The Snoring Clinic

Patients referred for snoring or sleep apnoea are assessed by the practice nurse and Dr Clancy in the snoring clinic. We gather information about your breathing in sleep, symptoms of daytime tiredness, other health problems and family history and the treatments you may have already tried. We then measure your height, weight, neck circumference and blood pressure and examine you to assess the nose, throat, tongue and larynx (voice box). This includes an endoscopy.

You will then receive education about snoring and sleep apnoea and advice on which tests you may need and which treatments could help you.

We work closely with South West Sleep and with Dr Andrew Bradbeer, Respiratory and Sleep Medicine Physician, who provide sleep studies and CPAP services. Dr Richard White, of Lady Bay Dental Clinic provides fitting of mandibular advancement splints.

Snoring and obstructive sleep apnoea (OSA)

Snoring and OSA in children

Treatment of snoring and sleep apnoea in children is different to adults. Most children improve with tonsillectomy and adenoidectomy or weight loss.

Snoring and OSA in adults

What is the difference between snoring and OSA (obstructive sleep apnoea)? Is it harmful?

Normal breathing is silent. Snoring or noisy breathing in sleep indicates there is partial obstruction or blockage to the passage of air through the nose, mouth and throat. When we inhale (breathe in), oxygen from the air is transferred to the small blood vessels in the lungs. When we exhale (breathe out) waste gases (carbon dioxide) leave the blood vessels in the lungs and are breathed out. Noisy breathing can cause problems with getting oxygen in and getting waste gases out of the body.

In some people, snoring is noisy but not harmful. This means the noise bothers your sleeping partner but is not causing unrefreshing sleep or health problems for you. Treatment of simple snoring is aimed at reducing the noise of snoring.

In other people, snoring is due to obstructive sleep apnoea (OSA). This means that you are not breathing well enough to have enough oxygen or to breathe out enough carbon dioxide. You may be breathing too little (hypopnoea) or stopping breathing every so often (apnoea). As the brain senses this is happening, you will rouse or wake slightly to breathe better. This interrupts the normal cycles in sleep that lead to you feeling refreshed on waking. Frequent pauses in breathing during the night causes unrefreshing sleep and daytime tiredness. This increases the risk of car accidents and can be associated with feeling down or losing concentration and losing interest in life. If OSA is untreated over several years, there is a higher risk of blood vessel disease that can lead to heart attack and stroke.

Treatment of OSA has 3 aims:

  1. Reducing the noise of snoring. This improves the sleep quality of your sleep partner.
  2. Improving the quality of sleep so you wake feeling refreshed and are not sleepy during the day. This improves your quality of life and reduces the risk of accidents.
  3. Reducing the risk of heart attack and stroke.
How can you tell the difference between snoring and sleep apnoea?

Listening to the person and their partner describe snoring and how they feel during the day helps but for accurate diagnosis a sleep study is required. A sleep study can be done at home or in hospital. Monitoring devices are attached to the nose, chest and scalp to measure the noise of snoring, the oxygen levels in the blood, what stage of sleep you are in and whether you have apnoea (pauses in breathing) while you are sleeping. In the morning the monitors are removed and the data is analysed by a sleep physician. Sleep studies done without a sleep physician are not helpful.

What causes snoring and OSA?

In adults, there are often several reasons for snoring and OSA.

Your ENT surgeon and Sleep Physician work together to find out what is causing your snoring and OSA, using:

  • The information you tell them,
  • Examination including nasal endoscopy of the nose, mouth and throat,
  • Your sleep study,
  • Sometimes blood tests and CT scans,
  • The practice nurse will measure your height and weight (to calculate your BMI) and your blood pressure.

The 3 main groups of causes are:

  1. Being overweight: People who are overweight are more likely to snore and tend to snore less if they lose weight. Loss of as little as 5kg may make a big difference to snoring.
  2. How relaxed the throat muscles are in sleep. What makes the throat muscles too relaxed in sleep?
    • Drinking alcohol,
    • Medications that cause sleepiness or muscle relaxation including sleeping pills, pain relievers or migraine preventers like Codeine, Oxycodone, Endep, Lyrica, old style hayfever tablets (like Phenergan, choose the non-sedating types), night time cold and flu tablets,
    • Marijuana,
    • Low muscle tone (e.g. neurological disorders, down’s syndrome).
  3. The shape of the nose, mouth and throat. There are several levels in the upper airway that can affect snoring:
  • Blocked nose due to
    • Rhinitis, polyps or septal deviation.
    • Nasal valve collapse: in older people or people who have had a rhinoplasty, the nostrils can be soft and can collapse inward when breathing.
    • Large adenoid.
  • Big tonsils or a long soft palate and uvula.
  • Big tongue or small jaw: the tongue is attached to the jaw. The back of the tongue forms the front wall of the throat. When the jaw is small the tongue sits further back and the throat is narrower at tongue level. This is worse when your jaw muscles relax in sleep, particularly if you are lying on your back.
What treatments can work for snoring?

In most people a combination of things are required to get an improvement in snoring, starting with simple things first.

  • reducing weight: your doctor can refer you to a dietitian Dietitians Association Australia:
  • Avoiding alcohol, drugs and medications that cause sleepiness or muscle relaxation. Talk to your doctor before stopping prescription medications.
  • Relieving blocked nose by treating rhinitis (link), polyps (link) or septal deviation. Stop smoking.
  • using a device to stop nasal valve collapse and hold the nostrils open during sleep
  • Removing large tonsils and adenoid.
  • Wearing a mandibular advancement splint to hold the tongue and jaw forward in sleep ( These are best fitted by a dentist. I recommend Richard White at Lady Bay Dental Clinic. You can ask your dental clinic if they offer this service. Cheap “boil and bite” splints that you can fit at home are available at but may not work as well and may be more uncomfortable. Their main advantage is that they are cheaper than a custom fitted splint.
  • Avoid sleeping on the back: Snoring and OSA can be worse when sleeping on your back. To help you stay on your side during sleep, the cheapest option is to sew a pocket into your pyjamas to hold a tennis ball. You can also look at the following devices:,,
  • Surgery to stiffen or scar the palate used to be common but the results don’t last and there can be permanent damage to the function of the palate.
  • If snoring persists despite all these other measures over 2-3 years and your weight is in the healthy range, you may be referred to a tertiary sleep clinic to consider major operations to reduce the size of the tongue or to advance the upper and lower jaw to make the throat larger. These operations are major and take months to recover.
What treatments work for OSA?

For mild sleep apnoea, treatment is the same as for snoring as outlined above, especially loss of weight, avoiding sleeping on the back and Mandibular advancement splint.

For moderate to severe sleep apnoea, the best treatment is CPAP (continuous positive airways pressure). This means wearing a mask attached to a machine to keep the air pressure high in the upper airway. This keeps the throat widely open while sleeping and allows you to breathe well. This results in a more refreshing sleep and over time will reduce your risk of heart attack and stroke.

Where can I find more information?
The Australian Sleep Health Foundation

Driving and OSA

The following information and link are from the VicRoads webpage for driving and OSA:

All motorists are required by law to advise VicRoads of any serious or chronic medical condition or disability that may impair their ability to drive safely. Sleep disorders can cause excessive sleepiness during the day. Excessive sleepiness can cause you to fall asleep unexpectedly. Sleep disorders increase your chance of crashing and put other road users at risk. Don’t drive until your condition has been investigated by a doctor and treated.

You are required by law to report any serious or chronic medical condition or disability that could affect your fitness to drive. A medical review will assess your ability to drive safely and hold a licence.

Friendly warning!

There are lots of products available online and at the pharmacy that don’t work! The consumer advocacy organisation Choice has a good review article to help you avoid them: