Three Patients, One Symptom: The Clinical Phenotypes of Snoring

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.

It could be related to the significant muscle wear and tear from extensive exercise, with the recovery process possibly interfering with sleep — but I have to be honest that I'm not certain about this specifically in athletes, and it would need further looking into.

Yes. A 42-year-old man with obesity and a thick neck, a 28-year-old athletic man with nasal allergies, and a 35-year-old woman with a sensitive throat all present with snoring and poor sleep, yet each has a distinct underlying mechanism.

No. Both the athletic 28-year-old man and the 35-year-old woman in these profiles have a normal BMI, but his snoring traces to nasal allergies and turbinate hypertrophy while hers traces to throat sensitivity and mild oropharyngeal crowding.

No. Any obstruction from the nasal vestibule to the level of the vocal cord, such as a deviated septum, turbinate hypertrophy, adenoids, tonsillar hypertrophy, or a tongue that falls back during sleep, can cause snoring or fragmented sleep. The cause has to be identified at the correct anatomical level before treatment is planned.

The obesity driven case shows a thick neck with a bulky tongue and palate. The allergy driven case shows a deviated septum with turbinate hypertrophy and a nose that blocks specifically when lying down.