Restore Sleep
Obstructive Sleep Apnoea (OSA), Snoring, UARS & Insomnia
What is obstructive sleep apnoea?
Obstructive Sleep Apnoea (OSA) is a sleep-related breathing disorder where the upper airway repeatedly narrows or becomes blocked during sleep for a period of 10 seconds or more.
This can happen for a number of reasons, including the soft palate falling towards the back of the throat, the tongue moving backwards and narrowing the airway, the epiglottis folding back towards the throat, or the walls of the throat collapsing inwards.
Excess weight can also contribute to airway narrowing, particularly when sleeping on your back, as additional tissue around the neck and upper airway can place more pressure on the airway. But OSA isn’t simply a condition associated with being overweight, nor is it a condition that only affects men.
Other factors, including airway anatomy, nasal obstruction, craniofacial structure, age and hormonal changes, can also play a role.
I'm particularly passionate about this for women because OSA is often under-recognised and underdiagnosed in females. Women can present differently from men, with symptoms such as fatigue, insomnia, morning headaches, anxiety or mood changes, rather than the classic picture of loud snoring and obvious daytime sleepiness.
So if you're a woman, you're slim, you're relatively young, or you don't fit the stereotypical picture of someone with sleep apnoea, don't assume you're in the clear. If your sleep is poor, you're exhausted during the day, you're waking with headaches or dry mouth, your partner has noticed changes in your breathing, or something about your sleep simply doesn't feel right, it's worth having the conversation with your GP.
These events can happen repeatedly throughout the night, sometimes without you knowing they're happening. Often it's partners who notice that someone's breathing pauses or “freezes”, followed by a gasp for air, snort or change in breathing. Loud snoring can also be a feature, and it can be a scary thing to witness.
Snoring is my first red flag
If you snore, I recommend getting it investigated.
If you snore, I'm sure you've been told. Maybe there's a small level of denial? But it really does need to be taken seriously.
It might be keeping your partner awake but have you also considered that it might be impacting your ability to hit sufficient REM and deep sleep where the brain cleanses and repairs? Snoring can occur when the volume being breathed into the airways is too large for the size of the airway tube, the airways then narrow and the airflow becomes more turbulent. This turbulence can create the vibration and sound we recognise as snoring.
This is where need breathing retraining to help us correct the volume of air we breathe so breathing becomes lighter and quieter and healthier for both you and your partner. And we need to train the lips to stay shut at night so we only breathe nasal. This allows the breath to slow as its a third of the size of the mouth.
I like to explain this with the paper straw analogy. Think back to the last time you were at a cafe drinking with a paper straw, as it gets more soggy, the liquid is harder to take through the straw. A similar thing is happening with your airways as you attempt to take in too much air.
Often someone who is experiencing poor sleep or daytime fatigue will be accompanied by snoring in their sleep and they don't connect the two. Its good to get on top of snoring now as it may turn into something more serious such as sleep apnoea. This diagram shows that snoring is the entry point before hypopnoea (partial collapse) and apnoea (full collapse).
If you snore regularly, particularly if your snoring is loud, persistent or accompanied by witnessed pauses in breathing, gasping, I will always recommend speaking with your GP about a referral for a sleep study. Once you have your results, we can go through them together and I can explain where the Buteyko Breathing Method can fit in.
Breathing re-education has also been proposed as one part of the wider picture in sleep-disordered breathing, particularly where factors such as breathing pattern, nasal breathing and other non-anatomical contributors may be involved.
Shut your mouth
Fun fact: it's impossible to snore with your mouth closed.
But more often than not, snorers are caught catching flies. It's critical that we train the mouth to stay shut and we introduce this with mouth tape if appropriate to do so. This may be a short term solution (approx. 3 months), if the muscles around the mouth are able to be retrained or a life long addition if the mouth wants to continue to open without the mouth tape support.
Nasal snoring may stop but may also continue with the mouth shut. This may be because of physical obstruction or again the volume of air being too large and also fast.
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You can read more about the relationship between breathing, snoring and sleep in my blog, [The Missing Link with Sleep Apnoea].
Already had a sleep study?
A number of my clients have undergone a sleep study and, following a positive diagnosis, have been recommended a MAD (Mandibular Advancement Device) and/or CPAP. But I believe there’s another piece worth considering: the breath itself.
Breathing retraining with a Buteyko Breathing Method (BBM) Practitioner can help you understand and work with the breathing patterns you bring into sleep. This is a third of our day after all.
Buteyko looks at breathing patterns that sit alongside your sleep apnea, including mouth breathing, nasal breathing and how you breathe during the day and night. Research has also begun to explore breathing retraining as an adjunct to conventional OSA management. A 2020 review examined 14 studies involving different breathing retraining approaches, including the Buteyko Method.
AHI (Apnoea-Hypopnoea Index)
An AHI of five or more events per hour is considered within the range used to diagnose OSA. The table below shows the commonly used AHI ranges for adults and children.
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Mild
Moderate
Severe
Adults
5–15
15–30
30+
Children
1–5
5–10
10+
For milder cases of OSA, the treatment recommendation is often a Mandibular Advancement Device (MAD). As the severity increases, the ‘gold standard’ is CPAP (Continuous Positive Airway Pressure), and in some cases a combination of MAD and CPAP may be recommended.
But here's where it gets interesting: neither of these approaches are able to support Central Sleep Apnoea and I often still find MAD and CPAP as generic recommendations for this group.
Central Sleep Apnoea is different from Obstructive Sleep Apnoea; the issue isn't primarily that the upper airway is collapsing; it's that the signals from the brain to the muscles responsible for breathing don't send the correct message to breathe. This is another reason I believe there is value in looking at breathing retraining given we're working to reset the breathing centre of the brain.
AHI can look different in women
There isn't a separate “female” or “male” AHI range. The diagnostic thresholds are the same, but women can present differently from men and may experience significant symptoms at lower AHI values.
I've heard Patrick McKeown explain this in his teaching, where he highlights that a woman can have an AHI around 2.5 and therefore not meet the usual threshold for an OSA diagnosis, yet experience symptoms that can feel just as significant as a man with an AHI of 15.
While still feeling exhausted, unrefreshed, foggy, anxious or simply like something isn't right with her sleep.
More than a number on a page
When you have a sleep study, there is much more information available to us than simply your AHI.
We can look at things such as:
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Oxygen saturation (SpO₂)
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Respiratory events
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Snoring events
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Sleep position
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Whether events are more pronounced during certain stages of sleep
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Your arousal index, where reported
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The difference between apnoeas & hypopnoeas
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Oxygen desaturation information
That's why I like my clients to understand their whole sleep study, rather than focusing on one number.
I also personally recommend redoing your sleep study every 1–2 years. Your breathing and sleep health can change over time, and it's common to see improvements from your original numbers. Having a repeat study allows us to see what's changed and whether your current treatment is still appropriate.
How breathing retraining complements OSA treatment?
Breathing retraining is not a cure for obstructive sleep apnoea, and it isn't intended to replace CPAP, a MAD or other treatment
there is, however, research exploring breathing retraining as a complementary approach to sleep apnoea.
A 2020 review examined 14 studies looking at different forms of breathing training and breathing activities in sleep apnoea. The review reported that several approaches, including the Buteyko Breathing Method, had been associated with improvements in sleep apnoea and AHI ranges.
It is also relevant for people who have struggled with CPAP usage because of discomfort, mask issues or difficulty tolerating the therapy.
This is how we complement wherever you're at in your journey:
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Nasal breathing
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Mouth taping
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Habitual mouth breathing
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Breathing volume
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Breathing rate
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Diaphragm function
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Breathing efficiency
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CO₂ tolerance
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Breathing during exercise
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Breathing responses to stress
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Awareness of your breathing patterns
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Lifestyle changes
For some people, improving these patterns may be an important part of improving their overall respiratory function and sleep habits.
Already using CPAP?
If you've been prescribed CPAP (continous positive airway pressure), keep using it as directed by your healthcare professional. The Buteyko Breathing Method can be learnt alongside CPAP and any other recommendations from your healthcare team.
Your CPAP machine provides a band aid to stabalise the airways with the continous flow of air whereas breathing retraining teaches you to adapt your breathing habits to help stabilise the airways. Often after completing the Buteyko Program clients will feel ready to request a review of the pressure of their machine.
For some clients, we may also explore mouth taping to support nasal breathing. Where appropriate, I currently recommend MyoTape rather than fully sealing the mouth. This product can be comfortably and safetly worn with CPAP devices.
If you're struggling with CPAP, for example because your pressure needs adjusting, your mask needs refitting or you're experiencing other difficulties, these are also things worth discussing with your sleep or medical team.
What about a MAD?
A Mandibular Advancement Device (MAD) is an oral appliance designed to help keep the upper airway open by repositioning the lower jaw forward.
If you've been prescribed or fitted with a MAD, its still important to improve your respiratory health and breathing patterns. The two approaches are addressing different aspects of the picture. The MAD addresses the physical positioning of the airway and breathing retraining focuses on how you breathe to help maintain a more open airway.
I recommend working with a Functional Dentist who understands the relationship between the teeth, jaw, palete and airways. If you're local to Brisbane, I often recommend Dr David Cowhig at Dental Wellness. I also suggest listening to our podcast episode on Mouth Health Natters.
Often clients find their MAD device bulky and enourages mouth breathing which is only going to add to the domino. A perfect fit and comfort is critical.
What about snoring?
Snoring isn't just annoying. It's a sound coming from a narrowing airway.
Snoring happens when airflow through the upper airway becomes turbulent and causes the surrounding tissues to vibrate.
It can be as simple as your partner complaining that you're keeping them awake. But sometimes snoring is your first clue that something is happening with your breathing during sleep and then some.
The airway may be becoming narrower as you relax into sleep. Your tongue can move backwards. The soft tissues around the throat can become more relaxed. Nasal congestion can make breathing through your nose more difficult, encouraging mouth breathing. Or your breathing rhythm may simply be off; too fast, erratic or excessive.
Or maybe mouth breathing has become a terrible habit at night, allowing a larger volume of air to enter through a relatively narrow space. A recipe for disaster.
If you're mouth breathing at night, the first thing we want to work towards is comfortable nasal breathing during the day. Often, we may also add mouth taping to the picture at night to help keep the lips gently sealed, provided it is appropriate and nasal breathing is comfortably available.
Mouth snoring may then be reduced or eliminated, but it can also move upstream and become or add to nasal snoring. And often this is where we need to work on reducing the volume of air we're breathing.
Think about when you're in a cafe drinking a smoothie with a paper straw. Over time, it starts to narrow, and suddenly you're trying to push the same amount of smoothie through a smaller space.
Your breathing can be similar. When airflow becomes excessive for the available airway, turbulence can increase and this is when snoring may come. So we need to adjust what we're pushing through the delicate tube to better match the size of the airway.
So why do I care about your snoring?
Because I want you to live a long and happy marriage, but I also don't just want to silence the sound. I want to understand why you're snoring in the first place and address the root cause.
Nose first
If your nose is blocked, congested or difficult to breathe through, we're going to want to address that.
Nasal breathing helps warm, humidify and filter incoming air, and nasal obstruction can encourage mouth breathing. Mouth breathing can in turn influence upper-airway mechanics during sleep.
This is where some of the practical tools we use can come into play, including nasal dilators, nasal breathing exercises and saline nasal rinsing, depending on what's happening with your nose.
And then we look at the way you're breathing.
This is where the Nose → Light → Slow → Low framework comes back into the picture.
We can work on reducing unnecessary breathing volume, developing quieter and lighter breathing, slowing the breathing rhythm and developing more relaxed, diaphragm-led nasal breathing.
I always emphasise taking snoring seriously and getting it under control rather than simply accepting it as something you or your partner have to put up with. Persistent snoring can be a sign that your upper airway is narrowing during sleep, and in some people it may occur alongside obstructive sleep apnoea.
So if you're snoring, don’t wait until it moves into something worse. Work with me now to start mapping out lifestyle changes and better breathing habits that may help improve your nasal breathing, airflow and overall breathing pattern.
And if your snoring is accompanied by significant daytime sleepiness, witnessed pauses in breathing or gasping, I'll strongly suggest requesting a sleep study referral from your GP.
What about UARS?
Upper Airway Resistance Syndrome
Have you had a sleep study that came back saying you don't have sleep apnoea, yet you still feel like you've been hit by a bus come first light?
You might have headaches, brain fog, anxiety or difficulty concentrating. Perhaps you struggle to stay asleep or feel like your sleep is incredibly light. And yet your AHI is below 5. This is where Upper Airway Resistance Syndrome (UARS) may enter the conversation.
UARS sits within the spectrum of sleep-disordered breathing. Rather than the airway repeatedly closing enough to create a full apnoea or hypopnoea, the upper airway can become increasingly narrow and resistant to airflow. Your body then has to work harder to breathe. That increased effort can eventually trigger a brief arousal from sleep. You may not fully wake up or remember it happening, but your sleep has been disrupted. These events are known as respiratory effort-related arousals (RERAs).
Because UARS can involve increased breathing effort and repeated arousals without the significant oxygen desaturation typically associated with OSA, your AHI may remain below the threshold used to diagnose obstructive sleep apnoea.
So you can be told: “You don't have sleep apnoea.” And technically, your AHI may not meet the conventional threshold for OSA. But that doesn't necessarily mean nothing is happening with your breathing during sleep.
Your sleep may still be fragmented, making it harder to get the restorative sleep you need to feel replenished and ready to take on a new day. Your nervous system may still be repeatedly responding to increased breathing effort. And you may still wake feeling like you've barely slept.
And UARS can be particularly easy to miss
UARS has historically been difficult to identify because conventional sleep studies may not always capture the increased effort and airflow limitation involved. There is also still debate around its precise diagnostic criteria and whether it should be considered a distinct condition or part of the broader OSA spectrum.
Interestingly, research into UARS has found that women can make up a greater proportion of those with lower-AHI sleep-disordered breathing, and symptoms such as insomnia, headaches and fatigue can become more prominent as AHI decreases.
So if you're a woman who has been told, “Your AHI is too low to worry about,” but you know your sleep isn't right, this is a conversation worth having with your sleep specialist and, where appropriate, with Breathscape.
Where does breathing retraining fit?
This is where I become particularly interested in your daytime breathing and nervous system regulation.
If your upper airway is already working against increased resistance during sleep, I want to understand what is happening with your breathing while you're awake.
Are you breathing through your mouth?
Is your nose congested?
Are you breathing heavily or with unnecessary effort?
Is your breathing predominantly upper-chest based?
Does your breathing have a tendency to freeze?
Are you sighing and yawning frequently?
And are you carrying a high level of breathing effort into the night?
Does your fight-or-flight response increase at night?
These are the things we can explore through the Buteyko Breathing Method, helping you develop stronger, more functional everyday breathing so that what you bring into the bedroom at night is there to support you rather than play havoc with your sleep.
What about insomnia?
When your body is tired, but your brain doesn't seem to have received the memo.
Perhaps your biggest problem isn't snoring or waking with an obvious breathing event. Perhaps you simply can't switch off.
You get into bed exhausted, but suddenly your mind is wired. It replays conversations from the day and also thinks about tomorrow before it arrives. And now the fear of wondering how much sleep you're going to get joins the party.
Or perhaps you fall asleep easily enough, but wake at 2am, 3am or 4am and suddenly you're wide awake. You might toss and turn, sigh, take bigger breaths, change positions and become increasingly frustrated that you're still not asleep.
Your nervous system and your breathing
Sleep requires a shift towards a state where your body feels safe enough to let go. If your nervous system is constantly operating in a state of heightened alertness, settling into sleep can become more difficult.
With my clients with sleep issues, I make a huge point of emphasising what I call ‘Book Ends of the Day’. If we're racing to the finish line and then expect our head to hit the pillow and get to sleep shortly after, then we need to rethink this.
Our worlds are getting busier, but it's critical that we create some down time as we're winding down into the later part of the evening.
This is also where light becomes really important. Your body has its own internal clock, and light is one of the strongest signals that helps set it. As evening approaches, your body should naturally begin increasing melatonin, the hormone involved in signalling that it's time to prepare for sleep. At the other end of the night, cortisol naturally rises towards waking, helping your body become more alert and ready to start the day.
So if we're flooding our eyes with bright artificial light late into the evening, particularly light from screens, we're giving the brain a very different message from the one it would naturally receive as the sun goes down. Evening light exposure can suppress or delay the normal rise in melatonin and shift the timing of your circadian rhythm.
This is why my advice often includes reducing screen time in the later part of the evening, ideally switching off around 9.30pm, dimming the lights around the house and allowing your environment to start telling your brain that the day is coming to an end.
If you spend a lot of time on screens in the evening, you might also consider blue-light-blocking glasses. I don't see these as a magic sleep solution, but they can be another tool to reduce short-wavelength light exposure in the hours before bed.
And then there are the things we put into our bodies.
Caffeine can hang around much longer than you might realise. I generally recommend avoiding coffee and other significant sources of caffeine for at least 6 hours before bed. Research has found that caffeine consumed even 6 hours before bedtime can significantly disrupt sleep.
And alcohol is another one I want you to think about. You might feel that a glass of wine helps you fall asleep, but falling asleep faster isn't the same as getting better sleep. Alcohol can alter sleep architecture and reduce REM sleep, with even relatively low doses shown to affect REM sleep.
For anyone struggling with sleep, I recommend avoiding alcohol close to bedtime and experimenting with giving your body a proper alcohol-free window before sleep. This is particularly relevant if you also snore or have OSA, as alcohol has been associated with worsening snoring, AHI and oxygen saturation in people susceptible to sleep apnoea.
And if you're someone who has dysfunctional breathing, this can add to your mind and body staying in a more alert state rather than moving towards rest and recovery.
So imagine if your breathing is a little faster than what I would like it to be, and most people have this problem. Your breathing pattern may be giving your nervous system more signals of activation when what we're really trying to create is calm.
We need to recreate this language of the breath to show calm and pave the way towards rest and recovery. This is where breathing can become one part of creating the conditions for better sleep.
Sleep is also where important processes such as memory consolidation and the clearance of metabolic waste take place.
These are the stages of sleep that we should be aiming to experience across the night. It can be interesting for those with smartphones, Whoop, Oura Rings etc. to see where they sit within these broad ranges. I also suggest looking at your nighttime respiratory rate as another piece of information. I'm more interested in the pattern and whether your respiratory rate is consistently elevated than one particular number.
As a rough guide:
Stage 1: 1–5%
Stage 2: 40–55%
Deep Sleep: 20–35%
REM: 15–30%
These ranges are a guide rather than a target you need to hit every night. Your sleep architecture naturally varies between people and from night to night.
I also remind people of a social hangover analogy. So if you have varying days where you go to bed substantially later and expect to get back into flow the next day, think again. Those who are ‘nanas’ in the week and then take advantage of Netflix binging on Friday and Saturday can throw their natural circadian rhythm into a spin. This is why I think having some consistency around your bedtime and wake time is so important.
We don't force sleep. We create the conditions for it.
One of the things I teach is how to use breathing to help your body move towards a calmer physiological state.
We work on developing breathing that is nose, quieter, slower and lighter and lighter already setting the scene of internal calm. Rather than trying to take increasingly bigger breaths to “relax”, we often do the opposite.
We reduce unnecessary breathing effort. We soften the breath. We allow the body to experience a little air hunger without creating distress.
Changes in CO₂ are also involved in the body's regulation of breathing and arousal, which is one reason I find this part of the Buteyko approach so interesting for this group. Often their frustrations of not being able to sleep, can blow off too much CO₂, which can create arousal in both the mind and breath.
Over time, the goal is for this quieter breathing pattern to become less something you have to consciously “do” and more something your body naturally returns to.
Buteyko isn't CBT-I
Cognitive Behavioural Therapy for Insomnia (CBT-I) is considered the first-line treatment for chronic insomnia, including in Australian sleep medicine guidance. But that doesn't mean breathing has no place in the conversation.
A 2026 systematic review of slow breathing techniques practised before bedtime found improvements in self-reported sleep quality and sleep duration, although the findings from objective sleep measurements were inconclusive.
So I see the Buteyko Breathing Method as another tool in the toolbox, particularly when your breathing pattern and physiological arousal are contributing to how difficult it is to settle.
My job is to create the conditions that make it easier for your body to get there. Our breath is the gate way to do this.
Ready for better sleep?
Better breathing starts while you're awake.
Whether you're dealing with sleep apnoea, UARS, snoring, insomnia or simply don't feel like you're getting the restorative sleep you need, let's look at the whole picture together.
We'll talk about your sleep, your breathing and what you're currently experiencing, and work out whether Breathscape is the right fit for you.
Important note
Breathscape breathing retraining is complementary to medical care and is not intended to diagnose, treat or cure obstructive sleep apnoea.
If you suspect you may have sleep apnoea, speak with your GP or an appropriate sleep professional about assessment.
If you've already been diagnosed with OSA, continue to follow the treatment recommendations of your healthcare team and do not discontinue CPAP, a mandibular advancement device or other prescribed treatment without medical advice.
Research & Further Reading
McKeown, P., O’Connor-Reina, C. & Plaza, G. (2021).
Breathing Re-Education and Phenotypes of Sleep Apnea: A Review. Journal of Clinical Medicine, 10(3), 471.
This review explores the role of breathing re-education in obstructive sleep apnoea, including nasal breathing, breathing patterns during wakefulness and the different physiological phenotypes of OSA. The authors conclude that more research is needed, but suggest that restoring nasal and functional breathing patterns may have a role as part of a tailored approach to OSA management.
Courtney, R. (2020).
Breathing retraining in sleep apnoea: a review of approaches and potential mechanisms. Sleep and Breathing, 24(4), 1315–1325.
This review examined 14 studies investigating different breathing retraining approaches in sleep apnoea, including the Buteyko Method, diaphragmatic breathing and inspiratory resistance training. The review found potential benefits from breathing retraining, particularly for people with daytime dysfunctional breathing and less pronounced anatomical factors, while noting that further research is needed to understand the mechanisms and identify which people are most likely to benefit.
Geer, J. H., & Hilbert, J. (2021).
Gender Issues in Obstructive Sleep Apnea. Yale Journal of Biology and Medicine, 94(3), 487–496.
This review explores the differences in how obstructive sleep apnoea presents in women and men. It highlights that OSA has historically been viewed as a predominantly male condition, despite being highly prevalent in women. Women are more likely to experience less typical symptoms such as fatigue, morning headaches, mood disturbance and insomnia, which can contribute to underdiagnosis and delays in diagnosis. The review also discusses differences in sleep-study findings, including women tending to have lower AHI values and more partial upper-airway obstruction.
Tsai, M.-S. et al. (2022).
Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing: A review and perspective. Journal of the Chinese Medical Association, 85(6), 672–678.
This review explores the relationship between nasal breathing, nasal obstruction, mouth breathing and obstructive sleep apnoea. The authors discuss how nocturnal nasal obstruction can promote mouth breathing and contribute to upper-airway collapse, and emphasise the importance of considering nasal breathing as part of a broader, multimodal approach to OSA management.
de Godoy, L. B. M. et al. (2016).
Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea. PLOS ONE, 11(5), e0156244.
This study compared people with Upper Airway Resistance Syndrome (UARS), mild obstructive sleep apnoea and healthy controls. The researchers found that people with UARS had worse sleep quality and more fatigue than those with mild OSA, as well as poorer sustained attention in the early morning. The UARS group had an AHI of 5 or below, highlighting why looking beyond AHI can be important when someone has significant symptoms but doesn't meet conventional OSA thresholds.
Understanding your breathing while you sleep
Do you wake feeling exhausted, or have you been diagnosed with obstructive sleep apnoea (OSA)?
Perhaps you've already had a sleep study, or there are signs pointing to OSA. Maybe you've been recommended a CPAP
machine or a Mandibular Advancement Device (MAD) after a positive diagnosis, but you're wondering whether there's anything else you can do to
support the condition. After all, apnoea means a pause or cessation of breathing, so surely breathing has to come into the conversation?
At Breathscape, we look at the breathing patterns that happen while you're awake and how they may relate to what happens when you sleep.
Using the Buteyko Breathing Method (BBM) can be a complementary approach to developing more efficient, functional breathing habits
and for some people, this work can be genuinely life-changing.