increased risk of heart disease and heart failure
- Higher risk of stroke
- Insulin resistance and type 2 diabetes
- Mood disturbances, including depression and anxiety
- Impaired concentration, memory, and work performance
- Increased risk of road and workplace accidents due to daytime sleepiness
Because many of these complications develop gradually and silently, early assessment, even for what seems like just snoring, can meaningfully protect long-term health.
Early assessment is an important step in reducing the long-term risks of obstructive sleep apnoea. Book a consultation to discuss your concerns.
How Is OSA Diagnosed?
Diagnosing obstructive sleep apnoea (OSA) begins with a consultation and examination by an ENT specialist. As breathing disturbances occur during sleep, they often go unnoticed without proper testing. Sleep studies are then used to confirm OSA, assess its severity and guide treatment.
Home Sleep Testing (HST)
For many patients, home sleep testing is the first step. A compact monitoring device records airflow, oxygen levels, heart rate and breathing patterns while the patient sleeps at home. Although less detailed than an overnight sleep study, it is reliable for detecting moderate to severe OSA.
Overnight Sleep Study (Polysomnography)
An overnight sleep study, or polysomnography (PSG), provides a more detailed assessment in a specialised facility. In addition to breathing and oxygen levels, it monitors brain activity and muscle movement to evaluate sleep quality, confirm the diagnosis and determine OSA severity.
Additional Airway Evaluation
Sleep studies confirm OSA but do not always identify where the airway is blocked. Additional procedures, such as nasopharyngoscopy or sleep endoscopy, may be recommended to locate the obstruction and guide treatment.
The most appropriate investigations depend on the patient’s symptoms, medical history and airway examination findings. Home sleep testing is often recommended first, while an overnight sleep study or additional airway evaluation may be advised when a more detailed assessment is required. Together, these investigations help confirm the diagnosis and determine the most appropriate treatment plan.
What Are the Treatment Options for Sleep Apnoea?
Managing sleep apnoea is not only about reducing snoring, but also about maintaining an open airway, improving oxygen flow, and restoring deep, restorative sleep. To achieve this, the ENT specialist first evaluates the cause and severity of the airway obstruction before recommending the most appropriate treatment approach.
Non-Surgical Treatments
For many patients, non-surgical treatments can effectively improve breathing during sleep and reduce symptoms.
Lifestyle Modifications
For mild cases, lifestyle changes may provide meaningful relief. Weight management, avoiding smoking and alcohol before bedtime, treating nasal allergies and sleeping on one’s side can all help improve airflow.
Positional Therapy
Some people experience worse OSA when sleeping on their back. Positional therapy encourages side sleeping to reduce airway obstruction and lower the Apnoea-Hypopnoea Index (AHI), and is often used alongside other treatments.
Continuous Positive Airway Pressure (CPAP)
CPAP therapy delivers a continuous stream of air through a mask to keep the airway open. Auto-CPAP and BiPAP devices adjust air pressure automatically to improve comfort.
Dental Devices
Custom-made oral appliances reposition the lower jaw and tongue to reduce airway collapse. They are commonly recommended for mild to moderate OSA or for patients who prefer an alternative to CPAP.
Surgical Treatments
Surgery may be considered when structural problems in the nose, throat or jaw contribute to airway obstruction, or when non-surgical treatments are not effective. The choice of procedure depends on the location and severity of the airway narrowing.
Septoplasty / Turbinate Reduction
This procedure improves airflow by correcting a deviated nasal septum or reducing enlarged turbinates that contribute to nasal obstruction.
Laser-Assisted Uvulopalatoplasty (LAUP)
A laser is used to remove excess soft palate tissue, helping to reduce vibration and widen the airway.
Uvulopalatopharyngoplasty (UPPP)
This procedure removes or reshapes excess tissue from the soft palate, uvula and throat to widen the airway and reduce obstruction during sleep.
Radiofrequency Ablation (RFA)
Controlled radiofrequency energy is used to shrink soft tissue in the soft palate, tongue base or nose, helping to improve airflow with minimal tissue removal.
Tonsillectomy / Adenoidectomy
Enlarged tonsils or adenoids are removed to relieve airway obstruction. This procedure is commonly recommended for children with obstructive sleep apnoea caused by enlarged tonsils and adenoids.
Palatal Implants
Small implants are placed within the soft palate to stiffen the tissue, reducing vibration and palatal flutter that contribute to snoring.
Maxillomandibular Advancement (MMA)
This procedure repositions the upper and lower jaws to enlarge the airway and is typically considered for severe or treatment-resistant obstructive sleep apnoea.
How Treatment is Chosen
No single treatment is suitable for everyone. The most appropriate approach depends on factors such as the severity of OSA, the location of airway narrowing, anatomy, lifestyle and personal preferences.
Dr Lau reviews the findings from the sleep study and airway assessment before recommending a personalised treatment plan. Where more than one option is suitable, the benefits and considerations of each are explained to help patients make informed decisions about their care.
If symptoms such as snoring, disrupted breathing or persistent fatigue continue despite treatment, further assessment may be recommended to identify the underlying cause and determine whether the treatment plan should be adjusted.
With over three decades of ENT experience, Dr Lau Chee Chong provides comprehensive assessment and personalised treatment for obstructive sleep apnoea. Schedule a consultation to discuss the most appropriate care for your condition.
Snoring & Sleep Apnoea in Children
Children can also be affected by snoring and obstructive sleep apnoea. Unlike adults, the most common cause in children is enlarged tonsils and adenoids, which can partially block the airway during sleep. Paediatric OSA often presents differently from adult OSA. Instead of excessive daytime sleepiness, children may show signs of hyperactivity, difficulty concentrating at school, mouth breathing, bedwetting, or restless sleep.
If your child snores regularly, breathes through the mouth during the day, or seems persistently tired or inattentive despite adequate sleep, an ENT assessment may be beneficial. When a sleep study confirms OSA in a child, adenotonsillectomy, which involves removing the tonsils and adenoids, is often the first and most effective treatment. Early intervention can help prevent sleep-disordered breathing from affecting growth, development, behaviour, and school performance.
Dr Lau sees both adult and paediatric patients with sleep-disordered breathing, including children with enlarged tonsils, chronic mouth breathing, and other paediatric ENT conditions that can affect sleep and breathing quality.
How to Prevent Snoring
Not all snoring can be prevented, but lifestyle adjustments can meaningfully reduce its frequency and severity, particularly in individuals who snore without significant structural airway obstruction. Recommended measures include:
- Maintain a healthy weight: Excess tissue around the neck and throat can narrow the upper airway during sleep.
- Avoid alcohol before bedtime: Alcohol relaxes the throat muscles and can worsen airway vibration and collapse during sleep.
- Quit smoking: Smoking irritates and inflames the airway lining, increasing congestion and airway instability.
- Treat nasal congestion promptly: Allergic rhinitis and chronic nasal blockage are common contributors to snoring and disrupted breathing.
- Sleep on your side: Sleeping on the back allows the tongue and soft palate to fall backward, which can narrow the airway.
- Use sedative medications cautiously: Sleeping pills and sedatives can overly relax the airway muscles unless prescribed and monitored appropriately.
If snoring persists despite these measures, or if symptoms such as daytime fatigue, gasping, or pauses in breathing occur during sleep, an ENT assessment may be recommended to evaluate for obstructive sleep apnoea.
Improve Your Sleep Health with ENT Specialist Dr Lau Chee Chong
Ear Nose & Throat Centre CC Lau is an ENT specialist clinic in Singapore where every consultation begins with understanding each patient’s sleep concerns, daily habits and overall health. Dr Lau Chee Chong provides comprehensive assessment and personalised treatment for snoring and sleep apnoea. Through careful assessment and open communication, Dr Lau helps patients understand how disrupted sleep affects their well-being and what steps can be taken to restore deep, uninterrupted sleep.
With over three decades of clinical experience, Dr Lau combines precision medicine with a patient-focused approach to long-term recovery. Each treatment plan is guided by evidence and tailored to your specific condition, ensuring sustainable results and better quality of life. Schedule a consultation with us today and take the first step toward better sleep, lasting vitality and improved quality of life.
Frequently Asked Questions About Snoring & Sleep Apnoea
3 Mount Elizabeth, Suite 14-11 (14th Floor)
Mount Elizabeth Medical Centre
Singapore 228510
