Myles Black's post about snoring was interesting; however, if you have a problem with snoring, then ENT might not be your best 'first stop'. Undoubtedly ENT surgeons do a fantastic job, both in diagnosis and treatment of many upper airway issues including simple snoring. However, NICE has assessed this area and, in terms of cost effectiveness, it would be a waste of NHS resources if surgery is pursued as the 'first route' to go down when looking for ways to treat snoring related sleep apnoea.

Ed Miliband recently underwent surgery for his sleep apnoea and I don't doubt that it was right for him, but the vast majority of sufferers are unlikely to find significant relief in surgery of this kind to treat their symptoms, as evidenced in many research papers.

There is a vast swathe of people whose sleep apnoea could be diagnosed by a simple questionnaire, which investigates the level of tiredness and sleepiness the patient is suffering, which would then lead to them being referred to a sleep clinic rather than ENT. Sleep clinic specialists would then conduct non-invasive monitoring to identify whether sleep apnoea is the problem. If it's something else then Myles Black's surgical options may be the right route, but failing to ask the right questions at GP stage could result in the wrong treatment and undiagnosed sleep apnoea, reduced quality of life and delays in accessing appropriate and effective treatment.

I acknowledge and respect the work of ENT surgeons; it is effective and vital, providing relief for many. I just want to make sure that anyone who thinks they may have sleep apnoea gets diagnosed and treated in the best way. If left untreated, this condition can cause raised blood pressure, daytime sleepiness (leading to road traffic accidents) and is linked to type II diabetes
Between 2-4% of the UK's adult population have sleep apnoea. Fewer than 10% of those affected are currently receiving treatment.

Without wanting to become too medical, it is important to explain what sleep apnoea is.
When we're awake, our open airway allows air to flow and we breathe easily. When we fall asleep the muscles in the throat relax, which causes the airway to narrow. Airflow can become turbulent, causing the airway to vibrate, resulting in snoring.

So, how do you know whether you're just a snorer or suffering from OSA (obstructive sleep apnoea) with snoring as a symptom? The common 'red light' indicators to consider are:

• Pauses in breath during sleep and or choking episodes to resume breathing, which your partner may have noticed
• excessive daytime sleepiness
• overweight
• morning headaches
• depression, poor concentration
• collar size above 17"
• high blood pressure

You can discuss with your GP or sleep specialist alternative options such as lifestyle advice, high street solutions, mandibular splints or even surgery. If OSA is diagnosed, treatment using continuous positive airway pressure (CPAP) is simple and successful. The CPAP device is worn at night, and gently blows air through the upper airway to prevent collapse, which in turn reduces sleep fragmentation. CPAP delivers pressurised air via a mask from a small device by the bedside.

As a specialist sleep nurse who has been treating people with OSA for many years, it concerns me greatly that in all the coverage of Ed Miliband's OSA, surgery is being focused on to the exclusion of all other treatments, NICE evaluated this area and showed the most effective treatment method is CPAP and only if this is not successful should alternative therapies, including surgery, be pursued.

For further information on snoring, OSA, symptoms, treatment and associated disorders, visit www.osauk.org where you will find information for both you and your doctor.