One drug could become the first effective treatment for millions of snorers – and their long-suffering partners. Photo / 123rf
One drug could become the first effective treatment for millions of snorers – and their long-suffering partners
When my partner Mike and I first got together four years ago, we needed to have a grown-up chat about the bedroom. The interesting thing as a mature couple, is it’s sleep, not sex, that can divide.
There’s no point being coy at 55-plus. There will almost certainly be snoring. Mike, skinny, athletic, rocks the house. A classic mouth breather (I have never understood how you inhale and exhale through your nose), I have been known to “vibrate” in my sleep.
“Snoring tends to become more common as people age,” confirms Dr Ramon Weishaupt, a senior sleep scientist for A. Vogel.
“This can be attributed to several factors, such as weakening of the muscle tone in the throat and airway, making it more likely that the airways will collapse during sleep. Weight gain also contributes, as fatty tissue around the neck can narrow the airway.”
The risk increases dramatically for women when they hit menopause, probably because female hormones oestrogen and progesterone provide some protection against snoring and sleep apnea. “But hormonal changes in midlife men do happen as well and may also influence sleep patterns, leading to more frequent snoring.”
Even after four years together, I still wear my Mute anti-snoring device when Mike stays over (a small double ring of plastic that fits inside the nose and opens up the airways). But I do feel resentful I’m the one making the effort. Mike simply laughs it off.
Mike and I are mostly tactful with each other about any foghorn tendencies, but I definitely suffer more shame. Admitting you’re a woman who snores goes to the very heart of femininity.
Because there are consequences for couples. Studies have shown that snoring often leads to poor sleep quality, not only for the snorer but also for their partner. If your partner has a tendency to snore or move around in bed a lot at night, it will prevent you from falling into the deepest, most restorative stage of sleep, known as REM sleep.
Over time, this can result in increased irritability, mood swings, and even relationship breakdown. One in six British couples now chooses to sleep in separate bedrooms, according to 2023 research commissioned by bedding company Woolroom with the University of Leeds, with snoring (66%) and restlessness (42%) the top culprits.
So I was thrilled to hear about a daily pill that could halve snoring symptoms for millions. And potentially save Mike and me from a sleep divorce.
A new study by Sweden’s University of Gothenburg (presented at the European Respiratory Society congress in Vienna) recently found the drug sulthiame could halve symptoms for sufferers of obstructive sleep apnoea.
Currently prescribed for childhood epilepsy, the drug works by inhibiting an enzyme called carbonic anhydrase which “is extremely abundant in the human body,” says Jan Hedner, a professor of respiratory medicine at Sahlgrenska University Hospital and the University of Gothenburg, who presented the research. It’s located in the bloodstream, saliva, cell walls. By dampening down the enzyme, sulthiame helps to stop muscles around the throat from collapsing and keeps the upper airway open at night. This drives ventilation more efficiently and stabilises breathing (both at night and during the day).
The drug is still at trial stage, but experts hope it will provide the first effective medical treatment for millions of snorers and long-suffering partners.
Chronic snoring is often dismissed as trivial or comical. But sleep apnoea, which repeatedly interrupts breathing during sleep, triggering a fall in blood oxygen levels and poor quality of sleep, is actually a major heart health “red flag”.
Sometimes with obstructive sleep apnea, people think, “Oh, it’s just a little bit of snoring”. But it can have a serious impact on your physical and mental health. And if not diagnosed, it can lead to more serious health issues, such as heart disease and Type 2 diabetes, and it increases your risk of stroke or high blood pressure. So it’s important it’s taken seriously,” says Erika Radford, the head of health advice at Asthma and Lung UK.
Many sufferers need to wear a mask attached to a continuous positive airway pressure (Cpap) machine throughout the night, which blows air through a face mask to keep the airways open. One friend has banished her partner to the spare room because she hates him seeing her in her “Darth Vader mask”.
It’s estimated up to one in eight adults in Britain suffers from sleep apnoea, particularly elderly and overweight men, says Dr Swapna Mandal, a consultant respiratory, sleep and ventilation physician at the Cleveland Clinic London.
“But we are seeing younger individuals as well. They’re just getting into relationships and don’t want to have to lug a machine around with them, to stay at their partner’s place. So the prospect of being able to take a tablet to manage this is going to feel a lot easier and less embarrassing.”
CPAP really is the best treatment, Hedner stresses, but more than 50% of people abandon treatment out of panic or fear. So he and his team began to investigate the idea of a drug you take daily.
For their research, they recruited 298 patients with obstructive sleep apnoea from five European countries, with a mean age of 56 (26% were female) and a BMI of 29.1. All could not tolerate or refused to use Cpap machines.
After being given the drug sulthiame, patients had fewer pauses in breathing and higher levels of oxygen in their blood during sleep. Those on the highest dose, 300mg a day, experienced a 50% reduction in the number of respiratory pauses during the night, reducing the severity of snoring.
Sleep apnoea is a tricky disease, Hedner stresses. No one quite knows who will go on from mild/severe snoring to develop the full-blown condition. Around two-thirds of the patients he diagnoses probably are overweight or obese, but they also see people who are lean and athletic.
That may explain why Mike (who’s skinny) and myself (curvy) both have disordered breathing.
The optimism around sulthiame seems justified. As well as aiding good quality sleep, it potentially has other biological effects, including lowering blood pressure and cholesterol, and causing patients to lose weight. Hedner compares it to throwing a bowling ball and unexpectedly taking out extra targets.
If funding is raised, sulthiame next goes into larger-scale trials to validate efficacy and secure regulatory approval, with a potential timeline of three to four years. That’s actually fast, says Hedner. “In Europe, it could be a quicker development, because the toxicology and safety tests are all done.”
“We talk about personalised medicine a lot nowadays. So being able to say to patients: ‘We can trial a combination of this new drug together with you practising better sleep hygiene, giving up smoking, losing weight’ is amazing. We’re entering a really exciting era,” says Mandal.
Change your sleep posture
Many people are prone to snoring when lying flat on their back because it increases pressure on the windpipe and airways, and the key to a soundless night is in open airways.
Special pillows or devices can also encourage side sleeping, which may reduce airway obstruction, and keep the head extended and open up nasal airway passages. Weighted blankets can also help people stay on their side.
Cut down on alcohol and smoking
Alcohol relaxes your muscles more than usual during sleep, meaning the back of your throat may close in as you breathe, causing you to snore. “We know smoking causes inflammation in the upper airway, and so that can make you more prone to apnoea,” says Mandal. Also, avoid caffeine before bed.
Lose weight
Being overweight is a trigger: a lack of muscle tone around your neck and throat can sometimes be the cause of snoring. The fatty tissue squeezes the airways, preventing air from passing freely – often waking you up in the process. It’s estimated that a 10% loss of body weight could lead to as much as a 50% reduction in the degree of sleep apnoea.
Keep cool
Turn the thermostat down. The ideal temperature for sleep is between 15C and 20C.
Exercise
Active muscle training can help stabilise your airway, says Hedner. One study found excessive sitting can lead to sleep apnea but moderate exercise reduces fluids that build up outside the vascular space in the body.
Wear a nasal dilator
I’ve worn Mute nasal dilators for a decade. The discreet internal nasal dilator is placed in the nostrils to prop open nasal passages for better airflow and improved breathing (the manufacturer claims one clinical trial showed airflow increased by an average of 38%). Weishaupt suggests combining nasal strips with herbal inhalers, using oils such as eucalyptus or peppermint to open the nasal passages, or saline solutions to keep nasal passages open if you have congestion.
Get a humidifier
Invest in a humidifier or an air purifier with a high-efficiency (Hepa) filter, which removes pollen, dust, viruses and bacteria from the air, helping to reduce nasal congestion.
Upgrade bedding
Allergies such as allergic rhinitis can disrupt airflow between nose and throat, causing snoring. These can be worse at night, due to exposure to allergens such as dust mites and fungal spores which colonise synthetic bedding. Choose natural fibres (cotton, linen, wool), that breathe well, or hypoallergenic bedding. Research conducted by Leeds University and Woolroom found wool 43% more able to absorb excess humidity and moisture than polyester and 67% more than feather/down. I’ve found Woolroom’s mattress topper and duvet really helpful, plus silk pillowcases (silk is naturally resistant to dust mites).
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