Q. I snore badly. Should I be worried?

A. Does your spouse say you stop breathing or gasp? Do you have daytime drowsiness or nighttime awakenings (to urinate, for example)?

If so, your snoring may be accompanying sleep apnea, a condition where you stop breathing repeatedly throughout the night, causing near-awakenings and low oxygenation. Sleep apnea needs to be treated — it can lead to strokes, heart failure or high blood pressure.

If you think you have sleep apnea, get a sleep study. Women may not snore, and may have daytime fatigue rather than sleepiness.

Those with sleep apnea should sleep with a small nose mask or nasal pillows (consisting of prongs that rest within the nostrils) that allow breathing against air pressure (called continuous positive airway pressure, or CPAP) to hold open the airways. This improves sleep and energy level and reduces day drowsiness, heart problems and car crashes.

Nose-clip devices don't work. A recent review by the renowned Cochrane Database group found that nasal pillows seem to be more comfortable than nasal masks, which in turn are more comfortable than face masks. If you feel claustrophobic, keep practicing to get used to it. Or use it for one hour at a time and gradually increase the time.

Another option is the Oracle oral mask. Some machines have a "ramp" feature that improves comfort by slowly raising the pressure the first half hour. If there's excessive irritation, try using a mask one night and nasal pillows the next. If the feel of air pressure when breathing out is bothersome, try "c-flex" or a bilevel machine that reduces pressure when exhaling.

The cold, dry air of the CPAP mask may increase nasal congestion, and a humidifier attached to the CPAP may reduce nasal drying or congestion. Heated humidification is more expensive but may do the trick. If there's continued dryness or nasal obstruction, try a face mask. Nasal irritation and congestion may respond to inhaled steroids, ipratropium, or antihistamines.

If CPAP fails, try an oral device that pulls the lower jaw forward (mandibular advancement). Such mandibular positioning devices need to be fitted by a dentist working with a sleep physician, as the jaw needs to be moved forward gradually over weeks to months to avoid pain in the jaw joint.

When done in all comers, surgery works less than 50 percent of the time and can cause pain, bleeding, excessive narrowing of the upper throat, voice changes and occasionally death. Losing weight, treating nasal stuffiness and avoiding alcohol, sleeping pills and tranquilizers within four hours of bedtime can help reduce sleep apnea.

We doctors aren't very good at diagnosing sleep apnea, so bring symptoms to our attention — or go ahead and tattle on your bed partner! By staying awake — and thus reducing car crashes — you may save more than just your spouse's life.

Dr. Landis Lum is a family-practice physician for Kaiser Permanente and an associate clinical professor at the University of Hawai'i John A. Burns School of Medicine. Send your questions to Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or write islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.