That Snore Could Be Killing You in Your Sleep
Experts at Uganda's MCG Lung Institute issued a stark warning on World Sleep Day: what many Africans celebrate as the sound of deep, satisfying rest may be the body's SOS signal for a serious — and largely undiagnosed — medical condition.
In many African households, the rumbling sound of a sleeping relative who snores is met with laughter and a sense of satisfaction — proof, as the common saying goes, that the person is truly enjoying their rest. But according to leading pulmonologists at Uganda's MCG Lung Institute, that cultural comfort may be costing lives.
Speaking during a special public lecture commemorating World Sleep Day — observed annually on the Friday before the March equinox — Dr. Ivan Kimuli, Deputy Director of the MCG Lung Institute and specialist in sleep medicine, delivered an urgent call to action: snoring must no longer be dismissed as harmless.
"Snoring is the most common and most visible sleep-related breathing disorder," Dr. Kimuli told an online audience of clinicians, students and health professionals. "And it is frequently dismissed as normal or harmless. But it could be a warning sign of underlying disease."
"If you are snoring loudly, stop breathing at night, and wake up exhausted every morning — please, come and be evaluated. We would love to increase your lifespan."
— Dr. Ivan Kimuli, Deputy Director, MCG Lung InstituteWhat Happens When You Snore
Snoring occurs when the muscles of the upper airway — including the tongue — relax during sleep and partially block the passage of air. As air forces its way through the narrowed space, it causes the surrounding tissues to flutter and vibrate. That vibration is the snore.
According to Dr. Kimuli, approximately 20% of women and 40% of men snore. Of those who snore, roughly one in three may have a more serious underlying condition: obstructive sleep apnea (OSA) — a state in which the airway doesn't just narrow but collapses entirely, causing the sleeper to stop breathing altogether.
"When the tongue falls back completely and blocks the airway, the individual stops breathing," he explained. "The brain then detects falling oxygen levels and jolts the person partially awake to restart breathing. This happens repeatedly throughout the night — sometimes more than 30 times an hour — without the person ever knowing it."
Warning Signs of Dangerous Snoring
- Loud, habitual snoring that others can hear through walls
- Witnessed pauses in breathing during sleep
- Choking, gasping, or coughing fits during the night
- Waking up with a dry mouth or sore throat
- Morning headaches that have no other explanation
- Excessive daytime sleepiness despite spending enough hours in bed
- Poor concentration and irritability throughout the day
- Feeling unrefreshed no matter how long you sleep
The Hidden Health Toll
The consequences of untreated obstructive sleep apnea reach far beyond a tired morning. Each episode of stopped breathing triggers a cascade of physiological stress: oxygen drops, the nervous system surges into high alert, and the blood vessels are repeatedly strained.
Over time, this nightly assault on the body contributes to some of the most serious chronic diseases in Uganda and across Africa. Dr. Kimuli listed the complications: high blood pressure, heart disease, stroke, type 2 diabetes, depression, and — critically in a country with high road traffic fatalities — accidents caused by drivers falling asleep at the wheel.
"Untreated sleep disorders have contributed significantly to heart diseases, accidents, and low productivity," said Dr. William Worodria, a pulmonologist who moderated the session. "Many of our road accidents might be related to challenges with sleep."
Dr. Kimuli also highlighted a link that many patients and even some clinicians overlook: if you are being treated for high blood pressure or an irregular heart rhythm and the medication is not working as expected, obstructive sleep apnea may be the reason your body is not responding optimally to treatment.
How Severe Is Severe?
Sleep medicine uses a measure called the Apnea-Hypopnea Index (AHI) — the number of times per hour that breathing fully stops or significantly reduces during sleep. Severity is classified as follows:
| Events per Hour | Classification | Recommended Action |
|---|---|---|
| Fewer than 5 | Normal / Primary Snoring | Monitor; lifestyle adjustments advised |
| 5 – 14 | Mild OSA | Lifestyle changes; possible oral appliance |
| 15 – 29 | Moderate OSA | CPAP therapy or oral appliance |
| 30 or more | Severe OSA | Urgent CPAP; specialist review required |
Who Is at Risk?
While anyone can develop sleep apnea, Dr. Kimuli identified a cluster of risk factors particularly relevant to Uganda. Men are more commonly affected than women — a difference linked to the protective role of estrogen in maintaining muscle tone in the upper airway. However, this gap narrows significantly after women reach the age of 60 as estrogen levels decline.
Obesity is a growing risk factor as Uganda urbanises. Alcohol consumed within two to three hours of bedtime acts as a muscle relaxant and can trigger or worsen airway collapse. Sleeping pills — which many Ugandans are increasingly turning to — carry the same risk. Smoking, structural features such as a small chin or deviated nasal septum, large tonsils in children, and sleeping flat on one's back all compound the danger.
Sleep Apnea & Uganda's Urban Shift
Sleep medicine specialists note that urbanisation, rising obesity rates, widespread alcohol use, and the growth of night-shift work are converging to make sleep disorders increasingly common across Uganda — yet the field remains severely underdeveloped compared to Western countries.
"We do not look for it," said Dr. Kimuli, "but we know it is quite prevalent. Patients present with fatigue and high blood pressure, but sleep is never assessed."
What Can Be Done
The good news, specialists emphasised, is that obstructive sleep apnea is treatable. Options range from simple lifestyle changes to advanced medical devices, depending on severity.
Lifestyle changes are the first line of defence. A weight loss of more than 10% of body weight has been shown to meaningfully reduce OSA severity. Avoiding alcohol and sleeping pills, quitting smoking, and sleeping on one's side rather than the back can each make a significant difference. Wedge-shaped pillows can prevent a person from rolling onto their back during the night.
Continuous Positive Airway Pressure (CPAP) therapy is the gold-standard medical treatment. A mask worn over the nose and mouth connects to a small machine that continuously pushes pressurised air into the airway, preventing it from collapsing. "It keeps the airway continuously positively pressured," Dr. Kimuli explained. "People breathe better, sleep better, and their cardiovascular risk falls."
Oral appliances — custom-fitted mouthpieces that advance the jaw slightly forward — are an effective alternative for mild to moderate cases, or for patients who cannot tolerate a CPAP mask.
Surgical options exist for structural causes: removal of enlarged tonsils or adenoids, widening of the throat, or procedures on the tongue base. An emerging technology called hypoglossal nerve stimulation — a pacemaker-like implant that moves the tongue away from the airway when breathing stops — is also showing promise, though it remains beyond reach for most patients in Uganda due to cost.
Diagnosing the Problem
The MCG Lung Institute uses a two-stage approach. Patients first complete validated screening questionnaires: the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness, and the STOP-BANG questionnaire, which assesses the likelihood of obstructive sleep apnea.
High-risk patients are referred for a sleep study. A portable device can be taken home, worn overnight, and returned the next day — capturing data on brain activity, breathing, blood oxygen levels, and chest movement. Where more complex conditions are suspected, a full in-hospital polysomnography (PSG) study is conducted under clinical observation.
Quick Self-Check — Epworth Sleepiness Scale: Score yourself 0–3 on how likely you are to doze off while sitting and reading, watching TV, riding as a car passenger, or sitting in a public place. A total score of 10 or more indicates excessive daytime sleepiness and warrants medical evaluation.
"Sleep is one of the places where we have forgotten that it is actually something very important. We don't give it the attention it deserves — maybe because it comes naturally."
— Dr. Ivan Kimuli, MCG Lung InstituteA Field Waking Up
Dr. Worodria opened the session with a reminder of sleep's deep cultural and scientific history — from the Greek god Hypnos (whose name gave us "hypnosis") to Napoleon Bonaparte, whose conviction that great men needed only four hours of sleep may, historians now suggest, have contributed to his catastrophic defeat at the Battle of Waterloo through chronic sleep deprivation.
Despite centuries of human experience with sleep, formal sleep medicine remains one of the least developed specialties across sub-Saharan Africa. The MCG Lung Institute's annual Day of Lung Science is part of a deliberate effort to change that — training clinicians to ask about sleep and equipping the public to recognise when a problem needs medical attention.
The message from Uganda's lung specialists was consistent and clear: if you snore loudly, gasp or choke at night, wake up exhausted, or struggle to stay awake during the day — do not wait. Seek evaluation.
