Snoring and sleep apnoea are caused by blockage of the airway. Here is a picture of the back of the throat where the tonsils are so big they are virtually meeting in the middle of the throat. The whole thing is made worse by a thick and long uvula (the hanging down thing in the back of the mouth). All in all this patient has loud snoring and sleep apnoea and definitely needs intervention in the form of surgery to open up the back of the throat. This will mean laser tonsillectomy and palatoplasty, all under local anaesthetic.