The Science Behind Snoring

Stage 3 of non-REM sleep is when growth hormones are released, responsible for repairing the day's muscle wear and tear and, in children, for height and weight gain. If a patient isn't reaching stage 3 and stays mostly in light sleep, that reparative action doesn't happen and they feel tired the next day — in children, the consequence can be a genuine failure to grow as expected despite eating well.

Every individual goes through 4 to 5 sleep cycles a night, each around 90 to 110 minutes, split into non-REM and REM sleep. Non-REM has three stages: N1 is the lightest — waking from it causes no brain fog; N2 and N3 together make up around 75% of total sleep, and it's in N3 that physical recovery, growth hormone release and cardiovascular recovery happen. REM follows, the dreaming stage, where memories are consolidated into long-term storage.

It's a blend — mostly patients I've already treated referring others after a good outcome, some general awareness through social media, cross-referrals from other departments within Artemis, and GP referrals from outside the hospital, which make up roughly 20 to 30% of this OPD. GPs do a great job fixing the simple presentations themselves; it's when the problem isn't resolving that they refer on.

I haven't read that in any textbook or literature. Chamomile tea is said to calm the nerves and may help, and melatonin helps at night, but wine and alcohol generally disrupt sleep rather than improve it — alcohol causes dryness, and people often don't eat adequately alongside it, leading to a calorie deficit. If anything, it disrupts sleep rather than making it better.

A PAP machine is essentially an airway splint that sends a puff of air to open the blockage at the retropalatal or base-of-tongue level. CPAP delivers one continuous fixed pressure through both inspiration and expiration. BiPAP sets different pressures for each phase — for example 8 cm H2O on inspiration but only 4 cm H2O on expiration — which many patients who can't tolerate CPAP's constant pressure find more comfortable to breathe against.

Its metabolic consequences, from early hypertension to type 2 diabetes, take years to surface. By the time they appear, patients rarely trace the connection back to poor sleep.

It moves from three real clinical scenarios with identical symptoms but different causes, through the anatomy of the upper airway from the nasal vestibule to the vocal cord, the science of sleep stages, the assessment pathway from questionnaire to sleep study, CPAP versus BiPAP, the surgical options, and paediatric obstructive sleep apnoea as a distinct, easily missed problem.

She is Consultant, ENT at Artemis Hospitals, Gurugram, and the speaker behind this masterclass.

Doctors across Africa, delivered live as part of the Jivo Masterclass series.