“My wife says I stop breathing in my sleep — but I just need something for the snoring”

Snoring with WITNESSED APNOEAS (partner-observed pauses/gasping), excessive daytime SLEEPINESS and obesity is the classic picture of OBSTRUCTIVE SLEEP APNOEA — not simple snoring — with supporting features of unrefreshing sleep, morning headaches, nocturia, poor concentration, reduced libido and a large neck circumference. Assess properly: quantify daytime sleepiness with the EPWORTH Sleepiness Scale and consider STOP-Bang (NICE NG202, 2021: the Epworth score alone should not decide referral, because not everyone with OSA is sleepy), document witnessed apnoeas, neck circumference and BMI, and screen the associated/consequent conditions (often resistant hypertension, atrial fibrillation, type 2 diabetes, cardiovascular risk) — and ask DIRECTLY about sleepiness while DRIVING and any near-misses. Refer to a SLEEP SERVICE for a diagnostic SLEEP STUDY to confirm and grade OSA — prioritised for rapid assessment in vocational drivers and safety-critical workers (NICE NG202) — advise lifestyle measures (WEIGHT LOSS often substantially improves or resolves it, avoid ALCOHOL and SEDATIVES, side-sleeping, smoking cessation), and explain that CPAP is highly effective for moderate-severe OSA and transforms daytime sleepiness (NICE NG202 also advises considering CPAP for mild OSA with symptoms affecting daily life; mandibular advancement splints are an option for mild OSA or if CPAP is declined or not tolerated). The critical, examinable point is the DVLA/DRIVING duty: advise the patient NOT to drive while sleepy, explain the LEGAL obligation to notify the DVLA where the condition affects driving — DVLA: with suspected OSA and excessive sleepiness, no driving until the sleepiness is controlled, notification if not controlled within 3 months, and notification of confirmed moderate or severe OSA with excessive sleepiness; the medical criteria are the same for GROUP 2 (HGV/bus) drivers, whose licences are then reviewed at least annually — that it is the patient’s responsibility to notify, document the advice, and (per GMC Confidentiality: patients’ fitness to drive, 2017) be prepared to inform the DVLA promptly if a patient continues to drive against advice and cannot be dissuaded, telling the patient first where possible. This conversation cannot be skipped because the patient’s livelihood is at stake — handle it honestly but supportively (effective treatment usually allows return to driving), recognising the minimisation driven by fear of losing the licence, and do not collude with "just give me something for the snoring".