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Q1: Last week when I was on holiday with some German friends, my husband was lying on the beach and one of our friends woke him up because he was snoring. We laughed, thinking they were complaining about the noise but they said that they woke him up because "snoring is really bad for your health". A rather heated debated then ensued. Is this true? Name and address withheld

A1: Not only were the Germans being kind but there are good medical reasons for their statement, even if they have failed to distinguish between different types of snoring. If they had said to you that there are some types of snoring that may be associated with problems that can in some cases increase the chance of having a stroke or heart attack their comments would have been both kindly and accurate. Although only one pattern of snoring is related to sleep apnoea and cardiovascular disasters any heavy snoring may cause severe social and domestic problems and a host of other physical ones if it is associated with apnoea.

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Obstructive sleep apnoea is the sudden cessation of breathing so that the patient stops breathing for more than ten seconds. The usual picture is that the snoring is crescendo in type. Snoring becomes progressively louder until suddenly, when breathing stops, there is a welcome complete silence. As the breathing starts again the patient wakes momentarily but often noisily although is not awake for long enough to remember that he, or she, has woken. The cardiovascular problems that follow recurrent episodes of sleep apnoea are only some of the troubles that this can cause.

Sleep apnoea makes for restless sleeping, so that next day the patient wakes unrefreshed and often with a headache. Throughout the day the person whose sleep has been disturbed tends to nod off at inappropriate moments, their performance at work suffers, they become inattentive, irritable and depressed. They are bad drivers and dangerous ones if they drop off at the wheel.

"The really bad for your health" remark of the Germans refers to all the cardiovascular problems of which stroke and coronary heart attacks are most common but most people don't realise that it also includes high blood pressure, and hence heart failure as well as the damage that can be inflicted to the patient and others by road accidents.

If someone has a relative who has sleep apnoea they should consult their doctor. Possible treatments are discussed in answers to some of the other questions.

Q2: My snoring is so severe it disturbs my partner and I have been banished to the spare room most of the time for last 15 years. I snore nightly, some nights more frequently and more loudly than otherss. Alcohol, any amount of alcohol no matter how little, makes it worse and snoring can awaken me. I have tried nasal strips, snorease, lying on the side only, all to no effect (apparently). I take regular exercise, running and gym. I am slightly over weight but not much. How can I stop snoring? Name and address withheld

A2: Snoring is the result of obstruction of the airways whether this is in the nose, throat, back of the mouth or trachea. Any problem that causes an obstruction increases the likelihood of snoring. The obstruction doesn't always stem from an abnormality such as an enlarged uvula (the piece of tissue that hangs down like giant skin tag above the centre of the back of the tongue), a floppy palate, enlarged tonsils and adenoids, a big tongue or a loss of tone in the muscles at the back of the throat but these physical causes always have to be looked for. Even an enlarged neck can cause pressure on the airways. This may be one reason why men who take collars of size 17 or more are found to have an increased incidence of cardiovascular disease. Obviously if the nasal airways are blocked, possibly because of a deflected septum, congestion from a cold or allergy, snoring also becomes much more likely.

Loss of weight is always the first measure that should be recommended. The amount of alcohol drunk should be reduced, especially drinks late in the evening. Some heavy snorers make it a rule not to drink after lunch - socially and professionally a difficult resolution to keep. Smoking also increases the chances of snoring because it causes swelling and inflammation of the lining to the airways. Allowing yourself to become excessively tired before you go to bed increases any tendency to snore. Exercise should not be taken after early evening.

Only when any possible local cause of heavy snoring has been excluded should there be any thought of turning to surgery. The surgery of the uvula and palate so that these are reduced in size, and the airway thereby increased, has recently been improved by the introduction of laser-assisted procedures. Among these changes are different types of vaporisation or excision of the obstructing tissue. The patient should always be warned that the mouth after surgery may seem rather dryer, and the tone of the voice may be altered.