Does neck size cause snoring and sleep apnea?

Neck size is one of the most consistent predictors of snoring and sleep apnea that researchers have found. A thicker neck usually means more soft tissue around the upper airway, which leaves less room for air when your throat muscles relax at night. Doctors use rough cutoffs of about 16 to 17 inches, and the good news is that part of what drives neck size, especially weight, can change.

Does neck size really affect snoring?

Neck size affects snoring more than most people expect, and in some studies more than overall body weight. The clearest example is a 1991 study in Thorax that started with 1,001 men aged 35 to 65 registered at one general practice in England. Researchers visited 900 of them at home, measured them and asked about symptoms. Seventeen percent said they snored "often."

When the researchers looked for what predicted snoring, only three things stood out independently: neck circumference, cigarette smoking and nasal stuffiness. Neck size came first. Together the three accounted for at least a sixfold difference in the likelihood of being a frequent snorer. Overnight drops in oxygen, a sign of sleep apnea, tracked best with neck size and alcohol, and less with age and general obesity.

That doesn't mean a thick neck guarantees snoring, or that a slim neck protects you. It means that if you snore, your collar size is a reasonable clue to part of the cause.

Why does a thick neck make you snore?

A thick neck makes snoring more likely because the extra tissue narrows the airway from the outside. The National Heart, Lung, and Blood Institute (NHLBI) says people with obesity can have increased fat deposits in the neck that can block the upper airway, and lists a large neck among the features that can narrow it. It also notes that fatty tissue can build up in the neck and tongue as you age.

The NHS says snoring is caused by parts of the mouth, throat or nose vibrating as you breathe, because they relax and narrow while you sleep. Obstructive sleep apnea, the NHLBI explains, is caused by conditions that block airflow through the upper airway during sleep. A thicker neck adds to that narrowing from the outside.

Neck fat seems to matter on its own, not just as a stand-in for overall weight. A 1992 study in the European Respiratory Journal measured 670 people referred for suspected sleep apnea. The researchers then matched 156 people with sleep apnea one-for-one with 156 people without it, by body mass index (BMI) and age. Their waists were about the same, but the people with sleep apnea had thicker necks: 41.2 cm on average against 39.1 cm. The authors concluded that obese people with sleep apnea have fatter necks than equally obese snorers who don't have it.

What neck size is considered too big?

The neck sizes doctors watch for are roughly 17 inches in men and 16 inches in women. These come from screening tools and guidelines rather than a single hard line.

The 2009 American Academy of Sleep Medicine (AASM) guideline lists increased neck circumference alongside other signs a doctor should look for, including a BMI of 30 or more, a receding jaw, large tonsils and an enlarged uvula. If you're curious about those, see our guides to snoring with a small jaw and a long uvula.

STOP-Bang is a screening questionnaire developed and validated for surgical patients. It combines four yes/no STOP questions with four "Bang" items: BMI over 35, age 50 or over, a neck over 40 cm and being male. A 2014 study of 516 surgical patients who had sleep studies found that a score of 3 or more picked up 87% of people with moderate to severe sleep apnea. It also found that, for people who answered yes to at least two STOP questions, being male and having a BMI over 35 predicted sleep apnea better than age or neck size. So neck size counts, but it works best as part of a bigger picture.

Does neck size matter differently for men and women?

Neck size matters for both sexes, but men's larger necks don't fully explain why they get sleep apnea more often. A 2003 study in Chest looked at 3,942 people referred to a sleep clinic. Sleep apnea was more common and more severe in men, and men had larger necks. But once neck size was adjusted for height, the difference in neck size between men and women became much smaller.

The best single predictor in that study was neck size relative to height, which explained 19% of the variation in sleep apnea severity. Even so, men still had more severe sleep apnea than women with the same neck-to-height ratio and BMI, so the authors concluded other factors must be involved too. Our guide to sleep apnea in women covers the other differences.

How do you measure your neck size?

You can measure your neck at home with a flexible tape measure. The steps below follow the method in the MrOS sleep study manual, published by the US National Institute on Aging's Aging Research Biobank:

1. Sit upright and look straight ahead, with your head level.
2. Wrap the tape around your neck just below your Adam's apple (the bump at the front of the throat).
3. Keep the tape at right angles to your neck rather than forcing it level with the floor.
4. Use only enough pressure to keep the tape touching your skin, without squeezing.
5. Read the number, then repeat twice more. The study measures three times.

Write the number down along with your weight, so you can see whether either changes over time.

Can you reduce your neck size to snore less?

You can reduce the part of neck size that comes from fat, and the evidence suggests it helps. You can't change your bone structure, but weight and muscle tone are both within reach.

Weight loss

Weight loss is the most direct way to shrink neck fat. The NHS lists losing weight if you're overweight as one of the first things to try for snoring. For sleep apnea, a 2000 study in JAMA followed 690 employed adults in Wisconsin for four years. Compared with stable weight, a 10% weight loss predicted a 26% fall in the apnea-hypopnea index, a measure of how often breathing slows or stops. A 10% gain predicted a 32% rise. Modest changes counted. There's more on this in our guide to weight loss and snoring.

Mouth and throat exercises

Mouth and throat exercises may also trim neck size a little, even without weight loss. In a 2009 trial in Brazil, 31 people with moderate sleep apnea did either sham exercises or a set of tongue, soft palate and throat exercises for about 30 minutes a day for three months. In the 16 who did the real exercises, neck circumference fell from 39.6 to 38.5 cm on average, snoring frequency and loudness dropped, and the apnea-hypopnea index fell from 22.4 to 13.7 events an hour. Their BMI and waist size didn't change significantly. It's a small study, but a useful one. See our guide to mouth and tongue exercises for snoring for how the routines work.

Alcohol, smoking and sleep position

The 1991 Thorax study linked oxygen drops at night to alcohol as well as neck size, and snoring to smoking. The NHS advises not smoking, not drinking too much alcohol, avoiding sleeping pills and sleeping on your side. None of those changes your neck, but each is a snoring trigger you can work on. Our guide to alcohol and snoring explains how evening drinks affect it.

Your nose and mouth

A thick neck narrows the throat, and a blocked nose or an open mouth can add to the problem. The 1991 study also found nasal stuffiness was an independent predictor of snoring. Nasal strips can help a nose that feels tight, and mouth tape is an option for adults with a clear nose whose mouth falls open at night. Neither shrinks your neck or treats sleep apnea, so they're for simple snoring once apnea has been ruled out. Try our nose test first. We don't recommend mouth tape for children.

When should you see a doctor about neck size and snoring?

See a doctor if your neck is above the guideline sizes and you also have other signs of sleep apnea. The NHS advises seeing a GP if you feel sleepy during the day, your breathing stops and starts while you sleep, or you make gasping or choking noises. It also suggests seeing one if lifestyle changes aren't helping or snoring is having a big impact on you or your partner.

A large neck plus loud snoring and daytime tiredness is the kind of combination screening tools like STOP-Bang are built to catch. A doctor can arrange a sleep study, which may be a home sleep apnea test. If you're pregnant, have a blocked nose that won't clear or have a health condition, ask your clinician before trying any snoring product. Our list of sleep apnea warning signs has more.

Our pick (paid partner): Titan Sleep System

If your neck is in the normal range or your doctor has ruled out sleep apnea, and your snoring seems linked to your nose or an open mouth, our pick is the Titan Sleep System. We haven't tested or ranked these products ourselves; this is our recommendation.

Titan says the system pairs TitanAir Nasal Strips, drug-free external nasal dilators with flexible spring-loaded bands, with Titan Bamboo Silk Mouth Tape as one nightly routine. Titan describes the tape as a soft, breathable bamboo silk strip in one oval size, 76 by 38 mm, and suggests 20 to 30 minutes of daytime practice before the first night. It says every batch is third-party tested and certified PFAS-free, and its 30-night guarantee refunds you if your sleep isn't better after 30 nights. If you only need help with your nose, Titan also sells TitanAir Nasal Strips on their own.

Read next

• Why do I snore if I'm not overweight?
• Snoring vs. sleep apnea: how to tell the difference
• The best anti-snoring kit

* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.